EXPERTMAIL February 2024 – Peripheral Arterial Disease (PAD)
Dear Readers,
We have recently
added the indication peripheral arterial disease (PAD) to our
Orthosis Configurator. In today's EXPERTMAIL, we would like to take the
opportunity to inform you more detailed about it and in particular
about orthotic treatment options.
With best regards
from Lüneburg, Your FIOR & GENTZ team
General
Information on PAD
The peripheral
arterial disease (PAD) is a circulatory disorder that mainly affects
the lower extremity and is caused by arteriosclerosis in about
95% of cases. In Germany, around 4.5 million people (as of 2023)
suffer from chronic damage to the vessel walls, also known as intermittent
claudication, which increases in frequency with age. PAD
usually progresses insidiously, as initial symptoms such as cold
feet or skin changes are not recognised as indications
(asymptomatic). Only when the muscles start to ache
cramp-like when walking and under strain due to insufficient
supply do those affected take notice.
PAD is a systemic
disease and cannot be cured. Any therapy can only help to promote blood
circulation, strengthen the muscles and therefore counteract the
progression of the disease (see table).
The updated S3
guideline of the German Society for Angiology (DGA), which will be
published soon, aims to reduce the use of minimally invasive procedures
and amputations and to strengthen conservative therapies with
medication and exercise. A structured gait training is already
considered to be the first method of choice, as many patients move less
due to the painful strain and consequently suffer from weakened
muscles. The symptoms usually occur in the feet and are characterised
by muscle atrophy or paralysis of the foot and lower leg muscles. In stage
II, a weakness of the calf muscles (plantar flexors) and the foot
lifting muscles (dorsiflexors) often leads to functional
restrictions in gait, such as drop foot, and causes great instability
when standing and walking as the disease progresses. Insufficient
pressure relief can also lead to chronic wounds and often to partial
foot amputations.
Previous
Options and Typical Errors in the Orthotic Treatment for Patients with
PAD
Many patients are
treated with the previous gold standard, a diabetic foot orthotic
that ensures plantar pressure redistribution. The disadvantage
of this type of treatment is that the overall pressure of the
body weight is not reduced, but merely distributed over the
entire foot area. However, sufficient pressure relief is required to
ensure long-term mobility and quality of life for the patient.
Left:
Overall pressure on small area of the foot
Right:
Overall pressure on larger area of the foot
In many cases,
patients with PAD are subsequently diagnosed with a weakness of the
foot lifting muscles, leading to a basic dorsiflexion assist
orthosis being prescribed. A weakness of the calf muscles often goes
undiagnosed. Preproduced dorsiflexion assist orthoses compensate
for the weakness of the dorsiflexors, but have no influence on the
weakness of the calf muscles, which deactivates the forefoot lever.
Insecurities when standing and walking are therefore only
insufficiently corrected.
Modern
Orthotic Treatment Options for Patients with PAD
That is why we
are presenting a modern orthotic treatment today that should be used
for patients with stage II at the latest and has the potential to
ensure that the walking ability is maintained. A custom-made orthosis with
a front shell and rigid foot piece, the dynamics of which are
realised via an ankle joint with precompressed spring units,
transfers part of the overall pressure exerted via the orthosis
directly into the ground. This results in a reduction in the
pressure exerted on the foot. The rigid foot piece also allows the
already reduced pressure to be distributed even further over the entire
foot area. For this, you should also integrate an additional custom-made
foot orthotic in the foot piece.
Reduction of the
overall pressure on the foot by transferring pressure via the orthosis
In addition to
redistributing and reducing pressure, a dynamic orthotic treatment
counteracts muscle fatigue in the foot lifting and calf muscles, thus
regaining safety when standing and walking. An orthosis with a NEURO
SWING system ankle joint not only compensates for impaired foot
lifting, because the precompressed spring units mounted in the system
joint also activate the forefoot lever to bring the body into a stable
balance. In addition, the spring units are strong enough to counteract
the body weight for a safe stance and gait and to lift the heel for
energy-efficient walking. The required resistance in both directions of
movement can be adjusted to the individual muscle weakness of both
muscle groups separately using the exchangeable precompressed spring
units.
Orthosis
compensates for the paralysis of the muscles - restoration of safety
when standing and walking
We have integrated
this indication in our Orthosis Configurator.
You can select it independently or as an additional indication. It will
be taken into account when configuring the orthosis. For example, in
the case of paraplegia, a KAFO with a partially flexible foot piece is
selected as a standard. If you select an additional PAD, the
recommended construction will change to a rigid foot piece.
Do you have any
questions about PAD? Feel free to contact our headquarters in Lüneburg
at +49 4131 24445-0 or info@fior-gentz.de.
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