Tag Archives: patient care

Carol’s new socket saved her from surgery!

After many years of living with pain and limited mobility, Carol came to George for a second opinion.

George and Carol first met in May of 2021. She lives with Bilateral Symes Amputations and was experiencing significant knee pain. Doctors were recommending bilateral knee replacement surgery to possibly ease her pain and she was hesitant.

Prosthetic solutions for increased mobility.

George observed that Carol’s pain was exacerbated by the alignment of her bi-lateral Symes prostheses and the knee flexion contractures she had developed. The construction of new sockets with the correct alignment enabled Carol to have her foot flat on the ground. She now has added stability while ambulating and has less pain in her knees. Over approximately 10 appointments with George that included measurements, adaptations and adjustments, she was satisfied with the fit and function and was able to take her prostheses home.

It took her whole life to find the help she needed.

Congenital amputees are one of the most difficult population of patients to work with. A prosthetist needs the experience to recognize that the anatomy in regard to bone structure, nerve innervation, muscular presence and function is often abnormal. As lifelong amputees, congenital patients are very tuned in to how they feel their prosthesis should function, and it is our job to help them reach those goals with the proper device.

Learn more about Practitioner George and his congenital limb experience.

View on YouTube

Resources and Reading for Congenital Limb Patients and Families

Syme Amputation, what is it?

https://www.footcaremd.org/conditions-treatments/injections-and-other-treatments/syme-amputation

Why some people choose not to wear a prosthesis:

https://www.armdynamics.com/upper-limb-library/why-do-some-people-choose-not-to-wear-a-prosthesis

Congenital Differences resources – blogs – podcasts

National and state resources:

https://new-horizons.org/cmtamp.html

Parents of children with limb loss resources:

https://www.armdynamics.com/upper-limb-library/resources-for-parents-of-children-with-upper-limb-differences-or-limb-loss

Lucky Fin Project (kids):

Kids and sports: Protect their sprains and strains!

Organized sports have so many benefits for kids, but exuberant over-use can cause repetitive stress injuries. Children who play basketball, volleyball, soccer, football and those who ski, are most likely to injure their Anterior Cruciate Ligaments when they slow down, pivot or land after a jump.1 When minor injuries are addressed promptly, a brace can help with recovery and often get them back in the game with less chance of re-injury.

1. “Recognizing and ACL injury in children”

Once you have a diagnosis, we can help!

Our trained and certified pediatric practitioners are here to answer your questions. You can learn more about specific sport injuries from foot pain to stress fractures with the resources below. Bookmark this page so you can come back to it later if needed.

You can be prepared with resources for many common pediatric sport injuries.

If your child gets hurt, there is no substitute for a doctor’s advice and diagnosis. Once you have a diagnosis and prescription, we can assist you to find the device that best suits your child’s needs.

The 3 most common injuries we see in youth athletes:

  • Knee Sprains: when a ligament stretches or tears; for example, an anterior cruciate ligament (ACL) or medial collateral ligament (MCL) tear
  • Tendonitis: when a tendon gets irritated or inflamed, usually from overuse or poor training (for example, in jumper’s knee)
  • Meniscal Tears: When the cartilage between the upper and lower leg bones (the menisci) tears

Pediatric Sport Injury Resources

Double Upright AFO gets patient back on his feet

Mr. Harrell, a 50-year-old diabetic, presented with a very unstable gait and had been previously diagnosed with left foot drop secondary to a stroke and leaving him with left side paralysis. Mr. Harrell would use his arms for balance while ambulating, and had experienced a number of falls.

Gait Stability

To resolve his unstable gait, we fabricated a left double upright Ankle Foot Orthosis with extra depth shoes and custom accommodative inserts for Mr. Harrell. The AFO is used to control the instability in his lower limb by maintaining proper alignment and controlling motion and drop foot.

The Double Upright AFO will be attached to the diabetic shoe which allows for edema and protects the diabetic foot from any shear forces. His diabetic neuropathic condition requires extra depth shoes and custom diabetic inserts to accommodate his misshapen feet. The AFO will also protect his de-sensitized feet from repetitive stress and irritation – something his current shoes were not providing.

Mr. Harrell has been wearing the Double Upright AFO for a few weeks now and it has boosted his confidence. He has been very satisfied with the progress he has made toward resuming his normal walking routine.

Mr. Harrell had a few words to describe his patient experience at Collier:

“I had a stroke and lost a lot of my left side. I was treated with professionalism and the practitioner was very kind. I can now walk a lot better, love my new brace and shoes!” — AFO Patient Troy Harrell

Do you have a question about a current health issue?

How we help patients after their stroke.

The role of an O&P facility is to provide an orthosis that will aid the patient’s stability and ambulation during the stroke recovery process.

The Orthotist will visit the patient at their care facility and is brought up to speed by the physical therapist and physician with the patient’s diagnosis and outcome goals. We fabricate orthoses for patients with mobility issues who need help with ambulation and rehabilitation at home.

The O&P facility’s job is also to educate the patient and their caregivers on the goals and benefits of using the prescribed device. Follow up appointments with the clinician are very important due to the drastic and sudden changes stroke patients can go through during their rehabilitation process and to check for things such as skin irritation and unusual pain when wearing the device.

Post Stroke Patient Care Methodology

Our process when treating foot drop patients.

Fixed Ankle

During the motor skills assessment our team member walks the patient in parallel bars with no shoes or socks, the Orthotist holds the knee and foot to attain what kind of forces need to hold the patient in correct alignment and stabilize their muscle insufficiency. This is determined by the counter forces that we place on the knee and foot. Once we determine how much force is needed to control the patient’s ankle, foot and knee, a decision can be made on what brace will best help the patient walk. 

The team agreed that an ANC (articulated non-cut) AFO (Ankle Foot Orthosis) was the right solution. The function of this brace is to lock the patient’s ankle at the desired position (90 degrees). This helps with toe clearance and to prevent the foot from dragging while walking. It also helps mitigate hyperextension.

Free Ankle

The ANC AFO solution is fairly common for patients graduating from rehabilitation settings but who still need ambulation support to get back to their daily activities. The ANC orthosis we have developed is unique – it can be hinged at the ankle once the patient regains stability and strength. This gives the patient a more natural gait as they transition through their therapy. Essentially it is two braces in one, saving the patient a second co-pay, and saves waiting time during the healing process. For any stroke patient, it is critical to fabricate and fit a brace in a timely fashion to get the patient ambulatory as soon as possible for neuro muscular regeneration and gait training. We put a high importance on getting the patient what they need to continue to improve.

When it is determined what type of orthosis is needed, it is fabricated to specifications. It must help the patient meet therapy goals such as:

  • Toe pick up, ankle stabilization and improved gait
  • Sufficient clearance or relief for the head of the fibula
  • The patient can ambulate safely in the orthosis
  • The Varus/Valgus correction provides the desired support
  • Skin check was satisfactory
  • The range of motion settings meet prescription criteria

When we fit the patient after fabrication we double check:

  • The orthosis conforms to the contours of the body
  • The finished height of the orthosis is appropriate
  • The patient is stable while standing
  • The workmanship of the orthosis is satisfactory
  • The patient can sit and adequately flex knee with orthosis

Follow up from the clinician is a very important step we take due to the drastic and sudden changes these patients can go through during their rehab process. If you would like to speak with one of our practitioners about a specific issue, please send us an email.

Stroke Awareness: Three important milestones.

Why the first 3 hours, the first 3 days, and the first 3 months are significant during stroke recovery.

  • The first 3 hours are vitally important for patient to have critical medical care that will make a difference in their survival rate. Call 911, do not drive self or patient to hospital. Emergency responders can begin medical care as soon as they arrive and while patient is being transported
  • The first 3 days in the hospital gives doctors time for tests and assessments to determine the course of care. Rehab can begin as early as 24 to 48 hours after the stroke while the patient is still under hospital care.
  • The first 3 months are therapeutically important as this is when the brain is most capable of making reconnections through neuroplasticity. This can also be an exhausting time for a stroke survivor and they may need mental health and caregiving support.

Stroke Resources:

The American Heart Association has a plethora of resources about stroke research, recovery, and prevention. This article talks about Foot Drop and other effects due to stroke.


In Northern California at the Kaiser Foundation Rehabilitation Center in Vallejo, we work weekly with stroke patients who are completing their intense rehabilitation and preparing to transition home. Read more about their patient and family support.

NAMI: National Alliance on Mental Health

Stroke survivors have a high chance of developing depression and may have other mental health needs. This organization has terrific resources for family and caregivers.

Arthritis knee pain flaring up with the change in weather?

knee pain relief graphic

An unloader knee brace is specifically designed for treating arthritis knee pain.

Do your bones ache when the weather changes?  Does your osteoarthritis knee pain prevent you from enjoying your daily activities? Studies show that cold, wet weather negatively affects people with rheumatoid and osteoarthritis. 

For osteoarthritis knee pain relief, you need a prescription from your doctor for an unloader-style knee brace. A custom-fitted unloader knee orthosis (brace) has a range of settings to dial in to make the brace as comfortable as possible. Your practitioner should be able to show you how to use the different settings.

Osteoarthritis Knee Pain Solutions

An OA brace can relieve bone-on-bone joint pain and slow down the degenerative process. Dynamic OA braces open the joint only when the leg is extended and the most pain relief is needed. No pressure is applied when the leg is bent. With dynamic unloading, these braces are comfortable to wear for extended periods of time.

Treatment with the correct knee brace can relieve most osteoarthritis symptoms:

  • Pain, after overuse or after long periods of inactivity
  • Aching and soreness of the joints
  • Stiffness after periods of rest, swelling of the joints.

Cold weather brings on aches and pains – it is not your imagination. Most common in weight-bearing joints, the pain can settle into your knees, hips and ankles. It is important to remember that stiffness is one of your body’s early warning signs. If the symptoms persist, be sure to check in with your doctor. If stiffness and joint pain persist it might be a sign that you have arthritis, and you want to address the issue as soon as possible with your doctor to prevent further progression.

The Collier-Laurence Orthotic Team works with your doctor and other care providers to find the correct knee orthosis (brace) for your diagnosis. We have these tips for those who might be shopping for an osteoarthritis knee brace:

1)     How many patients does the facility see monthly? The busiest clinics tend to have the more experienced practitioners.

2)     Look for an orthosis (brace) recommended by your doctor for your specific condition. How many different OA braces do they offer to patients?

a.     Petite style

b.     Large styles

c.     Valgus / varus

d.     Custom / off the shelf

e.     Hand Dexterity problems

f.      Sports related

3)     Do they have a return policy on braces that don’t provide pain relief? Will they provide other options?

4)     Your brace can’t help you if you don’t wear it regularly. If your brace is uncomfortable or pinching, contact the provider and they should be able to make adjustments for a better fit.

Additional Reading:

Unfortunately, there is no cure for arthritis, but there are ways to manage the pain and slow down the progression of arthritis. Although it maybe difficult, staying active is important. Make sure to check with your doctor or physical therapist for appropriate exercises for your condition.

What causes so much pain in my knees?

The stages of Osteoarthritis