Patient Assessment & Casting for the Moore Balance Brace

Presented by Josh White, DPM, C.Ped

Agenda

1. Fall Facts

2. Patient Selection

3. Fall Risk Assessment

4. Footwear

5. AFO Casting

6. MBB Dispensing

7. Keys to Success

Fall Facts

• Leading cause of injury related death in seniors

• Leading cause of hospitalization for injury in adults 65+

• Cause of 95% of hip fractures

• 67% of fall victims (65+) are discharged to nursing facilities; 50% of whom will never live independently again

• Direct medical costs associated with falls >$30B annually

Reference: www.cdc.gov

Patient Selection & Awareness

Patients to look out for

• 65 and older

• Already fallen

• Use assistive devices such as walkers or canes

• Difficulty rising from a chair

• Unsteady on their feet

• Ill-fitting shoes

It all starts here…

The Patient Assessment

Patient Assessment

• Fall Risk Assessment

• Shoe Fitting Assessment

• Biomechanical Examination

• Comprehensive Diabetic Foot Exam (CDFE)

Patient Assessment

• Observe gait pattern

• Manually assess range of motion of the foot and ankle

Fall Risk Assessment

Assessing Footwear

• Are shoes causing pain • Are they poorly fitted • Are the soles/heels slippery • Are the soles too thick/heavy • High-risk styles

o High heels o Mules o Slippers o Flip-flops o Sandals

Postural Sway

• Constant displacement and correction of the center of gravity over the base of support

• Factors found to be correlated with increased postural sway include: o Reduced peripheral sensation

o Poor near visual acuity

o Slow reaction time

Casting Materials

CONTENT OF CASTING KIT 1. Medium Mid Leg STS Sock (2) 2. Foot Board 3. Casting Foam 4. Scissors 5. Letter Opener 6. Plastic Bag (2) 7. Indelible Pencil 8. Plastic Tube 9. Cutting Strip

• Other items needed: o Tape o Gloves o Water

Positioning the patient

• The patient should be seated, semi-weight bearing, with the hip, knee and ankle all at 90°.

• Be aware of the patient’s positioning before and during the casting. Prevent patient tendency to gradually change position before casting is complete.

Using a foot board

Casting using a contoured foot board enables the AFO to fit better inside a shoe.

The importance of a good cast The Moore Balance Brace is custom made to the cast that is sent. Accuracy in casting is a requirement for the brace to fit properly.

Casting with an STS Sock

STEP 1 With the foot at 90° to the leg, place cutting strip on dorsum of foot.

Casting with an STS Sock

STEP 2 Then tape cutting strip to secure strip in place.

Casting with an STS Sock

STEP 3 Tape channel tube on top of cutting strip.

Casting with an STS Sock

STEP 4 Place plastic baggie on foot and leg.

Casting with an STS Sock

STEP 5 Remove STS sock from package and submerge into luke warm water.

Casting with an STS Sock

STEP 6 Gather STS sock and slide onto the limb.

Casting with an STS Sock

STEP 7 Clearly delineate boney prominences and any areas of concern.

Casting with an STS Sock

STEP 8 Snip a small hole at the base of the cutting tube for easier removal of the cast later.

Casting with an STS Sock

STEP 9 Position in semi-weight bearing on foam with ankle at 90°.

Casting with an STS Sock

STEP 10 After gently massaging the STS sock with wet gloves, hold the patient’s

limb in the desired position until the STS sock becomes hard.

TIP - Positioning the patient

Patients commonly look down and watch as you cast,

especially as the sock hardens. This will alter their

positioning. Encourage them to remain in a neutral

position.

Casting with an STS Sock

STEP 11 Once the STS sock has set, remove the cutting tube.

Casting with an STS Sock

STEP 12 Starting from the hole you made at the base of the cutting tube, cut upward to allow for the removal of the cast.

Casting with an STS Sock

STEP 13 Remove patients limb from cast and then remove plastic lining.

Casting with an STS Sock

STEP 14 Place a rubber band around the cast which will help it remain in it’s correct form as it hardens.

Casting with an STS Sock

STEP 15 Examine cast to ensure that it has captured the desired position.

Video Instructions available at: YouTube.com/ArizonaAFO

Bad casts = Headaches

Examples of bad casts

Not enough coverage and plantar-flexed.

Examples of bad casts

Too short and not enough coverage.

Examples of bad casts

Too plantar-flexed.

Examples of bad casts

Didn’t allow enough time for cast to set prior to shipping and cast became disfigured.

Examples of bad casts

Improper knee alignment leads to improper cast alignment.

Take time to ensure the best results

If you are unsure about the quality of the cast you have taken, take another one. You will save time and money and your patient will appreciate not having to return on another day for a second casting session.

Shoeing the MBB • The right shoe is critical for the

success of the MBB. • Recommendation: SafeStep shoe

catalog has category called “Balance Improvement” o New Balance 812 o Orthofeet 910, 916, o Brooks Addiction Walker o Apex Berries

Shoeing the MBB

• Order shoes along with the MBB

• Alternatively carry a size run of balance shoes

• Educate MBB patients about the importance of wearing appropriate shoes

Donning the MBB

1. Replace shoe insole with MBB spacer.

2. Place MBB into shoe, snug against the heel.

3. Show the patient how to grasp the MBB so that they can slide their foot into both the shoe and the MBB.

o If the foot doesn’t slide smoothly into the shoe/MBB, re-evaluate shoe size and width.

Donning the MBB

4. Show the patient how to grasp the MBB so that they can slide their foot into both the shoe and the MBB.

o If the foot doesn’t slide smoothly into the shoe/MBB, re-evaluate shoe size and width.

5. Once foot into MBB/shoe, show patient how to adjust the tongue of the MBB and to pull the Velcro straps over and across the ankle.

6. Allow the patient to adjust the tightness of the straps

7. After fastening the 2 velcro straps, the patient should be ready to walk

Walking for the first time with the MBB

• Require patient to continue using their cane or walker.

• Ask if MBB hurts, rubs or causes any discomfort.

o If so, check shoe fit.

• Check that straps of MBB not too tight.

o Most common complaint upon first walking

• Encourage a “break in” period, though don’t prevent continuous use if MBB feels good and offers improved stability.

Keys to success

• Look for patients at risk for falling • Schedule separate fall risk assessment

appoinment • Educate about shoe fit and other risk factors for

falling • Educate using an MBB sample • If indicated, cast for MBB on fall risk assessment

visit • Encourage additional treatment modalities (PT,

home health care, exercise)

SafeStep

MBB Post-Webinar Starter Kit

• MBB Sample

• STS Casting Socks

• Fall Risk Assessment Tear off Pad

• Exercise Guide

• Compliance Docs

• Order Forms

• UPS Labels

• MBB Patient Brochures

• MBB Poster

• SafeStep Shoe Catalog

Schedule a free Training Session with a DME Expert at

SafeStep.net

Questions?