ORTHOSES / BRACES
We are not a central fabrication facility or laboratory. All AFOs are custom fabricated and not customized from pre-designed or pre-made orthotic shells or frames.
On occasion, if scheduled well in advance, Dr. Jordan does attend some surgeries. Dr. Jordan's office is not part of or linked with any other doctor's office. Our schedules are independent.
It is not possible to design AFOs, or any custom fabricated orthoses, without having first examined the child.
The design must come together based on a detailed physical hands-on evaluation and assessment of movement & gait.
The specific design is then translated and discussed with the orthotist who then handcrafts each AFO from plaster impression model to its finished state ready for fitting and fine tuning.
The quick answer for those children flying in for surgery and orthoses is that it is NO. If is not reasonable & not possible to have surgery on a Thursday and be fit with orthoses on a Tuesday.
The physical properties of the materials we use generally make this an impossible task.
Yes. But you must call first to find out when we are in the office and we need to discuss what needs to be done.
When orthoses are mailed back to our office for adjustments and strap changes. The office Suite number (#98) MUST be written on the package.
SPML/SPL/PECUTANEOUS MYOFASCIAL RELEASE
It is a reasonably old, time-tested Surgical "tool" ; a Surgical Technique rather than a following or cult. So it is not really “new.”
The initial concept of this soft tissue surgery by Dr. Roy M. Nuzzo, some 35+ years ago continues to evolve with subtle changes. (SPML)
Many other surgeons duplicate the technique although referring to it by many other names. So it might appear that only 3-4 pediatric orthopedic surgeons are using the technique while in reality there are many more although with considerable variation of outcome goals & technique.
Some surgeons who report doing SPML are doing basic, simple tendon lengthening through small incisions in a traditional manner instead. This is more popular with pediatric clubfeet rather than neurological conditions since lengthening tendon will truly weaken muscle that is not weak to start.
The technique emphasizes functional control of a child's active range of motion rather than a goal for increased passive range of motion or to "align" bone-joint structures differently on X-ray.
What it is NOT is a percutaneous or small superficial release or lengthening of tendons. That is a simplistic, basic & traditional procedure that might be of benefit in non-neurologically affected child.
It can be performed on an infant, toddler, teen or adult.
You need to revisit the WHAT anatomical regions are in need of this surgical technique,WHAT are you anticipating in outcome?
If myofascial constraints/contractures/limitations are interfering with that specific child's active skills then yes, he/she is a candidate.
Going for PROM [passive range of motion] as the goal or end point? Stop, don't do any type of soft tissue releases; including SPM. You will be disappointed.
Contrary to what some parents believe, NO LASER is used in SPML procedure performed by any surgeon.
Instead, a very small, pin-point scalpel blade is used (borrowed from pediatric eye surgery)
Very sharp and tiny scalpel blades are used for the small portal of entry beneath the skin.
- For optimal long term outcome below-knee 'walking' Casts are used. They aid in healing while retaining the joints and muscles in their best possible alignment.
- The children are more comfortable while in a cast offering maximum touch and gentle compression.
- A well designed walking cast DOES NOT cause muscle atrophy. Do not confuse this type of cast with a Fracture cast; it is not.
- Using Pre-operative AFOs simply hold the leg and foot in their pre-surgical, maladapted and deformed position. This typically encourages more rapid return to soft tissue deformity at the hip-knee-ankle and foot level combined.
Selective obturator nerve block was first described by Gaston Labat in 1922.
Ethanol, when injected around a peripheral nerve, can decrease spasticity without paralyzing or weakening voluntary contraction of the muscle.
Alcohol does so by diminishing the basic involuntary neuromotor stretch reflex.
Diluted acohol (ethanol) injection affects the spastic child in a number of ways.
1. Voluntary contraction of muscle is not affected... not weakend, not strengthening, not affected.
2. The Large peripheral nerve fibers are not changed or altered as seen in histological microscope studies
3. Cholinesterasic activity is normal for large nerves and associated muscle
4. However, the Stretch Reflex (that is excessive in spasticity) has been clearly shown to be decreased.
5. Small nerve fibers viewed under a microscope are observed to be Demyelinated; a positive finding especially if we are trying to reduce spasticity.
6. Cholinesterase activity is diminished in the small muscle spindles that sense/trigger the reflex arc.
Limited and variable neuromotor benefits.
If benefit is observed it is usually very short-lived.
Typically the myelin sheath repairs itself in 6-10 months. At that time the nerve block may need to be repeated or best case is the child has gained better volunatry motor control making it appear that the block continues to be "working."