Application of the Veterans Administration Prosthetics Center below-knee, weight-bearing brace to a bilateral case.

1 1 Based upon a recent study at the Veterans Administration Prosthetics Center. Administration Brooklyn Outpatient Clinic, who suggested that his patient "be fitted as a below-knee amputee." The Veterans Administration has many beneficiaries who suffer from an inability to bear weight on their feet. Etiologies include gunshot wounds, crushing injuries, painful ankylosis, arthritis, and other conditions which produce pain upon bearing weight. For many years, these patients have been fitted with long leg (leg-thigh) braces in an attempt to un-weight the leg at the level of the ischium, or they have been required to use crutches and braces. Either method results in the loss of knee function in order to treat a condition of the feet, ankles, or tibiae. In an effort to provide more effective or-thotic treatment, the Veterans Administration Prosthetics Center developed 4 a brace designed to unweight the foot at the level of the patella and tibial condyles, an adaptation of the patel-lar-tendon-bearing prosthesis. It consists essentially of a PTB-type prosthetic socket modified to permit donning by means of a posterior "door," or hinged section, which is closed with Velcro fasteners. Attached to the hinge and sandwiched between the layers of the laminate is a framework which permits vertical adjustment of the socket on the side-bars. Conventional stirrups are used with sidebars which insert into channels provided in the socket. In general, ankle joint motion is completely restricted in dorsiflexion and limited in plantarflexion. The shoes are modified to include a resilient heel pad (SACH foot principle) and a rocker bar. Details of the construction have been reported previously (2,3). During the past four years, approximately 80 veterans have been fitted with this device. On a clinical basis, this treatment is considered successful because patients continue to wear and prefer the below-knee, weight-bearing brace, returning at regular intervals for replacement. The Veterans Administration Prosthetics Center has not attempted an objective evaluation of its own development, but the Orthotic Study Group of New York University is now independently evaluating the cases that have been fitted in an attempt to determine the general utility of the brace. The Veterans Administration Prosthetics Center is participating in this study only to the extent of providing the electronic instrumentation to measure the loads borne by the braces, or the degree to which the brace unweights the leg. Until recently, all the patients fitted with this brace at the Center were unilateral …