Indication: ADM Night Brace / optional Day ADM
The standard of care for this category of case, where the boots and bar are not working or not being used, is to re-cast the foot to regain correction and undertake an anterior tendon transfer. Anterior tendon transfer is a significant undertaking involving a lengthy period in plaster cast and AFOs followed by further lengthy period of rehabilitation. Success is not guaranteed.
For patients in this group the ADM offers a possibility of effective non-surgical management, which may be preferable for some families.
Whilst there is no published data for this category of case we do have examples of success ie., where the range of motion has been restored to acceptable levels and the need for a anterior tendon transfer has been avoided.
Our general advice is to recast the foot to gain as much correction as possible and then to fit an ADM to maintain and enhance the correction. The ADM is designed to support a corrected foot and the likelihood of fitting and tolerance issues will increase with a severely relapsed foot.
Patients in this group are typically able to wear a day time ADM, which can provide an extra level of functional support.