Remodeling means to reshape or reconstruct. An orthodontist remodels ones mouth when braces are used to realign teeth. The Greek prefix “Ortho” means to straighten. Braces or orthoses by definition should correct any existing deformity. Remodeling orthotic support systems for various pathologies including Polio, Spina Bifida and CMT are available. Dynamic Bracing Solutions has created a systematic approach that will address the fixed or rigid foot and ankle in addition to knee deformities. This process can be used as a conservative treatment plan in place of surgery. In cases where surgery has been performed and problems persist, remodeling can still be effective.

Remodeling of what was once considered “fixed” deformities of the foot and ankle complex, is now possible. The primary medical treatment plan has been surgical intervention for foot deformities, the use of accommodative orthoses or both. A typical surgical procedure that has been performed for many years is the triple arthrodesis. This consists of altering the structure and fusing the three major bones of the ankle complex. The intended purpose is to restore the normal anatomy of the foot and to prevent further deformity. Studies have shown that fusions have not been successful. One study recommended the procedure be used only as a salvage procedure. The mechanical stresses of ambulation are too great on the fusions. In time, nearly all fusions break down, which can compromise future medical treatment plans. Other joints and the body as a whole are also affected by such procedures. Balance and security issues arise as a result. The original intent to prevent deformity can actually increase deformity!

Remodeling has been utilized in certain orthotic applications for decades and is still in practice today. Fracture braces realign certain fractures and hold bones in position until the fracture is healed. In fact, even the healing process of the bone is called remodeling. Scoliosis bracing of the spine applies triplanar corrective forces for extended periods of time for the purpose of remodeling the curve. The term triplanar refers to the three major planes of motion that comprise human movement. Ironically, this concept has not been applied to all orthotic systems. Most orthoses for the lower extremity are one-dimensional devices. They control forces in one plane only. Over time this type of orthosis becomes the cause of deformities in the remaining planes of motion. Human motion is three-dimensional. This fact cannot be ignored by the surgeon or the orthotist!

Surgery in itself presents complications. Any surgical procedure is serious and there is the potential for complications. In addition to the extended recovery time and rehabilitation, there are psychological issues involving inactivity, anxiety and family pressures. If orthotic intervention is to be used in place of surgery, the support system must address present and future deformities. Although the time frame varies, deformity is progressive. The use of a conventional or one-dimensional orthoses will only accommodate existing deformity; in addition, they are static rather than dynamic. The use of such devices may ultimately lead to surgery or the termination of ambulation.

The use of remodeling orthotic support systems is designed to decrease deformity over an extended period of time. This allows the individual to remain active during the treatment. In the case of surgery, the best alignment is obtained within the timeframe of the procedure without the possibility of improvement. Since the remodeling process is ongoing, the alignment potential is more favorable. As in any situation, prevention is better than correction after the fact. Remodeling is most effective when the joint structures and tissues are supple and not fixed or rigid; however, remodeling also works in these cases as well.

The process requires very skilled practitioners along with committed clients to be successful. As in the case of the orthodontist, follow-up visits would be required to maintain constant corrective pressures as the fixed deformities slowly give way. As alignment improves, so does balance, weight distribution on the foot and reduction of the deforming forces. Each degree of improvement makes a difference. Remodeling is a corrective process that takes time. In some cases, only a few months are required while other cases take longer depending on complexities. Positive outcomes have been obtained utilizing this technique.

The Remodeling process requires advanced skills and techniques that maintain consistent triplanar corrective forces in both stance phase and swing phase of the gait cycle. The corrective forces are applied at all times while the remodeling device is worn. The remodeling process works continuously while sitting, walking or lying down. The Remodeling device is functionally utilized like any other AFO for walking. As the deformities decrease, there will be a corresponding increase in balance, security and function.

Orthotic support systems that incorporate remodeling techniques are temporary. The objective is to maximize potential. As the foot and ankle become more supple, increased corrective forces can be applied. The first orthosis can be adjusted as long as the triplanar control is maintained. It would be counterproductive to continue beyond this point as it would limit further improvements and possibly cause regression. Eventually, a new orthosis would have to be fabricated reflecting the positive changes and allow for the continuation of corrective forces and continued progress.

Remodeling outcomes have been very encouraging. It is a positive approach with improvement as a goal rather than the accommodation of an existing problem. For some it has prevented unwanted surgeries and fusions. For others it has ended the progression of deformity. Even in cases involving surgical fusion where deformity is apparently fixed, positive results have been demonstrated over time. In complex cases, the use of silicone technology in combination with triplanar control can enhance treatment. As deformity decreases, balance and function increase. The potential for improvement is possible through determination and the dedication to finding Dynamic Bracing Solutions.