"Where do we most need progress in pediatric O&P?”

Pediatric knee joints. For the ratchet styles, [we need] more options and smaller increments. Ratchets [adjust by], what, 7 degrees? That’s a lot for a pediatric flexion contracture. We see a lot of kids for Botox clinics, and we slowly try to work out those flexion contractures, but 7 degrees is a huge amount to jump from one locking point to the next. 

We tell [the manufacturers]. We’ve got a pretty good rapport with Otto Bock, Becker…they ask us about new products, whether or not we like how they’re doing on our patients, and we’re pretty honest.

Right now, our best option for the ratchets is OTS, because the other competitors out there are failing us—the [patient’s] parents can’t lock and unlock the joints. OTS has a standard ratchet knee joint, the Step Lock, that is definitely more user-friendly than the competition. The only problem with it is that it’s pretty bulky. And this is the one with the 7-degree increment. Something like 3 degrees would be better.
Kristin Smith, CO, RTO
Kristine Nolan, CPO
Gillette Children’s Specialty Healthcare
St. Paul, Minn.

We need more orthotics research. It’s more on prosthetics and such, now. I would say that [we need research on] AFOs. 

When a physical therapist or a doctor asks us a question, we need to have actual statistics and data. The issuer [must have] supported solutions for what works and doesn’t work. We need recorded outcomes.
Craig DeCamp, CO
Mobile Limb & Brace Inc.
Orlando, Fla.

[We need progress in] selection of prosthetic componentry. Having worked at Shriner’s for 15 years, I found that was one of our biggest issues. 

The change has to come from the manufacturers. In the adult population, there’s a much bigger market. I’ve talked with the various vendors at national conferences, and it’s the same story from each of them: they don’t spend the money because they don’t feel [pediatrics] is a big enough market.

There is a very limited selection of knees for AK amputees. There is, maybe, one vendor that offers a decent hydraulic knee—that may be Otto Bock. So we have one option, and that’s what we use. 

The other item would be [durability]. [Children are] ruthless on components. I’ve had some [children] blow seals out on the knee in a matter of weeks. Seldom do they last more than a year. The components that are out there now need to be built better to withstand the rigors of these kids.
Don Helper, CPO
Valley Orthopedic/Willamette
    Orthotics and Prosthetics LLC
Salem, Ore.

A lot of times kids will have a contracture that won’t straighten out, and I refer them on to get Botox injections and then serial casting so that their feet will get into a 90 degree grade. The results are a lot better for the kids. I think that more of us in this position should realize that we can [do that] in order to fix the contractures before bracing. 

I see a lot of people that still try to [fabricate] the brace to accommodate the contractures. It’s pretty hard to make a brace if patients can’t stand flat on the bottom of their feet. Then it’s difficult for a patient to wear. The patient is struggling and trying to get the brace adjusted because the foot won’t go down into it.
Todd Stone, CPO
Teter Orthotics & Prosthetics Inc.
Traverse City, Mich.

I think a lot of times [pediatricians] don’t know what’s available to them, so they really do nothing to treat the patient for certain types of conditions. [If] a patient has some low-tone, valgus deformity of the foot, the doctor doesn’t know that there are specific foot orthoses he can use. Many times [the pediatrician] feels that the patient will outgrow it. [But] early intervention is the key to helping to correct problems like that. 

I think it’s our job to educate [pediatricians] about what is available, because they’re probably not going to learn that in their normal practice or education. 

When new things come out, we take the new items and show them to the doctors and explain what they do and how they work. Just in the last six months, as we’ve been marketing to the pediatricians, they’ve been sending patients over [to us]. 

I think we also need to educate the public a little better about what’s available for their children, kind of like how drug companies advertise on TV. [If we had television ads for O&P items, parents] would go in and tell the pediatrician, “I saw this or that, what about [if we use] that?”
Bob Leimkuehler, CPO
Leimkuehler Inc.
Cleveland, Ohio