Week 5:
Attention to Detail

Jon & Jean Reynolds Fellow in Prosthetics & Orthotics

Maughan Prosthetic & Orthotic | Silverdale, Washington

July 12, 2020

Another week has passed and left me filled with joy, confidence, and reassurance.  This week was a bit different from my previous weeks because our head practitioner Justin Maughan was out of the office for vacation. With Justin gone we had a bit of a slower week with less patient appointments and more time spent in the lab. To go along with the shift in pace I had this week, my blog is going to take a shift too. This week I want to show you some of the projects we worked on and take you on a little fabrication journey.

To start it off I want to share an ankle-foot orthotic (AFO) we made and delivered this week that we were especially proud of. This AFO is designed to provide the patient with stability and to improve their gait. I observed each step of this AFO being made, helping wherever I could. Our technician was proud of this AFO because it was stiff in the ankle, providing support, bendy at the top for ease of getting the brace on, and it was light. The trim lines were done perfectly and the AFO fit the patients leg and fit into the shoe with no adjustments needed. As the patient left the office wearing it his gait was already looking better.

This is the medial (inside) view of the AFO. The black portion provides most of the structure, it is made from layers of carbon fiber. The clear portion is called the inner bootie, it provides some stability and helps with comfort and fit. The white that can be seen through the inner bootie is a pad to help comfort. There is an insole in the bottom of the inner bootie that supports the foot.
This is the lateral (outside) view of the AFO. The straps I sewed myself and if you look closely my stitch lines can be seen. It took a lot of practice over the past five weeks to sew straight strap lines! I also cut, shaped, and grinded the black and grey pads under the straps. It is important to get straight edges and uniform corners to keep the brace looking professional.

Next I want to present an above knee (AK) prosthetic. Above knee prosthetics are more complicated and less common than below knee prosthetics. We were fixing the straps on this AK prosthetic.

The patient’s residual limb goes into the black, carbon fiber socket and the straps help to suspend it. Below the socket is a prosthetic knee, these vary greatly in their complexity! Hidden beneath the sock is the prosthetic foot and ankle.

Now that you have seen a finished AFO, it is time to learn more about the process of making one. The patient this AFO is being made for has a plantar flexion contraction, meaning that she is unable to flatten her foot on the floor. To account for this we are putting a large lift in the AFO.

This is the beginning stage of the lift. Pieces of cloud (a soft foam material) are heated and wrapped to the plaster mold of the patient’s leg. The layers have to be added one by one, slowly building up the the lift in the insert. At this stage it looks like a bit of a mess! The black line you see is marking the approximate trim line.
After a lot of work in the grinding room this is the side of the insert. The bottom of the insert was grinded to be flat and the sides were grinded to be smooth. The lift is under the heel to support the foot where it does not reach the floor.
From this view you can see how the patient’s foot will slide into the insert and how it will fit the foot.
Here the insert is shown on the plaster mold of the patient’s leg. It is important to have a smooth transition from the leg to the insert. If the insert stands out too far or there are gaps then the plastic when pulling an inner boot may seep in and create a crease.
If the insert is done correctly the plaster mold of the leg will stand in it on its own. As we are grinding we test this often, if the leg leans or wobbles in any one direction than the bottom of the insert is not flat. If it is left like this the patient will be off balance when they wear it. A stable plaster leg standing in the insert will translate to stability for the patient.
Once the insert with the lift was finished, an inner bootie was pulled over it and the lamination process begun. Carbon fiber is layered onto the leg and then hardened with resin. This is what the AFO looks like after lamination. The dark black is where the carbon fiber is, this will become the brace. The silver trim line can be seen between the solid black carbon fiber and the material above it. The next step is to follow the trim lines and cut out the AFO. It can be difficult to visualize the final brace at this stage but once it is cut out it really starts to come together.

This AFO is still in progress and has not yet been finished. I have really enjoyed making this AFO and I have learned so much along the way. I look forward to being apart of the rest of the fabrication journey and seeing how the final AFO helps the patient.

Outside of the office this week I was able to drive out to Quilcene, Washington to visit a coworker. Quilcene looks like it came straight off the pages of a fairy tale! The mountains can be seen peeking up over the trees, the water is shimmering, and I even drove down a road with tree that look like a tunnel over you.

Just a small glimpse of the gorgeous views I experienced this weekend!
Meet Hershey! She is one of my coworker’s dogs and is so much fun to be around. She is bigger than me and may look a little scary but she has a big heart.

Sarah Carvo '22

Sarah is a kinesiology and psychology double major from Broomfield, Colorado.