By Mitchell Warner, CPO
Ortho Rehab Designs Prosthetics and Orthotics, Inc., Las Vegas Nevada
Part One: “Do I need corrective lower limb bracing?”
Corrective lower limb bracing is devoted to helping people whose lower limbs have deformities, injuries and/or are affected by various diseases that make it hard and/or painful for them to walk.
However, many people who seek to improve their walking with corrective lower limb bracing (CLLB) are often disappointed with the results. Their disappointment usually stems from the failure to determine and insist upon:
- proper diagnosis
- proper brace selection
- proper brace fit
Inadequate attention to any of these elements can lead to disappointing CLLB results, but proper diagnosis is generally the most important – and hardest – element to get right.
There are three primary reasons that individuals need corrective lower limb bracing
- deformity correction/compensation
- trauma correction/compensation
- disease compensation
Deformities are mostly the result of birth defects and CLLB for these usually starts at an early age, sometimes before children can talk or otherwise effectively communicate with their caregivers. This inability of patients to tell their caregiver what’s wrong can sometimes lead to misdiagnosis, but for the most part, deformities are easy to see and assess so there is relatively little misdiagnosis in this area.
Trauma is much the same. Car accidents, sports injuries and other such mishaps often require CLLB to aid in recovery – or to help patients compensate for loss of function when they don’t recover completely from their injuries.
Disease-related need for CLLB is much harder to diagnose, and misdiagnosis in this area is the proximate cause not only of many disappointing results, but the reason some people suffer years of frustration, pain and debilitation. Thus it’s extremely important to get a correct diagnosis of your disease from the very beginning in order to get the best results from corrective lower limb bracing.
Most disease-related need for CLLB comes from neuropathy, which is a disease or disorder that affects the nervous system. There are two principal types of neuropathy:
Non-Hereditary neuropathy is caused by diabetes, deficiencies of vitamin B12 and other vitamins and minerals, tumors, strokes, and/or infections, to include HIV.
Your first question, of course, must be: “Is there neuropathy in my family history?” If the answer is yes, then learn – and, if possible document – all you can about your family neuropathy history, then see your doctor as soon as possible and bring everything you’ve learned with you. The information will be invaluable in helping your doctor properly diagnose your condition so that you can then select the proper brace for your needs.
If you have no neuropathy in your family history, you might still have CMT or other hereditary neuropathy, but before you go to your doctor, research possible causes for non-hereditary neuropathy.
Look first to diabetes. It’s the most prevalent non-hereditary cause of neuropathy, which generally results from diabetic microvascular injury to the blood vessels that supply nerves (vasa nervorum). Diabetic neuropathy is perhaps the most common non-hereditary form of neuropathy due to the explosion of non-hereditary Type II diabetes in this country (as of 2011, more than 25 million Americans had diabetes and 79 million more were diagnosed as pre-diabetic).
If you don’t have diabetes or any of its precursor physical or lifestyle symptoms, then look to some of the other listed non-hereditary neuropathy causes and learn if you have any additional symptoms related to those areas.
Then see your doctor if numbness persists in your extremities. If you don’t have family neuropathy history, ask to be tested for diabetes since that’s the “prime suspect” for non-hereditary neuropathy. The same goes for the other non-hereditary causes listed – “If there’s doubt, check it out.”
Finally, be aware that you may not have neuropathy at all, even though you show similar symptoms. It is not at all uncommon for people to be misdiagnosed as suffering from some form of neuropathy when they have an entirely different condition causing their neuropathy-like symptoms. Before you go to your doctor, be sure to learn as much as you can about alternative diagnoses even when you’re certain you have neuropathy.
By now it should be clear: The key thing in determining whether you need corrective lower limb bracing is to figure out from the beginning exactly what’s wrong with you before you proceed to brace selection and fitting. As you can see, neuropathy is a large field and both you and your doctor could think you have one form of it when you have a different form – or no neuropathy at all!
One final note on proper diagnosis. Most people who experience numbness in their hands and/or feet do not go immediately to the doctor; they either shrug it off, or figure it’s a transitory problem that will go away. Then, when their symptoms get so severe that they’re forced to go to the doctor, they still have no idea what’s going on – and no database of observations and their own knowledge to share with their doctor.
That’s the reason for this “quick start” guide: to help you learn about and understand what may be happening with your body before you go to your doctor, so that when you do finally go, you can help your doctor more quickly and accurately diagnose your condition. If you do, it will save you a lot of pain and suffering and frustration and wasted time and money.
Next Post: Part Two: Proper Brace Selection