KALISPELL – Prior to a chance encounter with a wounded warrior at the Honolulu International Airport, Kalispell orthotist Doug Jack had never heard anyone gush enthusiastically about an ankle-foot brace.
Medical technology has advanced the field of prosthetics to unprecedented levels, allowing amputees to excel in sports and accomplish amazing feats of athleticism – take, for example, South African Olympic sprinter and double-amputee Oscar Pistorius. But a more common orthopedic technology, called an ankle-foot orthosis, or AFO, has seen little advancement in the specialized field.
An AFO is a brace that helps correct and support muscular deficiencies in the lower extremities by realigning the foot, ankle, knee and hip. The braces are used to improve conditions caused by trauma and neuromuscular diseases, like a foot drop due to multiple sclerosis or muscular dystrophy.
But the disparity in the performance of orthotics and prosthetics technologies is so great, Jack said, that clients who keep their limbs have requested amputations because a prosthetic limb would allow them to function at a higher level than an AFO.
“The conventional designs are very limiting in terms of performance,” said Jack, who owns Northern Care in Kalispell. “The AFO designs I learned how to make in college are basically the same ones we’re using today. They get people by. They get people from point A to point B. But they don’t augment performance.”
So when Jack approached Capt. Ray O’Donnell at the airport and inquired about the peculiar-looking brace protruding from the cuff of the man’s pants, the orthotics specialist from Montana was not prepared for an enthusiastic rant about the optimum performance of the device.
The brace had not only helped O’Donnell to walk again, but also to begin competing in biathlons and triathlons within two years of being injured in a Humvee rollover in Afghanistan.
He suffered multiple injuries in the accident, including traumatic brain injury, facial fractures, a crushed pelvis, spinal damage, a fractured hip and hip socket, a dislocated femur and severe nerve damage. He underwent countless surgeries and spent eight months in the hospital before relearning how to walk.
One of the permanent effects is the near total paralysis of his lower left leg.
An avid runner, O’Donnell experimented with various braces and orthoses, but nothing enabled him to do more than plod along with a slight hitch in his gait.
Then he contacted Dynamic Bracing Solutions in Carlsbad, Calif., and began working with a pioneering clinician named Marmaduke Loke, who had been outfitting wounded warriors and others with a carbon-fiber, spring-loaded AFO that helped them regain muscle strength.
Among the lackluster lineup of AFOs that O’Donnell had tried, Loke’s device was a shining example of what should be the new standard.
O’Donnell then passed the Army Physical Fitness Test, and returned to military duty, performing at the same level as an able-bodied soldier.
“In 25 years, I had never had a patient rave about an AFO,” Jack said of the encounter with O’Donnell. “But this guy raved.”
Jack was impressed by what he heard, but he returned to Kalispell and a heavy and conventional workload, and gradually forgot about O’Donnell and Marmaduke Loke.
Two years later, at an orthotics convention in Seattle, Jack was eating lunch in a busy conference room when he recognized his neighbor’s nametag – Marmaduke Loke.
The encounter would lead to a partnership that is helping to introduce the AFO technology to Montana’s underserved population.
After the convention, Jack traveled to California to learn more about the AFOs that Loke was developing. The timing couldn’t have been more perfect.
While he was there, Loke’s office secretary received a call from Kathy Warrington, a Plains woman living with muscular dystrophy. She also is a longtime patient of Jack’s, and was calling to inquire about Loke’s AFOs, which she’d seen advertised in a muscular dystrophy periodical. They looked different than the conventional plastic braces that she’d been wearing since 2000 and were barely adequate.
Loke’s secretary handed the phone to Jack.
“She said, ‘Doug, is that you?’ and I said, ‘Kathy, I think I’ve found something that can help you,’ ” Jack recalled.
Last week, Loke was in town mentoring Jack on the complex casting and fitting techniques for the AFOs, and Warrington was the first client through the door. She is now working her way through a “boot camp” regimen designed to prepare her for a new level of mobility, which will engage muscles that for years have been dormant.
“It’s not just a coincidence,” she said. “I was fed up. I was ready for a wheelchair. My wish was just to be able to stand without holding onto something. But in my last dream before I woke up this morning, I was running. And that’s where I’m headed.”
Loke says it’s unacceptable that there are so many high-end prosthetics available for amputees, but no bracing technology of the same caliber for men and women who keep their limbs.
“We see many more orthotics patients than amputees, so that whole population is being grossly underserved,” Loke said. “We had clients asking for amputations. Preventing that and saving these limbs is an enormous accomplishment.”
Outfitting a patient with an AFO from Dynamic Bracing Solutions is more complex than outfitting someone with a prosthetic, though less expensive, Loke said. In order for a brace to be effective, it has to be precisely cast and measured, and requires the foot, ankle and knee to be perfectly aligned.
“Marmaduke has been kind enough to mentor me and teach me this technology step by step,” Jack said. “And there are a lot of steps.”
After casting and fitting Kathy Warrington with a pair of new braces, Jack received another timely phone call from the parents of a longtime client, an 11-year-old girl named Brooklyn Lamers.
A neuromuscular disease had resulted in the misalignment of her foot, causing Lamers to overpronate and walk on the outside edge of her foot. Over time, the extra pressure on the edge of her foot caused severe ulceration, and an infection that spread to the bone. A portion of the foot was amputated, and further amputation seemed likely unless Lamers could find a more effective solution.
Last week, Lamers was cast and measured for a brace, and hopes to rejoin her peers in a host of physical activities when she begins middle school later this month.
“It sounds like the brace will help me do regular things as a kid,” Lamers said. “I like to play basketball and volleyball, and that kind of stopped for a few years. I want to get back to that. It’s hard not fitting in with the other kids.”
The decision didn’t come easily. In braces or on crutches since she was 2 years old, Lamers said she’s always held out hope for a permanent solution that did not involve either.
Although the new brace will help her regain strength in her foot and ankle, it’s not temporary.
Lamers worried about how it would look, and whether or not she could still wear her favorite pair of skinny jeans or tennis shoes.
“I was worried, but I’d rather be able to do what other kids are doing, and I think this will help,” she said.
Last week, Lamers and her mom, Diana, got a sneak preview at her new brace as Jack and Loke meticulously sculpted a cast of Lamers’ leg and fit the brace accordingly.
“This is the future of bracing,” Jack said. “And we’re bringing it to Montana.”
Reporter Tristan Scott can be reached at (406) 531-9745 or at firstname.lastname@example.org.