From Opinion to Evidence: Multisite Evaluation of Custom Dynamic Orthosis Best Practices

Severe lower extremity trauma often leads to poor long-term outcomes for service members and civilians. Carbon fiber custom dynamic orthoses (CDOs) consist of (1) a full-length, custom molded, rigid foot plate that supports the foot and acts as a lever to allow bending of (2) a posterior, carbon fiber, dynamic strut that stores and returns energy while transferring force from the foot plate to (3) a cuff below the knee that effectively transmits load proximally and have been shown to significantly improve mobility, quality of life, and limb function following lower extremity trauma in injured service members. Direct changes in alignment, and heel wedge induced changes in alignment, most affect patient preference and limb mechanics. This presents the opportunity to systematically determine if subject matter expert recommended and vendor recommended benchmark configurations produce better outcomes than variations from this configuration or independent clinician decision making. The objective of this study is to provide data-driven guidance for CDO clinical fittings for two types of CDOs. This study leverages best available evidence, decades of combined experience,and multiple complementary measures to evaluate recommended CDO benchmark configurations relative to alternate configurations.