Pioneer Valley Orthotics & Prosthetics
138 Doty Circle
West Springfield, MA 01089

The “Achilles Healer”

Achilles Contracture Management Orthosis - A.C.M.O.

When looking at children or adults with flat feet or who walk on their toes all the time, it is often possible that the underlying problem is a tight Gastrocnemius, or calf muscle. In a lot of cases the calf muscle can be contracted, or too short, and needs to be lengthened for the foot to be able to have a full range of motion.

This process can usually be done through surgery to lengthen the Achilles tendon, or a process known as serial casting. There are a few ways to lengthen the Achilles tendon through surgery, but all of them involve cutting the tendon and allowing it to heal in a position to allow the desired length. There are two draw backs to this method. The tendon could not be as strong as it was before the surgery and might rupture or tear during any type of strenuous activity. The other is that the patient has to spend a period of time with the foot in a surgical boot which must be put on every day, and if applied wrong could result in less than the desired range of motion.

The second method of lengthening a contracted calf muscle is to have the patient go through a process called serial casting. Every week the patient must go to the doctor’s office and have a cast applied to hold the foot in a desired position to provide a long term stretch stimulus. Every week the cast is removed and a new one is applied to hold the foot and ankle in a new position with the increased range of motion that was achieved from the previous week. Although this has historically been a proven method to achieve the desired range of motion, like surgery it also has its draw backs. The foot is in a cast one week at a time, and so it cannot be washed which might lead to a build up of bacteria on the foot. If the cast is not set in the right position it proves ineffective. The cast must be removed every time with a loud cast saw, which can be traumatic to younger children.

Orthotists have been looking for a way to build a brace that is effective as serial casting but without all the negative draw backs. Different types of braces and splints have been used, all failing to hold the foot in a neutral position which allows the proper stretch stimulus to be applied. Having tried all of these different methods in a children’s clinic over many years Frank Twyeffort designed a brace that has all of the positive effects of serial casting while eliminating the negative effects, the “Achilles Healer”.

The “Achilles Healer”, or A.C.M.O., is a brace designed to hold the patients foot at the limit of their comfortable range and hold them there for 22 hours a day providing a stretch stimulus to the muscles encouraging them to grow. The soft liner of the brace which holds the entire foot and lower leg provides a complete contact fit ensuring the foot cannot slip within the brace. The plastic shell has an ankle joint on it so that every week a small adjustment can be made to the brace allowing for it to be closed tighter, increasing the range of motion for the patient. A walking base is added to the bottom of the brace so that it can be worn as a boot to allow the patient to have a normal daily activity level.

The boot is held together with cable ties which can be purchased at most hard ware stores. By using the ties we ensure that the boots cannot be removed by small children and that there is no slippage from Velcro getting worn or wet. Because the boots can be removed daily for bathing there are fewer problems with bacteria growth and any fitting issues can be noticed and resolved before they become major issues. We fabricate these braces here at our facility, but they can also be acquired through Pro Tech International.