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SureStep Shrinks HEKO Brace for Young Patients
By Brady Delander Traditionally, the smallest patients with genu recurvatum—hyperextension of the knee--have been treated with a basic ankle-foot orthosis (AFO). For many years, that was the only treatment option for toddlers as young as a year old, simply because there wasn't a small-enough hyperextension knee orthosis (HEKO) available.
Bernie Veldman, CO, owner of Midwest Orthotic & Technology Center, South Bend, Indiana, says fitting younger pediatric patients with an AFO was a necessary evil. It wasn't ideal, but it was the only choice available. "To stop hyperextension, normally you put an AFO on the child," Veldman says. "But that blocks plantarflexion, and that was just destroying the gait patterns for these children."
Veldman says addressing a knee problem, such as hyperextension, at the knee is a tried-and-true concept for adults and teenagers, but there wasn't a joint small enough to tackle the same issue for children. "No one ever made a hinge that small for the knee," Veldman says. "I think the reason for that is because for every 700 or 800 adult athletes that have a knee injury, there is only one child that needs a knee brace. There wasn't enough demand."
 Those children who did need such a small brace were fitted with a rigid AFO, which left them unable to crawl on all fours or sit cross-legged.
That problem was solved in the spring of 2007, when Veldman, inventor and developer of the SureStep™ dynamic stabilizing system, and Timothy Pansiera, CO, president of OTS Corporation, Weaverville, North Carolina, unveiled the SureStep h.e.k.o. The new design is a fully functional orthosis for smaller pediatric patients, which approaches hyperextension by limiting knee movement without limiting normal function.
"This design is very lightweight, very thin, and, unlike alternative orthotic treatment, it doesn't lock up the foot and ankle," says Laura Dennison, national marketing director for SureStep. "You're not sacrificing function with this brace. Kids have more freedom, and they can crawl and sit on the floor more comfortably." The SureStep design does not impede normal floor mobility and allows the child to walk, run, squat, and jump.
Veldman says the SureStep h.e.k.o. works in a similar fashion as the adult-sized Air Donjoy hinged knee brace, and will work for children as young as one year old. Though it functions well, Veldman says his model is still a work in progress. "It took about two years to make this joint work, and we're not done yet," he says, adding that different strapping systems are being tested.
One of the more difficult challenges was developing a hinge small enough to work on a brace for toddlers. "It's always been the mantra of our industry that we want to get things smaller, and in the pediatric market we're talking extremely small," Pansiera says. "Then, at that young age, they abuse things incredibly for their size, so it has to be strong too."
What makes this brace distinctive, however, is the action of the pins that couple the support arms and hinge plate. "Bernie came up to me and asked if I could come up with a polycentric joint with an interior stop," Pansiera says. "The reason this new little design is unique is that it pivots on one of the pins while the other pin follows the arch. Then the pin that follows that arch locks into place and becomes the pivot point, allowing the other pin to follow the joint." A presentation developed by Pansiera shows that both support bars pivot around pin A as pin B travels to the end of its groove. Pin B then becomes the new pivot point, and pin A may then travel to the end of its groove. The grooves are only concentric around the pivot points at the end of the grooves.
This design maintains the small size, light weight (listed at four ounces), and child-proof strength, but more importantly it allows for full range of motion, from zero to 135 degrees. The low profile allows the brace to be worn underneath clothing, and donning and doffing is easy for children or parents, according to developers. Veldman says the current brace has a weight limit of 5060 pounds, depending on the activity level of the child. SureStep and OTS are nearing development of a larger version of the joint, which will support a higher weight limit.
Looking ahead, Pansiera alluded to pediatric orthotic innovations currently in development, including a version of the OTS StepLock knee joint. "Everybody said that we needed smaller steps for children, so we came up with a solution to that problem," Pansiera says, adding that the joint should be available by this autumn.
Photograph courtesy of Midwest Orthotic & Technology Center.
Editor's Note:
The O&P EDGE
does not endorse any company or product. Companies and products mentioned in this article are for the reader information only. 
Table Of Contents - April 2008
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