​A different approach to foot drop

If you have foot drop or weakness lifting your foot, an ankle foot orthosis (AFO) can help improve foot position and control during walking.

The TurboMed XTERN takes a different approach from many conventional AFOs.

Rather than sitting inside the shoe, the XTERN is worn externally on the outside of the footwear. Its dynamic exoskeleton design is intended to assist dorsiflexion while allowing plantarflexion and maintaining movement at the ankle.

At MK Orthotics in Milton Keynes, we can assess whether a TurboMed XTERN may be suitable for your particular walking pattern, strength, footwear and lifestyle.

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What is foot drop?

Foot drop occurs when you have difficulty lifting the front of your foot.

This can make walking more difficult and may cause the toes to catch on the ground.

You may notice:

• Your toes catching when you walk

• Foot slapping

• A high-stepping gait

• Increased tripping

• Difficulty walking on uneven ground

• Difficulty lifting your foot

• Reduced confidence when walking

• Difficulty returning to activities you previously enjoyed

Foot drop can have a number of causes, including nerve injury and neurological conditions.

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How does the TurboMed XTERN work?

The XTERN uses an external exoskeleton spring design.

It attaches to the outside of the shoe and provides dynamic assistance to help lift the foot during the swing phase of walking.

One of the key features of the design is that it does not simply hold the ankle rigid. TurboMed describes the XTERN as allowing plantarflexion while assisting dorsiflexion, helping maintain ankle movement and calf function.

Because the device sits outside the footwear, there is no direct contact between the orthosis and the skin of the foot or ankle.

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What are the potential advantages of an external AFO?

For the right person, an external AFO can offer some practical advantages.

The XTERN design:

• Sits outside the shoe

• Does not occupy the same space inside the shoe as many conventional AFOs

• Has no direct skin contact with the foot or ankle

• Can be transferred between suitable shoes

• Allows dynamic movement

• Can be used with a range of footwear

• Is designed for walking and more active use

The exact suitability depends on the individual and the footwear being used.

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Which TurboMed XTERN do I need?

TurboMed currently offers several XTERN models, including the Classic+, Frontier and Summit.

XTERN Classic+

The Classic+ is the updated version of the original XTERN design.

It uses TurboMed's MonoCore technology and is designed to be lightweight and lower profile while providing dynamic dorsiflexion assistance.

It is intended for people with conditions including:

• Foot drop

• Dorsiflexion weakness

• Peroneal nerve injury

• Stroke

• Multiple sclerosis

• Charcot-Marie-Tooth disease

• Cerebral palsy

• Other motor neuropathies

TurboMed describes the Classic+ as suitable for walking, running and hiking, subject to individual suitability.

XTERN Frontier

The Frontier has been designed with ease of application particularly in mind.

Its frontal support design and magnetic fastening system can be useful for people who have difficulty managing conventional fastening systems or who have reduced hand dexterity.

This may be particularly relevant for some people following stroke or with neurological conditions affecting upper-limb function.

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XTERN Summit

The Summit is another option within the XTERN range and incorporates carbon fibre alongside thermoplastic and polymer composite materials.

It is designed for people who require the characteristics of the XTERN system with additional structural strength and stability. TurboMed currently lists a three-year warranty for the Summit's plastic and carbon-fibre components.

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Who may be suitable for a TurboMed XTERN?

TurboMed lists the following clinical indications:

• Foot drop and dorsiflexion weakness

• Peroneal nerve injury

• Charcot-Marie-Tooth disease

• Stroke

• Multiple sclerosis

• Cerebral palsy

• Guillain-Barré syndrome

• Motor neuropathy

• Motor neurone disease

However, having one of these conditions does not automatically mean that a TurboMed AFO is appropriate.

The assessment needs to consider your individual strength, movement, walking pattern, footwear and functional requirements.

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When might TurboMed not be appropriate?

TurboMed identifies a number of clinical limitations, including:

• Inappropriate footwear

• Significant fixed deformity of the foot or ankle

• Severe spasticity

• Significant quadriceps weakness

• Severe proximal weakness

• Crouch gait

This is why a proper orthotic assessment is important before deciding whether the XTERN is suitable.

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What footwear can be used?

The XTERN attaches to the outside of the footwear using its shoe-fixing system.

The TurboMed brace system is transferable between suitable shoes, including trainers, walking shoes and boots, with suitability depending on the footwear and individual requirements. The footwear ideally has a long lacing section and a wide based outer sole at the heel, which the brace depends on to function and attach to your shoe.

Your footwear is therefore an important part of the assessment.

Bring the shoes you normally wear — particularly the shoes you want to use with the AFO — to your appointment.

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Can I run or hike with a TurboMed?

The TurboMed XTERN is designed for dynamic activity rather than simply providing a rigid ankle position.

TurboMed states that the XTERN has been developed for activities including walking, running and hiking, and describes its use in demanding sporting and outdoor environments.

Whether you can safely run, hike or participate in a particular activity depends on your underlying condition, strength, balance, walking pattern and overall rehabilitation.

The AFO is one part of the solution; it does not replace appropriate rehabilitation or clinical management.

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Your TurboMed assessment at MK Orthotics

Before recommending a TurboMed XTERN, we assess how your foot and lower limb function.

Your assessment may include:

• Your medical and orthotic history

• The cause of your foot drop or weakness

• Muscle strength

• Ankle range of movement

• Foot position

• Knee control

• Lower-limb alignment

• Balance

• Walking pattern

• Functional movement

• Footwear

• Your current AFO or orthosis

• Your normal activities

• Your goals

Video gait analysis may be used to assess your walking pattern and identify how the foot behaves during different phases of gait.

We can then consider whether the TurboMed system is appropriate and which configuration may best meet your needs.

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What if I already use an AFO?

Bring your existing AFO to your assessment.

It is useful to understand:

• What your current AFO does

• What you like and dislike about it

• Whether it is comfortable

• Which shoes you can wear it with

• How it affects your walking

• Whether you have problems putting it on or taking it off

• Whether your needs have changed

A TurboMed XTERN is not necessarily the right replacement for every conventional AFO.

The important question is which solution is most appropriate for your individual requirements.

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Why consider an external AFO?

For some people, the ability to keep the orthosis outside the shoe can make a significant practical difference.

The XTERN's external design can mean:

• More space inside the shoe

• No direct skin contact around the foot and ankle

• Easier transfer between suitable shoes

• A dynamic rather than completely rigid approach to ankle movement

Whether these advantages are relevant to you depends on your individual circumstances and footwear.

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TurboMed XTERN in Milton Keynes

MK Orthotics provides specialist assessment for people with foot drop, dorsiflexion weakness and other conditions affecting lower-limb function.

If appropriate, we can assess whether a TurboMed XTERN external AFO may be suitable for you.

The aim is not simply to supply a particular product.

It is to understand your walking pattern, your needs and your goals and determine whether this type of AFO is appropriate.

MK Orthotics is based in Blakelands, Milton Keynes.

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Book a TurboMed assessment

If you have foot drop or difficulty lifting your foot and would like to find out whether a TurboMed XTERN could be suitable for you, contact MK Orthotics to arrange an assessment with the opportunity to loan the trial version of the classic Turbomed brace for up to a week.  Please note, to loan the Turbomed trial kit, requires the payment of a refundable deposit of £120.

Initial assessment with video gait analysis — approximately 90 minutes.

MK Orthotics, Blakelands, Milton Keynes.

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Book an Appointment