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SureStep: A stabilizing force for low-tone patients

SureStep's dual adjustable DA Hinge allows AFOs to be made with thinner, lighter plastics because the hinge itself extends into the AFO's strut, reinforcing what would otherwise be the device's weak point.

By PK Daniel

2018 LER Resource Guide

Bernie Veldman, CO, had been practicing for years when his young son’s condition—severe pronation similar to that experienced by children with hypotonia—led him to add to his clinical work a focus on research and development and eventually, to form a company to offer his solutions to other practitioners.

Veldman, SureStep’s chief executive officer, tested a variety of orthoses but found the rigidity of hard plastics either restrictive or painful for his son’s condition. After much research he identified a thinner, more flexible thermoplastic and created the successful SureStep supramalleolar orthosis (SMO).

Initially, the orthoses collapsed under the weight of his 10-year-old son Kevin. But Veldman discovered that tightening the SMO compressed the soft tissue of the foot, bringing more stability. “With that stability, [Kevin] was more comfortable,” said Veldman. “He could walk better. His running improved. Everything started to fall into place.”

SureStep developed its SMO, which has been a boon to the low muscle-tone population, in 1998 and launched it nationally in 2000. Initially, the South Bend, IN-based company operated as a divi­sion of Midwest Orthotic Services, but it became a standalone entity in 2008 with a wide range of foot, knee, and ankle foot orthoses. SureStep also offers a line of children’s footwear to accommodate orthoses of any kind, and is providing products for underserved markets.

Children with low muscle tone have a tendency to “W” sit, which occurs when their bottom is on the floor with knees bent and feet outside the hips, which provides a feeling of stability and tightness. “It’s a feeling they’re not familiar with, and they love it,” said Veldman. “It feels like a stable position. But it’s terrible for their knees. It’s terrible for their hips.”

To counter this tendency, Veldman developed Criss Crossers. The Spandex pants contain circuitry, wiring, and a switch on the inside of each knee. The switches create an audio cue—a high-pitched, irritating beep—when the insides of a child’s knees touch the ground.

The pants will be available in January, and SureStep encourages interested providers to contact the company to discuss suggested billing and coding for insurance coverage.

“Criss Crossers are going to be revolutionary,” said Veldman. “It reminds kids that [W sitting] is not the way to sit. And if it doesn’t remind them, it’ll remind mom two rooms over.”

SureStep’s prefabricated hyperextension knee orthosis (HEKO) was developed in response to a change by some insurance companies that now requires diagnoses of osteoarthritis or total knee replacement, both adult conditions, for coverage of custom-fabricated knee orthoses.

“Kids can’t get custom braces now,” said Veldman. “It forced us to go back to the drawing board, from custom to prefab.”

Veldman noted the super-lightweight HEKO uses flexible polyethylene and the same hinges as the custom braces. “The prefab has been very well received, and is returnable if the initial fit isn’t perfect, while a custom brace is not,” he said.

SureStep introduced the DA Hinge last September. The dual adjustable hinge allows ankle foot orthoses (AFOs) to be made with thinner, lighter plastics because the hinge itself extends into the AFO’s strut, reinforcing what would otherwise be the device’s weak point. The DA Hinge also has adjustability, and a lower profile. The adjustable stops limit and/or allow movement from 0˚ to 30˚ in both plantar flexion and dorsiflexion.

It’s available for toddlers who weigh up to 40 pounds and youths who weigh up to 80 pounds. “That’s the population that really needed something,” said Veldman, who noted the hinge is compatible with AFOs for children with both high and low tone. I can’t believe how these things are flying out the door.”

This new DA Hinge now comes standard in SureStep’s Indy 2 Stage AFO, which was developed as a solution for the low tone population, but also works nicely for the high tone population with mild spasticity.

The Indy 2 Stage AFO is a brace within a brace, in which the SureStep SMO facilitates dynamic stability—rather than rigidity—inside a more rigid AFO and promotes a more normal gait than walking in a rigid AFO alone. Without the AFO, children with higher tone would place too much force on the SMO, overpowering the thin, flexible plastic that would normally stabilize a patient with lower muscle tone.

“Children who need an AFO need stability, but the rigidity can make walking difficult and awkward. Think of walking in ski boots,” Veldman said. “That’s why the Indy 2 Stage became a good solution for the population with mild spasticity.”

SureStep has recently expanded its longstanding commitment to education. The company, which sponsors about 75 international educational courses each year to educate physical therapists, orthotists, and prosthetists about its products and the importance of early intervention in hypotonia, will soon add online offerings.

In 2014 SureStep’s website will feature online continuing education opportunities, including lectures and a certification course for orthotists.

Article sponsored by SureStep.

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