Ultimately, the best ADM springs to use are the ones that achieve a good stretch to the foot and which can be tolerated by the patient in use. Foot position in the ADM is a good guide for night bracing provided the foot is well corrected and has good range of motion. Foot position should be evaluated when the patient is calm and relaxed. Foot position is less helpful if the patient has poor range and or stiff / resistant feet. ADMs used with Ambulatory footwear are best evaluated through careful observation of gait and comparisons with the changes desired.
The Standard STJ / TTJ spring option is a good choice for many ADM users, but alternative spring options can be considered.
Strong STJ (abduction) spring with Standard TTJ (dorsiflexion) spring: This provides a stronger abduction force and may be used where the Standard STJ is not sufficient. This combination is used mostly for clubfoot patients with very resistant feet. Many children use the Strong STJ option without any issue, but stronger springs will increase the possibility of patient intolerance.
Strong STJ (abduction) spring with Strong TTJ (dorsiflexion) spring: This option may be appropriate for patients with resistant feet and more body mass provided it can be tolerated in use.
Soft STJ (abduction) spring with Standard TTJ (dorsiflexion) spring: This provides less abducting force. Lighter abduction springs are often more appropriate for patients with hyper-mobility where the sub-talar (STJ) joint foot has low resistance to motion.
Soft STJ (abduction) spring with Soft TTJ (dorsiflexion) spring: The Light STJ Light TTJ option is for patients with low muscle tone and body mass. Such patients offer little resistance to the ADM spring forces and may show too much dorsiflexion in the Light (STJ) Standard (TTJ) spring configuration. If a satisfactory foot position is achieved with light springs then this may be all that is required.