"Optimizing Combat Casualty Care"

Orthopedic Device Helping Wounded Warriors Return To Run

LEFT: Ryan Blanck, a prosthetist at the Center for the Intrepid shows how the energy-storing Intrepid Dynamic Exoskeletal Orthosis works. RIGHT: Spec. Michael Krapels works on his side-to-side running drills using the IDEO on his left leg. The design of the IDEO allows for side-to-side movement due to the struts that connect the top and bottom pieces together.

LEFT: Ryan Blanck, a prosthetist at the Center for the Intrepid shows how the energy-storing Intrepid Dynamic Exoskeletal Orthosis works. RIGHT: Spec. Michael Krapels works on his side-to-side running drills using the IDEO on his left leg. The design of the IDEO allows for side-to-side movement due to the struts that connect the top and bottom pieces together. Photo by Steven Galvan

By Steven Galvan, Public Affairs Officer
U.S. Army Institute of Surgical Research
07 FEB 2012

A new energy-storing orthopedic device along with an extensive rehabilitation program is allowing wounded warriors who previously had difficulties walking or standing due to lower leg injuries to run again. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) was designed by prosthetist Ryan Blanck at the Center for the Intrepid (CFI). It is a custom-fit device made from carbon and fiberglass that supports the foot and ankle and resembles an amputee’s running prosthetic.

The ability to run can be the difference whether a wounded warriors is allowed stay on active duty and to return to their units after having been considered for a medical discharge from the military. During a mission in Iraq in 2009, a Soldier from with the Army’s 4th Brigade Combat Team, 1st Armored Division at Fort Bliss, Texas, was in that situation after injuring his left leg in a roll over.

While on patrol, the Mine Resistant Ambush Protected (MRAP) vehicle that combat engineer Staff Sergeant Philip Davis was riding in rolled over and his left leg got wedged under his seat. “It pulverized it,” said Davis.

“I was given two options—to amputate or to have the foot and ankle fused.” Davis chose to have his ankle fused even after his doctor told him that he would never be able to run, jump, or play in any high-energy sporting activities.

“Before the surgery, I told him that the surgery would give him very little flexibility and mobility and that he was probably looking at a medical discharge or that if he stayed in the Army, he would have to look at another job other than being a combat engineer,” said Lt. Col. Joseph Hsu, an orthopedic surgeon at the Army’s Institute of Surgical Research.

Advances in surgical techniques enables Dr. Hsu to salvage mangled legs once previously destined for amputation. During the healing process, rehabilitation for each wounded warrior is designed to get them back to how they were before their injuries. Johnny Owens, director of Limb Salvage Rehabilitation at the CFI, tailors a rehab program for each warrior according to their injuries.

A rehab program aimed at getting wounded warriors running is called “Return to Run Clinical Pathway.” According to Owens, this multidisciplinary program is built around an aggressive rehabilitation plan. “Patients needing support to their lower legs can be fitted with the IDEO,” said Owens. “This enables them the ability to return to running, sports, and military deployments.

Some warriors can rehab for months, even years and may never gain full functional or capabilities. This lack of progress can be so discouraging that some warriors have requested an amputation. Due to these drastic requests, Owens, Blanck and Hsu came together in a collaborative effort under Hsu’s guidance to combine the critical surgical, orthotic design, and rehabilitation into one process.

“We came together because we noticed that there were a large number of wounded warriors who were considering or wanted late amputations,” said Owens. “During rehab, most of these young, highly motivated, and physically fit warriors were getting discouraged after seeing amputees with prosthetics who are able to run, jump, and participate in sporting activities.”

A late amputation is not as simple as a warrior saying “amputate.” It is a lengthy process that involves extensive counseling, but it can be an option for some wounded warriors. “That was not an option for me,” said Davis. “I wanted to run again when I began rehab. I pushed myself. I was determined to stay in the Army as a combat engineer and join my unit.”

After a few months of rehab, Davis was able to walk, but with a severe limp, and he couldn’t run or jump. “Then I was told about the IDEO. After being fitted with it and shown how to properly use it, I felt the difference almost instantly,” said Davis.

The IDEO is custom-made using a mold from the warrior’s leg. The three piece device fits in shoes and boots. The top piece that is shaped like the top portion of a prosthetic leg is placed just below the knee. Both pieces are held together by a sturdy and flexible support bar. The upper and lower sections are joined by a carbon fiber dynamic response strut system originating from prosthetic technology used with the high-activity amputee population within the Department of Defense.

“The way it works is very much like a runner’s prosthetic,” said Blanck. “As the warrior steps on it and moves forward, the energy of the foot piece is transferred to the back of the foot piece with a spring motion.”

In order to maximize the full benefits of the IDEO, warriors go through extensive rehab sessions. During the initial sessions, warriors are trained on how to step with the device. As they progress through the rehab, they are introduced to more stringent training that involves running and jumping up and down and side to side. Then weights are introduced into the rehab.

“They have to get used it to and learn how it works,” said Owens. “Once they feel comfortable with the IDEO, we encourage them to push themselves without overdoing it.”

Sixteen months after his injury, Davis was able to return to his unit as a combat engineer and ready to deploy.

“I’m able to move like I did before the injury,” he said. “I can run, jump, and play my favorite sport—softball; but most of all, I kept my job as a combat engineer.”

Since its inception, 143 wounded warriors have been fitted with the IDEO. The majority of its recipients are in combat arms specialty jobs like the Navy SEALS and Army Rangers. The IDEO is allowing these warriors to run, parachute, and perform demanding physical activities required from these Special Forces members. “After a couple of years of using one, I had a Soldier who didn’t need it anymore,” said Owens. “The IDEO helped him regain full use of his leg and no longer requires it.”

Davis is still using the IDEO. He is amazed at what he can do with it. “I was playing outfield during a softball game. When a ball was it in my direction, I was able to take off and chase it down,” he said. “I didn’t realize what I had done until after I caught the ball.

In another instance, I was playing second base. I was able to turn a double-play. That’s pretty hard for a lefty, but once it again, I was able to do it because of the device—it did what it was supposed to do.”

The IDEO is working for Davis and many other wounded warriors who want to be physically active, redeploy with their units or just lead a normal life. Spec. Michael Krapels, a member of the Chosen Company, 2nd Battalion, 503rd Infantry Regiment, was told by his doctors at Walter Reed Army Medical Center that he would not redeploy to Iraq or Afghanistan after taking a gunshot to his lower leg.

“I was told I was going to lose my leg,” said Krapels. After hearing about the IDEO, he requested temporary orders to Fort Sam Houston to see if the device would work for him and it did. Krapels is now going through some intense physical therapy to prepare for another tour overseas with his unit.

Wounded warriors like Davis and Krapels are just two examples of warriors who motivated Blanck to develop the IDEO and join forces with Hsu and Owens to develop the Return to Run Clinical Pathway program.

“They push us to come up with these types of devices and programs and we’re going to support them, no matter what it is,” said Blanck. “Whether it’s going and playing with their kid in the backyard or redeploying to Afghanistan with their Special Forces team, we’re going to do all we can for them.”