November 2015

O&P teams treat limb loss, deformity in developing world

Donating parts, funds aids efforts

By Brigid Galloway

Christian and FOOT Foundation team member Bryan Sinnott, CPO, LPO. (Photo courtesy of the FOOT Foundation.)

Christian and FOOT Foundation team member Bryan Sinnott, CPO, LPO. (Photo courtesy
of the FOOT Foundation.)

Each year, Dino Scanio, CO, LO, and his five-member team of pediatric O&P specialists arrive in Guatemala City to perform a challenging task. In just four days in their most recent clinic in August, for example, they fit nearly 50 young patients with custom devices and trained local practitioners on fabrication and maintenance techniques.

Scanio and his wife, Lisa, established the Tampa-based Florida O&P Outreach Team (FOOT) Foundation in 2011. They are part of an effort among practitioners to find creative ways to sustain the O&P needs of the world’s resource-poor nations. In Guatemala the gross national income per capita is $3410. There, advanced medical care—let alone prostheses—is not widely available.

As the clinic heads into its ninth year, Scanio looks forward to seeing familiar faces during the group’s May 2016 trip. Among those will be five-year-old Christian (pictured) and his mother, who will travel five hours by foot and bus from their rural home. Three years ago, Christian, who was born without legs, walked for the first time after being fitted with his first artificial limbs at the FOOT Foundation clinic.

“The first day we put legs on him, we were all crying,” said Scanio. “We weren’t sure how he would respond, but now we’re watching him grow up. He’s done exceptionally well.”

Recycling O&P parts in resource-poor nations isn’t new, but some distributors are unethical, selling parts for premium prices.

Children like Christian can outgrow an artificial limb every eight to 10 months, so the demand for quality O&P devices is ongoing. It’s made more difficult by challenges in attaining appropriate components. “Materials we commonly use in the US, such as gel liners, cannot be sustained in Latin American countries where temperatures are hot and the gel breaks down quickly,” Scanio said. “In many parts of the world, if a component breaks, it can’t be replaced. So it’s very important that we use readily available materials that are indigenous to the area and can withstand the terrain and living conditions.”

The FOOT Foundation relies on financial contributions to underwrite its philanthropic work, but it also solicits a different type of donation: used parts. US regulations prohibit the use of recycled O&P components, but this form of recycling is acceptable in Guatemala. “Parents happily bring their [outgrown] child’s braces in the hope that they can be used by other, less fortunate children,” said Scanio, who is a pediatric orthotist at Shriner’s Hospital for Children in Tampa.

He’s selective. He only uses what is “repeatable and repairable,” and, while in Guatemala, he trains local practitioners to maintain the prostheses with available materials. Pediatric pylons, knees, and feet are the most in-demand components. Because the FOOT foundation custom builds orthoses onsite, the group doesn’t accept fabricated limbs. (Some organizations, such as Physicians for Peace, do.)

Recycling O&P parts in resource-poor countries is not new, but some distributors may be less than ethical, Scanio said. Demand for materials often inspires opportunists to sell donated parts on the black market at premium prices, and Scanio cautioned against donating prostheses to anyone who cannot demonstrate membership with a bona fide humanitarian organization.

He advises that donations of parts and funds be given only to organizations like FOOT, which has been awarded the Code of Conduct for Humanitarian Organizations Seal by the International Society for Prosthetics and Orthotics (ISPO). This code requires that humanitarian organizations support sustainable healthcare through the use of local materials, manufacturers, maintenance, and support, and take care not to defray the income of local businesses or practitioners.

Seattle, WA-based Mobility Outreach International (MOI) works with children and adults with limb loss or deformity and is another of the 13 organizations to which ISPO has given its seal.

“I admire volunteer efforts of practitioners who take initiative and give freely of their time, expertise, and resources to help impoverished communities,” said Raymond Pye, director of MOI Emerging Programs. “But, invariably, donors don’t last forever, so our goal is to develop self-sufficiency.”

Pye manages MOI teams in Sierra Leone and Haiti, and is developing new efforts in the world’s poorest communities. The teams seek out local technicians, compatible materials, and manufacturers that can fabricate prostheses from local materials. For example, MOI often uses a simple but durable monolimb design for below-knee prostheses.

Scanio and Pye agreed that meeting O&P needs in these economically disadvantaged communities is a challenge, but said organizations such as the FOOT Foundation and MOI are finding solutions.

For more information about the FOOT Foundation or to make a donation, go to To donate to MOI, go to To review the compete list of organizations with the ISPO seal, go to

Brigid Galloway is a freelance writer in Birmingham, AL.

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