The Clinical and Scientific Affairs Department of Hanger Clinic, headquartered in Austin, Texas, has created a series of clinical practice guidelines (CPGs) to improve clinical outcomes by defining evidenced-based and patient-focused O&P care. Two of these CPGs were published in October in the Archives of Physical Medicine and Rehabilitation.
The CPGs for post-operative care and prosthetic foot selection were produced by Hanger Clinic colleagues Chief Clinical Officer Jim Campbell, PhD; Clinical Research Review Committee Chair and Clinic Manager Phil Stevens, MEd, CPO/FAAOP; Clinic Manager John Rheinstein, CP, FAAOP; and Research Scientist Shane R. Wurdeman, PhD, MSPO, CP, FAAOP. The recommended CPGs are summarized below:
Post-operative Care
- Rigid removable dressings (RRDs) should be used to reduce both the healing time of the residual limb and time to prosthetic fitting following transtibial amputation.
- RRDs should be used as the preferred means of reducing post-operative edema.
- Given the comparable wound infection rates observed with the two treatment options, RRDs are preferred over soft dressings due to their additional attendant benefits.
Prosthetic Foot Selection
- For patients ambulating at a single speed who require greater stability during weight acceptance due to weak knee extensors or poor balance, a single axis foot should be considered.
- Patients at elevated risks for overuse injury (i.e., osteoarthritis) to the sound-side lower limb and lower back should be managed with an energy-storage-and-return (ESAR) foot to reduce the magnitude of the cyclical vertical impact forces experienced during weight acceptance.
- Neither patient age nor amputation etiology should be viewed as primary considerations in prosthetic foot type.
- Patients capable of variable speed and/or community ambulation are indicated for ESAR feet.
