Case Presentation:
Patient has severe peroneal tendon dysfunction, beginning with rupture, followed by repair and several rounds of infection, debridement, revision of the surgery resulting in resection of all remaining peroneal tendons. Essentially has little resistance into varus and uses metal and leather AFO with lateral wedge inside shoe for protection. Requires the use of steel toe boot for work. Failed polypropylene AFO over the long term, although this provided great control, recurring cellulitis made us leery to come in contact with his skin anywhere along the lateral side. Has been using standard AFO for 7 months, during which time the stirrup has pulled through the sole and out of the shoe several times, as well as issues with the rivets pulling through the shoe and the added reinforcements. This is primarily due to the fact that he climbs a ladder on a truck with limited space for his foot, and therefore puts all of his weight on his forefoot while climbing and this is beyond the reach of the long tongue stirrup. The problem is compounded by the fact that he uses a hose to wash cement off the boots multiple times a day so the leather is damp most of the time.
Past inadequate solutions were to add an internal carbon plate the entire length of the shoe and rivet the stirrup through this, change to a heavy duty sole, increase the number of rivets to decrease the stress on each, etc. At this time, I have him with the longest tongue stirrup that Becker makes, I have reinforced both the inner and out sole with carbon plates and have the stirrup sandwiched between, attached with broad head rivets. This lasted only 4 months. I am hopeful that adding a full length steel plate contoured along the inside of the footbed, so that the stirrup could be attached through this, sandwiching most of the sole, would prove more durable.
Question to the list:
Can anyone recommend a central fabricator that might undertake this project? Can anyone recommend an alternative that might prove more durable?
Thanks in advance for any assistance-I will post a digest in a few days
Harry Phillips, CPO for Carin Caves, CO
Triangle Orthopaedic Associates, P.A.
Orthotics and Prosthetics Department
120 William Penn Plaza
Durham, NC 27704
(919) 281-1814
Fax: (919) 281-1877
