Dear list,
After reading once again the work of Dillon and the Academy SSC on partial
foot amputation, it is clear that the optimum treatment for a
transmetatarsal amputation must include an anterior shell up the tibia if we
are to offset poor late stance phase moments. For the past few years, we
have been using a custom insert (toe filler) with slight relief of the
plantar distal metatarsals in conjunction with a blue-rocker AFO. This
seems to be stiff enough (visually) to support the patient at late stance
and provide improved gait.
Unfortunately, many of the transmet patients we see (and slightly higher
levels too) tend to get impingement on the lateral upright of the blue
rocker, usually distal to the base of the 5th with the widening of the
metatarsals. We have tried other manufacturer’s prefabricated carbon AFO
with medial upright but the toe plate seems too soft to provide adequate
kinetic improvement.
My question is: Is there an alternative to the lateral upright that is
stiff enough and if not, how are you all managing these patients to provide
improved gait parameters and maintain some level of acceptable cosmesis?
Thank you so much in advance.
Gary
Gary M. Berke MS, CP
Adjunct Clinical Instructor,
Department of Orthopaedic Surgery
Stanford University
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