Thanks so much to everyone who took the time to respond. Below is my original post and responses.
Dear List, Over the years I have had patients who suffered a crush injury to their foot, and after healing from the incident were left with hyper-sensitivity of the extremity. I recently had a healthy 28 yo patient come in with a Rx for an Arizona AFO who is 2 years post accident and has been unable to wear a shoe since the injury. She had a sub-talor fusion after the accident, but is now structurally sound with an acceptable range of motion. I showed her a picture of the recommended brace and she told me in no uncertain terms that she would not wear it because she cannot tolerate the pressure it would apply. I would appreciate input from the list on how you have been treating folks in similiar situations and will post responses anonymously. Thanks in advance for your help.Darrel Templeton COA Step Forward O&P
Darrel,
She most likely has RSD, we see it often in the wounded warriors that we see. Like with amputees, she needs to go through desensitizing the limb. She should see a well trained PT in this area. In time, she will be able to tolerate wearing a very fine tuned device on her foot. I have one such person just returning from Iraq. The fitting and adjustments were at times challenging. In attempt to relieve a pressure area, a paper thick pad was too thick, yet when removed, it was not enough relief. This gentleman over the past two years is less sensitive, but still has hyper sensitive issues. For him, it is now manageable.
I had a patient with RSD from a crush injury. She was in an Aircast walker for about a year and decided to try a custom Arizona style circumferential AFO. The one thing she demanded was adjustable compression with airbladders. I never had a chance to make the AFO but I sourced out the air bladders that are used in sockets and was planning to use them in between the horsehide and leather.
You might want to try her in an Aircast to see if she really can tolerate the contact afterall. My patient was extremely hypersensitive but preferred constant contact to unpredictable or accidental contact.
I had a similar patient with a resulting slight mis-alignment of the ankle… She agreed to try an Arizona, and after donning the Brace and experiencing the support… Was very happy…
Try a 3ply gel sock the longer BK type: Comfortgel from Comfort.
