Dear Colleagues,
Thank you all for replying to my post and following are the replies for the
benefit of the whole.
There was a little confusion as this is not someone I have seen or will be
seeing. The post was for someone not on this List. Most responses were for a
prosthetic solution although surgical revision is also a possibility.
Thank you once again for the assistance you have provided for this individual.
Respectively,
Al Pike, CP
ORIGINAL POST:
All the toes were removed, and the amputation goes at an angle to his heel.
He is facing possible further amputation because of the angle being hard to
fit prostheses. It is also causing him pain and back problems.
He is almost 40 years old. The amputation was caused by trauma (accident).
It is emotionally hard for him to think about taking off more of his foot.
Would that be the best thing? Does he have other options?
RESPONSES:
What type of pros. have you tried and what has been the outcome..I have had
good success with
our type of pros…for partial foot amps.
AL, my best opinion is for this patient to see a local prosthetist or
orthotist with clinical experience to evaulate the problem. I would think
with all the wonderful new materials out there something could be done. Of
course if this patient is still mourning the loss I don’t know if they will
accept any recommendation.
Contact someone local to see them, and have the professional get back to you.
Good Luck! Rick Feldman, CPO
Hi Al-
As you know, a “bad” partial foot is one of the most debilitating losses.
Without a photo or x-rays, it’s hard to make any recommendations but I’d
check out the following questions:
1] Has he tried a silicone prosthesis? [In my experience, these are
surprisingly forgiving and dissipate forces.]
2] Has he tried an articulated AFO clamshell design with a rigid toe plate
plus rocker sole? [I had good success with a young soldier who blew off the
front of his foot with such a prosthosis.]
3] Is he aggressively stretching out his tendoAchilles on that side? [If he
will walk “flat-footed” without heel off his symptoms will likely subside.]
My final thought is that if he wants a expert orthopedic opinion, he should
see John Bowker at the U of Miami. John loves partial feet and is a
virtuoso surgeon in this area, but he is nearing retirement.
Hope some of these thoughts help.
–John W. Michael, CPO
Yeah. Get over the emotions. Find a surgeon who understands the basic
realities of
prosthetics and rehabilitation. GB.
Hi Al:
You know, as we all know, that it’s very difficult to provide specific advice
without having detailed information on the case provided. I believe, however,
to be safe in saying that partial foot prosthetics has become so much easier
and “consumer-friendly” in today’s times of using carbon fibre composites for
the structural and kinetic components and silicones or gels for the interface
component.
Let us share more information on the case and someone with hands-on
experience in partial foot prosthetics and in more recent technologies may
come up with a good solution.
Always yours,
Wieland Kaphingst
ortho-bio-med.llc
Marketing, Education, Technology Transfer
International Consultants
Hi Al
Has he been fit with anything as of yet? How much weight bearing can he
take on the heel and whats left of the foot ?Is the foot painful? Is there
full range of motion?Is the ankle joint intact?These are all questions that
must seriously be considered before embarking on any plan However ,whenever
possible we like to start with the least restrictive device first perhaps
a partial foot prostheses . While this may turn out to be too conservative
of an approach, it will give him the opportunity to experience it for
himself and help him to decide which direction to go in next. Then again it
might work. We generally fabricate a thermoplastic socket in the shape of a
SMO (we prefer co-polymer) leaving the posterior aspect open for donning and
doffing purposes you can use PPT or some other lining of choice. We then
take the socket and mold pelite out to extend the foot . We flatten the
plantar surface of the socket and pelite . We then glue on a springlite
carbon foot plate to the bottom. The next step is selecting a foot .We
carve it out to achieve an intimate fit between the outside of the socket
and Pelite transitioning to the foot. The foot becomes a custom shell
that extends from the dorsum of the socket all away around to the bottom of
the foot to the heel. This must be achieved with careful attention so as not
to oversize the foot and to maximize the glue surface for obvious reasons.
The last step is to glue and tightly wrap horse hide around the foot to the
socket with a skived transition. We then spray paint the foot.The foot plate
is sandwiched between the socket and the prosthetic foot.This technique
provides a relativly inexpensive and light weight prostheses.
