Hello Lisa,
With regard to the CROW orthosis, think of a custom ski-boot which locks
the ankle mortise in neutral and unloads the plantar portion of a charcot
foot.
The CROW is a padded AFO with an anterior shell, insert and crepe, rockered
sole. Relief of the ulcerated area is builtin to the positive model. The
posterior portion is made rigid for stability. The anterior portion can be
made of padded polyethylene. The insert provides for further unweighting of
the ulcerated area and I give my patients an extra insert . Since these
inserts are primarily accommodative orthotics (multi-density), they tend to
wear out. I found the crepe sole tended to come loose after protracted
usage. I now added leather to the plantar surface of the cast, rivet and
glue it; this makes the crepe- afo bond permanent. When making the anterior
shell its best to place the posterior portion on the positive model with a
spacer of some sort under the plantar surface. This allows room for the
insert, without creating excess presssure of the dorsum of the foot, and
still locks the ankle mortise into a neutral position..
Many of my patients are diabetics and the complications of diabetes,
neuropathy, and wounds close to amputation makes the fitting of these
devices; and their maintenance, oftentimes a long term situation, critical.
Gene Solyntjes LCO. C. Ped.
