reply summary Bilateral Heel Ulcers, part 2

reply summary Bilateral Heel Ulcers, part 2

Ted A. Trower

7/11/2000

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PTB orthosis sounds like the solution, except for the cost.

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I was going to propose the ipos heel relief orthoses when I read the first
part of your text. If he is too unstable for those and for PRAFOS I would
suggest a wheel chair while in wound care treatment. You dont want this
patient weight bear on open wounds and you dont want them unstable on
anything that would be considered stilt-like. The consideration for an
amputation however may be too early yet (depending on how long his
neuropathic ulcers have not healed yet and on how good a chance for healing
may be predictable). He will not be an easy candidate for prostheses either!

Yours sincerely,

Wieland Kaphingst

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I would suggest the Anatomical Concept PRAFOs. They have a sole on the
bottom to enable walking, yet have good relief to protect the current
ulcer areas. Bivalved AFOs , by your own description, would probably
not be put on by the current staff. The PRAFOs offer the simplest
solution, and offer the most likely compliance from the staff, in my
opinion. You probably will not be able to solve all the problems for
this patient.
Good Luck.
Don

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Dear Ted
I have had good success molding protective pads out of 1/4 pink plastazote.
There seems to be a property in the plastazote that promotes
re-epithelialization. If you give this a try, please let me know what your
experience is.
Another suggestion is to use the Cutinova products from Beiersdorf-Jobst.
Pat McKee
Associate Professor
Department of Occupational Therapy
University of Toronto

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Dear Ted
I'm sure this will be a recurring answer. Total Contact casts. keep him NWB as
much as possible. Once healed follow up with AFO's of a total contact nature. I
had a similar patient who had bilateral heel ulcers secondary to poor nursing
management following a total hip replacement. the contact casts healed his
ulcers, now we are making custom innersoles into custom footwear.
Hope this is of help
Regards
Ben

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You are correct that total contact casts are not as effective on heel ulcers
as they are on the forefoot. Given the current mess at Medicare, the casts
would still make sense. We just finished a study and the cast is still the
gold standard. No other product can match them for unloading. Next best
would be an air-cast boot completely inflated and a custom molded insert
again something Medicare won't pay for. Next is the DH walker. This might
be billable under part B since he is ambulatory, particularly if you could
unload his ulcers. It is a tough sell for bilateral BKs but that will
probably come in time, if he doesn't die first.

Keep the faith. Better times are ahead when the new politicians finally
discover that we really have a surplus, and stop acting like this is 1990
and we have not convinced Bill to sign the budget balancing act.

Don Shurr
CPO,PT

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Ted -- I too have run into problems like this that need economical answers.
One thing that I have done is to take
 1/2 plastizote and place it in a cast boot and grind out under where the
sore is to deweight it. This is cheap . I have also put this insole into
extra - extra -extra depth shoes- I used Otto Bock Cozy walker, and the
sores healed.
Good luck -- Stephanie

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I believe there is only one way you have a chance at healing this condition.
It is with total contact casting. It is going to take some work and time but
it can be done. Ask for information on Dr. Paul Brands work in this area
from the Gillis W. Long Hansen's Disease Center, 5445 Point Clair Road,
Carville, LA 70721.

Yours Truly,

Carl Riecken

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Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, MI, USA