response to leather substitutes

response to leather substitutes

Derek Kozar

2/16/2001

Thanks to everyone who replied. Below is my original question and all
the responses. I forgot to mention that my second attempt was to stitch
the leather to the calf band without using glue, but he still developed
the rash.

I have a Klenzak (conventional AFO) on an older patient/client who works

>in a factory here. He has developed in the past a rash around his calf

>under the leather (cow hide) calf band. I have asked him numerous
times
>to wash his socks daily that he wears as an interface between the
>leather and his skin. He claims that he wears a clean one every day
and
>that it stays in place. The rash will clear up, then reappear 3-4
>months later. Any ideas on a different calf band liner material? I am

>sure this is just a hygiene problem, but any ideas would be
appreciated.
>
>Thanks
>
>Derek Kozar, M.Sc.
>Orthotic Intern



An area that lacks clinical investigation in O&P is the effects of
contact
materials. Depending upon the tanning process of the lining leather, it
may
contain chromium or other retained chemicals. I am seeing occasional
apparent allergic reactions to materials that the individual previously
tolerated for years. An increased sensitivity over time? I have no
doubt.

The only alternative to leather, that incorporates the unique properties
of
leather, is another leather that has been tanned with a different
process. If
that fails, I have used Lynadure as a substitute ... but it's current
availability is something I am currently searching.



You could substitute a good upholstery grade naugahyde or other vinyl
upholstery material. It would not have the same characteristics as
leather
but would work just fine.



You can place a layer of ShearBan from Tamarack on the inner surface of
the
calf band. ShearBan is an adhesive backed material that is made from
PTFE or
by brand name Teflon. It is not hydroscopic, easy to clean, and will be
a
very neutral surface as far as skin contact is concerned. It comes in
beige
for that bland look. You will not have to replace the current calf band
padding, just clean up the leather to remove some of the body oil and
stick
the ShearBan in place.



Derek you can remove the leather and put in a piece of flexible
polyethylene.
Just make the polyethylene four to six inches top to bottom to
distribute the
pressure like an AFO would do. The bacteria from his skin will have
difficulty manifesting it's self in the poly. Ask him to wipe it off
occasionally and of course he should continue to wear clean high socks.
Good
luck.


We use a material called Alcantra for shoe insert toppings and I have
used it successfully for an AFO liner a couple of times. It doesn't
stink
or rot, breathes a little, looks a lot like brown leather and seems to
last quite a while. It's not cheaper, but good stuff. I do not know the
manufacturer, however. I'll ask our supplier, but they probably won't
tell me.


I have used the proximal trim sections of Alpha liners to pad
these
type of areas. It may be worn on the skin or sowed into a velcro
type
of pad which may be removed washed and reapplied.


Vibretta (synthetic leather) is avaiable from a number of O&P
suppliers. Another option would
be vinyl covered pelite (such as used in foot orthoses). There is,
however, another avenue of
approach which you might explore. Many people have reactions to
detergents with enzymes or
to detergents film in general. Ask your patient if he is sure his
washing machine is doing a
thorough job of rinsing his socks. You might suggest a double rinse for
his socks to be sure
all the detergent residue has been removed. While this is no panacea,
I have had number of
people (including both orthosis and prosthesis wearers) who presented
with rashes in areas of
contact with their devices who reported that the problem was resolved
with either a change of
detergent or extra rinse of the articles of clothing that acted as an
interface between their
skin and the device. Hope this helps.


It is possible that this guy is allergic to the solvents that are in the

glue used to put the cuff together. I would recommend that you scrub the

surfaces of the leather with acetone then seal the leather with a good
leather sealant.


Derek, I am one of those older orthotists (32 years in the field) and
due to
that I have had a lot of experience with similar problems. Unfortunately
even
with that experience I cannot offer an absolute solution, but I can
reinforce
what I think you may already know. Leather is an open cell material that
will
absorb bacteria. Until the cycle is broken, i.e.: a barrier between the
patients leg and the leather cuff the rash problems will reoccur. You
could
try using a closed cell vinyl instead of the leather on the cuff but
this
will probably promote additional moisture. Regardless it can be cleaned
and
that could help. Also there are manufactures promoting anti-wicking
types of
liner materials and these could also be of value and worth trying.


If you secure the leather with an adhesive such as contact cement there
is a chance he could be
having an allergic reaction to the adhesive residue coming through the
leather. Can you use
some other type of adhesive (unfortunately I don't have the name of a
good alternative) perhaps
poly-adhesive or no adhesive (sew the leather in place?)

THis may sound gross Derek, but Lamb skin with the wool still on, does
seem
to work in some cases where rashes/allergies persist with foams and
leathers.