Responses-insensate foot with other problems
Mohammad Reza Mirheydari
Description
Collection
Title:
Responses-insensate foot with other problems
Creator:
Mohammad Reza Mirheydari
Date:
6/10/2007
Text:
Thanks to anyone helped in this case, below are original post & responses :
Dear list
We have a patient whose sciatic nerve has been damaged in the thigh region because of late femoral Fx and has left insensate foot and left leg length discrepancy ( due to Fx malunion ) that reaches 54mm .
The foot has no sweating , plantar flexion ROM is limited to 4-6 degrees and dorsiflexion to 0 degrees although plantar/doorsi flexor muscles strength is about grade4 according to routine muscle testing methods .
Because of improper previous foot wear the 4th finger has been hyperextended and ride over 3rd finger and also some callosities has been grown in the sole of foot .
The metatarsophalangeal ROM is normal .
Wich shoe design and materials do you offer for this case ?
I would use a custom shoe with a extra wide toe box for the over lap. Let the shoe people know how hight off the ground the toe is elevated so they allow for it. Also any callous problems on the sole or lateral to the foot have them make a relief. The final Rx. goes into the type of foot insert you want/ flexible/foam/etc.
Good Luck,
Rick/cpo
Within the limits of not understanding the full case, I can make a few shoe recommendations that may help your patient. The 3 shoe issues that need to be solved seem to be: 1. A leg length discrepancy (54mm), 2. A highly restricted ROM at the ankle, and 3. An overlapped toe. In addition, the insensate foot needs to be protected from dermal breakdown, and this is further indicated by the callus build-up you noted on the plantar foot. If the patient can wear an extra depth shoe, which allows sufficient room for the overlapped toe, you should start there. You can insert a suitable protective orthotic (custom or prefab) with a plastazote top cover, to reduce the callusing. You may also want to put some drop/relief into the orthotic to off-load high pressure areas. The LLD will require that an external platform lift be added to the shoe. With such a significant lift the pedorthist can easily incorporate a full CAM-style rocker. A CAM rocker has no flat spot, and it will gently
roll from heel to toe. If a suitable extra depth shoe cannot be found, or if the feet are grossly mismatched, you may consider a custom shoe instead. Seamus Kennedy. CPed Hersco Ortho Labs 800.301.8275
HI Mohammad, I would recommend a rocker bottom sole on the shoes to improve toe off, which is perfect because you need to add a lift on that side anyway. I would also use a soft multidensity foot orthotic with a plastizote topping. The shoe should be deep and made with a soft leather and possible lined with plastizote as well Good Luck! Karen Boehm CO(c)
I would first evaluate and see if the foot could be fit with a depth inlay shoe (as for a diabetic foot) with custom molded insoles. If a suitable manufactured shoe cannot serve this purpose, then I would provide a custom molded shoe. Add a suitable lightweight heel and sole lift for the length deficit with a rocker bottom sole design. What are you thinking of doing for this referral? Keever Wallace
Mohammad reza Mirheydari
Director, Orthomir orth./prosth. center ( www.orthomir.org )
---------------------------------
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Dear list
We have a patient whose sciatic nerve has been damaged in the thigh region because of late femoral Fx and has left insensate foot and left leg length discrepancy ( due to Fx malunion ) that reaches 54mm .
The foot has no sweating , plantar flexion ROM is limited to 4-6 degrees and dorsiflexion to 0 degrees although plantar/doorsi flexor muscles strength is about grade4 according to routine muscle testing methods .
Because of improper previous foot wear the 4th finger has been hyperextended and ride over 3rd finger and also some callosities has been grown in the sole of foot .
The metatarsophalangeal ROM is normal .
Wich shoe design and materials do you offer for this case ?
I would use a custom shoe with a extra wide toe box for the over lap. Let the shoe people know how hight off the ground the toe is elevated so they allow for it. Also any callous problems on the sole or lateral to the foot have them make a relief. The final Rx. goes into the type of foot insert you want/ flexible/foam/etc.
Good Luck,
Rick/cpo
Within the limits of not understanding the full case, I can make a few shoe recommendations that may help your patient. The 3 shoe issues that need to be solved seem to be: 1. A leg length discrepancy (54mm), 2. A highly restricted ROM at the ankle, and 3. An overlapped toe. In addition, the insensate foot needs to be protected from dermal breakdown, and this is further indicated by the callus build-up you noted on the plantar foot. If the patient can wear an extra depth shoe, which allows sufficient room for the overlapped toe, you should start there. You can insert a suitable protective orthotic (custom or prefab) with a plastazote top cover, to reduce the callusing. You may also want to put some drop/relief into the orthotic to off-load high pressure areas. The LLD will require that an external platform lift be added to the shoe. With such a significant lift the pedorthist can easily incorporate a full CAM-style rocker. A CAM rocker has no flat spot, and it will gently
roll from heel to toe. If a suitable extra depth shoe cannot be found, or if the feet are grossly mismatched, you may consider a custom shoe instead. Seamus Kennedy. CPed Hersco Ortho Labs 800.301.8275
HI Mohammad, I would recommend a rocker bottom sole on the shoes to improve toe off, which is perfect because you need to add a lift on that side anyway. I would also use a soft multidensity foot orthotic with a plastizote topping. The shoe should be deep and made with a soft leather and possible lined with plastizote as well Good Luck! Karen Boehm CO(c)
I would first evaluate and see if the foot could be fit with a depth inlay shoe (as for a diabetic foot) with custom molded insoles. If a suitable manufactured shoe cannot serve this purpose, then I would provide a custom molded shoe. Add a suitable lightweight heel and sole lift for the length deficit with a rocker bottom sole design. What are you thinking of doing for this referral? Keever Wallace
Mohammad reza Mirheydari
Director, Orthomir orth./prosth. center ( www.orthomir.org )
---------------------------------
Got a little couch potato?
Check out fun summer activities for kids.
Citation
Mohammad Reza Mirheydari, “Responses-insensate foot with other problems,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/228340.
