LisFranc Responses

LisFranc Responses

Elisa de Jong

7/3/2007

Here are the responses so far. Thanks for everyone's advice. I'll let
everyone know what I decide to do.

1) Something to look into would be a Toe off brace with toe filler. Provides
good ankle stability,some dynamic toe response.Toe Off or Blue rocker
depending on weight and activity.
Good Luck
Wade Skardoutos CP

2) A fellow in Sweden named Karel Montan who had a midfoot amputation and
did a lot research and put it on a web site. It is too bad that it hasn't
been mirrored elsewhere after he died. The family just took it down. He
had XRays of his feet and photographs along with the different treatment
regimes he had over the years. He started with the stuffed shoe and toe
filler and went on from there to an AFO that gave him some toe off. If
someone you know has printed it off, can you please let me know? I
consulted it but never printed it out. Most of the people with amputations
I deal with are older folk who aren't so active. The shoe filler is what
they need because they are mainly walking around and propulsive gait is not
always required. The callusing you see is not a good sign for anyone and it
is a sign that not all is well. If he is active in basketball, the
preferred option would be some sort of AFO arrangement. Because I have
reached the limit of my expertise with this last statement, I will have to
reserve comments about the exact configuration of the solution. Will the
kid put it on regularly? That is a good question! There is a great
pressure to be normal and anything to get as close to normal is going
to give better compliance. (I have a daughter who is not too religious about
wearing simple foot orthoses. The rig you want to give this guy is more
involved than that!) I have some younger patients who have LLD and the more
that the 2 shoes look the same, the happier they are. I certainly wish you
well in arriving at a solution for this fellow. Jim Pattison C.Ped (C)
Canadian Certified Pedorthist.

3)Try a blue rocker toe off brace from Allard with a toe filler. If you
don't give him a rigid toe with a lever arm he will not get the push off
he needs and will likely get pressure distally. The foot plate of the toe
off brace goes under the insole of the shoe so the calf straps would serve
as suspension. You could use some skin grip strap pads to help prevent
migration. Allard actually has some recommendations for the toe filler to
prevent pressure. They would probably be a great source for information on
how to do this. I would like to know what you end up using and how well it
works. Thanks. Jared & Christina McNeill

4) We've had GREAT success with a custom socket for the residual foot
mounted on a ToeOFF foot plate. It gives them proximal stability and a
dynamic rebound effect that makes gait more symmetrical and fluid. Robert
Meier, CO, BOCO

5) www.cc-mfg.com these guys are good. Brent

6) ToeOff with toe filler. light, energy returning, very durable. he might
like the pure carbon looks, one never knows. you'll have all the benefits of
extended lever arm right where you need it - supporting his tibial crest
from the anterior, from midstance to toe off. as he does not have
anatomical foot on that side, i'd downsize the sound side foot length,
mostly for compliance reasons. he'll roll inside a silicone slipper
prosthesis. you, pretty much, are dealing with a ball shaped distal end,
only way to stop it from rolling is to purchase over tibia. as far as you
have him locked well in the afo. u might need to re-design the distal tibial
strap for something more comfortable and sturdy. also, on a soft patient,
ones that do not have much of muscle tone in triceps sure, you may need to
add a soft pad under the proximal strap, otherwise it cuts into the soft
tissue some be very diligent with bridging his tibial crest with pads they
provide. if he'll have some distal tibial pressure, re-arrange the footplate
in the shoe so that it is moved forward. either a leather flap glued to the
posterior aspect of the footplate, ot the custom toefiller itself needs to
be shaved in the front. i fixed some footplates in the shoe with velcro
strips before. if the kid is very active, opt for BlueRocker, it is a very
rugged brace, much stronger that ToeOff. i'd not finally attach toefiller
until all the little bugs are worked out in the brace itself. i. lesko, lcpo

7) Try a supra-mollelar design articulating AFO with a graphite foot
plate/toe filler. Your welcome.
Steven Fries, LPO

8) Hi , we have had good results using the Allard Blue Rocker AFO, and a
custom foot bed and a toe filler. This would give him good roll over and toe
off. You can purchase the brace from Allard, Knit Rite or Pel. Try it with
your custom foot bed and you can return the brace if it does not work out
for him. Good luck. Ron Cahill CPO

9) Is the LLD on the affected side, or is his good leg short? Usually with
Lisfranc, the client tends to some plantarflexion deformity. Either way, a
low profile anterior AFO with a very stiff foot plate will work. This in
combination with a silicone partial foot from Otto Bock Silicone House would
round out the script. The silicone foot would work for everyday getting
around and be less restrictive. When he is more active strap on the AFO.
If he was too stubborn before to wear anything, chances are he will still be
too stubborn until he has some major problems (and then he still may reject
any device!)
Brad van Lenth C.P.(c)

10) Just to start with I can suggest, try the carbon profile Toe Off brace
by Allard USA, incorporating the TCI with toe filler, that should help him
with the long lever arm & also help him for toe push off. Sanjay Kawankar.
ABCP, BOCO,CP.

Elisa

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