[OANP-L] treatment options
Rick Milen
Description
Collection
Title:
[OANP-L] treatment options
Creator:
Rick Milen
Date:
9/21/2007
Text:
Hello All,
62 y/o, 6ft, 190 lb male, kidney transplant recipient & low energy reserves with LE amputation half way between Chopart & Pirogoff in for a consultation due to apparent failure of a S.A. plastic AFO w/full foot plate, velcro closures at calf & ankle and a toe filler.
Problem: calcaneous is in full plantarflexion and the normally anterior portion of the bone is protruding inferiorly which has produced a plantar wound. Vascular surgeon referred pt to ankle surgery specialist-DPM and he's asking how I would prosthetically-orthotically approach this guy. DPM is planning to do an achilles release and reshaping of the anterior portion of the calcaneous. Along w/a wound protocol.
My immediate response is to tx prosthetically w/a clamshell-like symes situation. Lock him up so the calcaneous cannot cause trouble. Definitely not AFO secondary to excessive movement allowed and, of course recent failure. Size 11 1/2 shoe = huge lever arm forces; pt externally rotates foot vs. rolling over toe.
Suggestions of what you have successfully used for this difficult amputation level would be greatly appreciated. And NO, BKA is not an option at this time (I asked!).
Regards,
Rick Milen, CPO, PTA
NEXSTEP, Inc
Pennsylvania
62 y/o, 6ft, 190 lb male, kidney transplant recipient & low energy reserves with LE amputation half way between Chopart & Pirogoff in for a consultation due to apparent failure of a S.A. plastic AFO w/full foot plate, velcro closures at calf & ankle and a toe filler.
Problem: calcaneous is in full plantarflexion and the normally anterior portion of the bone is protruding inferiorly which has produced a plantar wound. Vascular surgeon referred pt to ankle surgery specialist-DPM and he's asking how I would prosthetically-orthotically approach this guy. DPM is planning to do an achilles release and reshaping of the anterior portion of the calcaneous. Along w/a wound protocol.
My immediate response is to tx prosthetically w/a clamshell-like symes situation. Lock him up so the calcaneous cannot cause trouble. Definitely not AFO secondary to excessive movement allowed and, of course recent failure. Size 11 1/2 shoe = huge lever arm forces; pt externally rotates foot vs. rolling over toe.
Suggestions of what you have successfully used for this difficult amputation level would be greatly appreciated. And NO, BKA is not an option at this time (I asked!).
Regards,
Rick Milen, CPO, PTA
NEXSTEP, Inc
Pennsylvania
Citation
Rick Milen, “[OANP-L] treatment options,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/228624.
