Patient with clubfoot

Patient with clubfoot

Paula Martinek

6/30/2009

Hello all: I have a patient who is about 47 years old. He has an Rx for diabetic custom shoes and AFO. He has a severe right clubfoot that apparently he was born with and no one ever corrected it. Ankle is in about 5 degrees of plantarflexion, hindfoot and forefoot is supinated severely. Basically when he is weightbearing his lateral malleoli and mid- border of foot is making contact with the floor. No correction is possible, he is fused in this position. In addition he has internal tibia torsion so his right foot is severely toed-in. He does drive and ambulate. Doctor wants to get pressure off of the lateral ankle. I have a few ideas in mind about how to approach this. I'm thinking a high top molded boot reinforced laterally with insert. Basically an Arizona type brace with a walking sole, using polyethylene sandwiched into the leather. My second idea is a Crow boot again using polyethylene. Frankly though I am worried that any sort of plastic AFO would cause the lateral ankle to break down. My other concern with a Crow boot is that he does drive. I'm not sure if his car is set up with any type of hand controls. I doubt it. I think a metal brace is out of the question given the severity of the toe in and the club foot. If anyone has any further ideas or any experience on which would be the best way to proceed I would appreciate it. Thank you as always. Paula Martinek, LPO