Replies to Calcaneal Fracture Orthosis
Keven Dunn (MSPO Student)
Description
Collection
Title:
Replies to Calcaneal Fracture Orthosis
Creator:
Keven Dunn (MSPO Student)
Date:
7/10/2009
Text:
Hello List,
Thank you for the wide variety of replies. Before submitting the question to the list I was thinking primarily about hydrostatic AFO designs and soft FO materials. I was encouraged by the creativity in the posts. When reading the list I like to see the responses quickly so I am posting them quickly. If any more are sent I will send a second response list. Here they are.
Thanks,
Keven Dunn
Georgia Institute of Technology
MSPO 2010
---------------------------------
The treatment for calcaneal fractures will vary considerably depending on the severity and duration of the condition. Simple pedorthic solutions for milder cases will include the use of heel cushions or foot orthotics with shock absorbing heel pads and dispersions.
The midsole of the shoe can also be modified with either a negative (or roller) heel; or a SACH heel (Solid Ankle Cushion Heel) that removes a wedge of the midsole, at the heel, and replaces it with a softer more compressible material.
Séamus Kennedy, BEng(Mech), CPed
Hersco Ortho Labs
----------------------------------
You can use a PTB Brace with a Patten bottom and the whole foot will be in the air and you may need a lift on the other foot but the patient will be able to walk without putting any pressure on the heel at all.
Jorge Gonzalez
Metro Limb and Brace
----------------------------------
You can use a CROW type walker with the heel area excised or a PTB. Either one is a bulky choice. As calcaneal fractures take a long time to heal, the more the fracture is supported, the better for the patient.
Dean Mason, C. Ped, BOCO, CO
----------------------------------
During the initial healing weight bearing period a pattelar tendon bearing AFO (PTB-AFO) should be used. It keeps the weight off the foot as it incorporates a PTB design (similar to a traditional below knee Prothesis; not a liner type design). The modifications you make to the cast of the lower leg uses specific weight bearing areas to accept the weight of the body and keep the foot 1/2 off the ground. The diagram of this design is at <URL Redacted>. It does not show the foot off the ground (which is the whole point of this design) but it gives you an idea of it's look. You add a soft foot bed for partial weight bearing and contact, but not full weight bearing. It will offlload 40% of the weight if well made.
If you are not a Prosthetist or Orthotist, you should call one and get a better insight to the biomechanics involved of this VERY SPECIFIC design. It looks straight forward, but the pressure distribution aspect of the modifications are CRITICAL. This design will only off weight, alowing the patient to walk after the acute phase is healed.
You will have to accomodate the leg length discrepency (long to the affected side because of the offlaoded position) by adding a shoe raise to the other side. If you do not, the patient will likely catch their toe during swing as the affected side is now longer than the contra side.
If you have any questions feel free to contact me.
Greg Williscroft BPe, CPO (c)
Alberta Children's Hospital
Neurosciences Department
-----------------------------
Check out the PRAFO with the available PSS addition. You should be able to find information on their web site or additional information by calling them and speaking to one of the practitioners.
Bill DeToro CO
-----------------------------
UCBL has worked well for me in the past, with a good grip on the calcaneus.
Gary A. Lamb LPO, CO, FAAOP
-----------------------------
Check into the PRIZM sock and Micro Z Mini for pain, healing and increase in circulation.
-----------------------------
I have very good feedback from calcaneal fracture patients wearing custom made silicone insoles.
Karlo Obrovac MD
-----------------------------
PTB un-weighting AFO
Eric O'Guinn CPO
-----------------------------
A true calcaneus fracture, not a contusion, may extend into the subtalar joint. There are many types of calcaneus fractures. If it extends into the subtalar joint then reducing the motion at this joint will help. One option is to lock it into pronation and therefore limit total motion, just the opposite of what one might tend to try. Many times there is a leg length discrepancy that results, this may also require recognition. If acute, unloading and preventing further collapse would be nice, with difficulty a PTB AFO could help. Again depending on the fracture pattern, a heel lift to reduce the pull of the achilles may also be of value. The options I just tossed out are a little bit on the rare side so I thought they might be of additional interest.If your having trouble with options, having the doctor explain the x rays could be a good practice builder and may allow visualizatin of the fracture pattern to aid in treatment. If the patient continues to suffer, isolated subtalar joint fusion may be warranted instead of orthotic management. CT imaging could then be of value?? Most docs dont like that type of surgery and will steer clear even though that may be the only thinbg that helps. lots of guessing on my end regarding the pathology of this particular patient.
Mike Saldino, DPM,CPO
------------------------------
I have a design that works well for me. I have put together an 8 minute video to illustrate my technique. If you or any of your collegues have time to watch I'd love feedback. I have also sent this video to the Listserv. Kevin
<URL Redacted>
Kevin C. Matthews, CO/LO
------------------------------
Depending upon the fixation, stability and the type of fracture, different orthotic interventions are appropriate.
We use Duraflex Orthoses trimmed like and SMO at the hindfoot and a 3/4 length FO distally for stable fractures that do not require ORIF. The Duraflex provides some shock attenuation and the orthosis has proven to be quite effective. It also fits into a variety of footwear easily.
For the less stable and post ORIF fractures we use a SAAFO (Short Articulating Ankle Foot Orthosis). This orthosis incorporates TPE construction with a jointed ankle, heel cup, plantar shock absorbing padding and an anterior shell. The ankle joints can be limited motion at first using the excellent USS Ankle Joints from Ultraflex. This orthosis protects the heel, cushions it, but also encourages extensibility of the Achilles to prevent shortening. It also stabilizes the talo-tarsal joints and keeps the midfoot and forefoot aligned appropriately throughout the step to reduce the stress on the hindfoot and allow healing to occur.
Jim Rogers, CPO, FAAOP
-------------------------------
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Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Thank you for the wide variety of replies. Before submitting the question to the list I was thinking primarily about hydrostatic AFO designs and soft FO materials. I was encouraged by the creativity in the posts. When reading the list I like to see the responses quickly so I am posting them quickly. If any more are sent I will send a second response list. Here they are.
Thanks,
Keven Dunn
Georgia Institute of Technology
MSPO 2010
---------------------------------
The treatment for calcaneal fractures will vary considerably depending on the severity and duration of the condition. Simple pedorthic solutions for milder cases will include the use of heel cushions or foot orthotics with shock absorbing heel pads and dispersions.
The midsole of the shoe can also be modified with either a negative (or roller) heel; or a SACH heel (Solid Ankle Cushion Heel) that removes a wedge of the midsole, at the heel, and replaces it with a softer more compressible material.
Séamus Kennedy, BEng(Mech), CPed
Hersco Ortho Labs
----------------------------------
You can use a PTB Brace with a Patten bottom and the whole foot will be in the air and you may need a lift on the other foot but the patient will be able to walk without putting any pressure on the heel at all.
Jorge Gonzalez
Metro Limb and Brace
----------------------------------
You can use a CROW type walker with the heel area excised or a PTB. Either one is a bulky choice. As calcaneal fractures take a long time to heal, the more the fracture is supported, the better for the patient.
Dean Mason, C. Ped, BOCO, CO
----------------------------------
During the initial healing weight bearing period a pattelar tendon bearing AFO (PTB-AFO) should be used. It keeps the weight off the foot as it incorporates a PTB design (similar to a traditional below knee Prothesis; not a liner type design). The modifications you make to the cast of the lower leg uses specific weight bearing areas to accept the weight of the body and keep the foot 1/2 off the ground. The diagram of this design is at <URL Redacted>. It does not show the foot off the ground (which is the whole point of this design) but it gives you an idea of it's look. You add a soft foot bed for partial weight bearing and contact, but not full weight bearing. It will offlload 40% of the weight if well made.
If you are not a Prosthetist or Orthotist, you should call one and get a better insight to the biomechanics involved of this VERY SPECIFIC design. It looks straight forward, but the pressure distribution aspect of the modifications are CRITICAL. This design will only off weight, alowing the patient to walk after the acute phase is healed.
You will have to accomodate the leg length discrepency (long to the affected side because of the offlaoded position) by adding a shoe raise to the other side. If you do not, the patient will likely catch their toe during swing as the affected side is now longer than the contra side.
If you have any questions feel free to contact me.
Greg Williscroft BPe, CPO (c)
Alberta Children's Hospital
Neurosciences Department
-----------------------------
Check out the PRAFO with the available PSS addition. You should be able to find information on their web site or additional information by calling them and speaking to one of the practitioners.
Bill DeToro CO
-----------------------------
UCBL has worked well for me in the past, with a good grip on the calcaneus.
Gary A. Lamb LPO, CO, FAAOP
-----------------------------
Check into the PRIZM sock and Micro Z Mini for pain, healing and increase in circulation.
-----------------------------
I have very good feedback from calcaneal fracture patients wearing custom made silicone insoles.
Karlo Obrovac MD
-----------------------------
PTB un-weighting AFO
Eric O'Guinn CPO
-----------------------------
A true calcaneus fracture, not a contusion, may extend into the subtalar joint. There are many types of calcaneus fractures. If it extends into the subtalar joint then reducing the motion at this joint will help. One option is to lock it into pronation and therefore limit total motion, just the opposite of what one might tend to try. Many times there is a leg length discrepancy that results, this may also require recognition. If acute, unloading and preventing further collapse would be nice, with difficulty a PTB AFO could help. Again depending on the fracture pattern, a heel lift to reduce the pull of the achilles may also be of value. The options I just tossed out are a little bit on the rare side so I thought they might be of additional interest.If your having trouble with options, having the doctor explain the x rays could be a good practice builder and may allow visualizatin of the fracture pattern to aid in treatment. If the patient continues to suffer, isolated subtalar joint fusion may be warranted instead of orthotic management. CT imaging could then be of value?? Most docs dont like that type of surgery and will steer clear even though that may be the only thinbg that helps. lots of guessing on my end regarding the pathology of this particular patient.
Mike Saldino, DPM,CPO
------------------------------
I have a design that works well for me. I have put together an 8 minute video to illustrate my technique. If you or any of your collegues have time to watch I'd love feedback. I have also sent this video to the Listserv. Kevin
<URL Redacted>
Kevin C. Matthews, CO/LO
------------------------------
Depending upon the fixation, stability and the type of fracture, different orthotic interventions are appropriate.
We use Duraflex Orthoses trimmed like and SMO at the hindfoot and a 3/4 length FO distally for stable fractures that do not require ORIF. The Duraflex provides some shock attenuation and the orthosis has proven to be quite effective. It also fits into a variety of footwear easily.
For the less stable and post ORIF fractures we use a SAAFO (Short Articulating Ankle Foot Orthosis). This orthosis incorporates TPE construction with a jointed ankle, heel cup, plantar shock absorbing padding and an anterior shell. The ankle joints can be limited motion at first using the excellent USS Ankle Joints from Ultraflex. This orthosis protects the heel, cushions it, but also encourages extensibility of the Achilles to prevent shortening. It also stabilizes the talo-tarsal joints and keeps the midfoot and forefoot aligned appropriately throughout the step to reduce the stress on the hindfoot and allow healing to occur.
Jim Rogers, CPO, FAAOP
-------------------------------
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Keven Dunn (MSPO Student), “Replies to Calcaneal Fracture Orthosis,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/230549.
