transmet recurring issue
Gary Berke
Description
Collection
Title:
transmet recurring issue
Creator:
Gary Berke
Date:
8/29/2011
Text:
Dear list,
After reading once again the work of Dillon and the Academy SSC on partial
foot amputation, it is clear that the optimum treatment for a
transmetatarsal amputation must include an anterior shell up the tibia if we
are to offset poor late stance phase moments. For the past few years, we
have been using a custom insert (toe filler) with slight relief of the
plantar distal metatarsals in conjunction with a blue-rocker AFO. This
seems to be stiff enough (visually) to support the patient at late stance
and provide improved gait.
Unfortunately, many of the transmet patients we see (and slightly higher
levels too) tend to get impingement on the lateral upright of the blue
rocker, usually distal to the base of the 5th with the widening of the
metatarsals. We have tried other manufacturer's prefabricated carbon AFO
with medial upright but the toe plate seems too soft to provide adequate
kinetic improvement.
My question is: Is there an alternative to the lateral upright that is
stiff enough and if not, how are you all managing these patients to provide
improved gait parameters and maintain some level of acceptable cosmesis?
Thank you so much in advance.
Gary
Gary M. Berke MS, CP
Adjunct Clinical Instructor,
Department of Orthopaedic Surgery
Stanford University
This email communication and any attachments may contain confidential and
privileged information for the use of the designated recipients named above.
If you are not the intended recipient, you are hereby notified that you have
received this communication in error and that any review, disclosure,
dissemination, distribution or copying of it or its contents is prohibited.
If you have received this communication in error, please notify this office
immediately by telephone at (650) 365-5861 and destroy all copies of this
communication and any attachments. Thank you.
After reading once again the work of Dillon and the Academy SSC on partial
foot amputation, it is clear that the optimum treatment for a
transmetatarsal amputation must include an anterior shell up the tibia if we
are to offset poor late stance phase moments. For the past few years, we
have been using a custom insert (toe filler) with slight relief of the
plantar distal metatarsals in conjunction with a blue-rocker AFO. This
seems to be stiff enough (visually) to support the patient at late stance
and provide improved gait.
Unfortunately, many of the transmet patients we see (and slightly higher
levels too) tend to get impingement on the lateral upright of the blue
rocker, usually distal to the base of the 5th with the widening of the
metatarsals. We have tried other manufacturer's prefabricated carbon AFO
with medial upright but the toe plate seems too soft to provide adequate
kinetic improvement.
My question is: Is there an alternative to the lateral upright that is
stiff enough and if not, how are you all managing these patients to provide
improved gait parameters and maintain some level of acceptable cosmesis?
Thank you so much in advance.
Gary
Gary M. Berke MS, CP
Adjunct Clinical Instructor,
Department of Orthopaedic Surgery
Stanford University
This email communication and any attachments may contain confidential and
privileged information for the use of the designated recipients named above.
If you are not the intended recipient, you are hereby notified that you have
received this communication in error and that any review, disclosure,
dissemination, distribution or copying of it or its contents is prohibited.
If you have received this communication in error, please notify this office
immediately by telephone at (650) 365-5861 and destroy all copies of this
communication and any attachments. Thank you.
Citation
Gary Berke, “transmet recurring issue,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/232895.