Searching for Fabrication/Design Assistance

Searching for Fabrication/Design Assistance

Harry Phillips

10/4/2011

Case Presentation:

Patient has severe peroneal tendon dysfunction, beginning with rupture,
followed by repair and several rounds of infection, debridement,
revision of the surgery resulting in resection of all remaining peroneal
tendons. Essentially has little resistance into varus and uses metal and
leather AFO with lateral wedge inside shoe for protection. Requires the
use of steel toe boot for work. Failed polypropylene AFO over the long
term, although this provided great control, recurring cellulitis made
us leery to come in contact with his skin anywhere along the lateral
side. Has been using standard AFO for 7 months, during which time the
stirrup has pulled through the sole and out of the shoe several times,
as well as issues with the rivets pulling through the shoe and the added
reinforcements. This is primarily due to the fact that he climbs a
ladder on a truck with limited space for his foot, and therefore puts
all of his weight on his forefoot while climbing and this is beyond the
reach of the long tongue stirrup. The problem is compounded by the fact
that he uses a hose to wash cement off the boots multiple times a day so
the leather is damp most of the time.

 

Past inadequate solutions were to add an internal carbon plate the
entire length of the shoe and rivet the stirrup through this, change to
a heavy duty sole, increase the number of rivets to decrease the stress
on each, etc. At this time, I have him with the longest tongue stirrup
that Becker makes, I have reinforced both the inner and out sole with
carbon plates and have the stirrup sandwiched between, attached with
broad head rivets. This lasted only 4 months. I am hopeful that adding a
full length steel plate contoured along the inside of the footbed, so
that the stirrup could be attached through this, sandwiching most of the
sole, would prove more durable.

 

Question to the list:

Can anyone recommend a central fabricator that might undertake this
project? Can anyone recommend an alternative that might prove more
durable?

 

Thanks in advance for any assistance-I will post a digest in a few days

 

Harry Phillips, CPO for Carin Caves, CO

Triangle Orthopaedic Associates, P.A.

Orthotics and Prosthetics Department

120 William Penn Plaza

Durham, NC 27704

(919) 281-1814

Fax: (919) 281-1877

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