Responses Perspiration with CROW

Responses Perspiration with CROW

Cheryl Lewis

2/28/2013

Thanks to all who responded - once again the esteemed members of this list came through.
 
Below is a list of responses - I am planning to suggest the patient try the Arrid X-Dry aerosol light application on a clean leg at night and then using the x-static Coolmax AFO Socks during the day. I couldn't remember the brand of Antiperspirant that is most effective - and someone suggested it specifically. My patient is only 40y.o. , very cognitively aware and has no skin issues so I think this will work well for her.
 
Here are the other suggestions:
 
try looking at knitrite, maybe give them a call. Usually they have items like that which aren't in the catalogue as sales for that item are small. Good luck

 
 

SmartKnit makes AFO-interface socks that wick moisture away from the skin. Many insurances cover them (usually only 3 per side per year and Medicare doesn't cover them).
 

I usually drill holes in both the anterior and posterior shells
to assist in air flow. The holes of course need to be placed so as not to
compromise orthosis strength. We also use long Coolmax socks that tend to
wick moisture away.
 

There have been many discussion about ventilation holes in CROWS. The air
flow is needed, but you certainly don’t want small rocks and debris falling
inside. Here in Arizona we do usually drill very small 1/8 holes....many
of them, to allow air flow. We have also suggested changing socks
regularly.
 
I use knit rite x-static socks with silver lining. You get the moisture control and bacterial control. Sps carries them
-------------------------
 

My only suggestion is based on this same problem with my prosthetic
patients, that use silicone/gel liners... it may or may not be suitable
due to risk of skin breakdown with additional material in the CROW,
however I have had good success using either nappy liners, or breast
feeding pads. These don't stop the sweat, but act as a good wick to
absorb the moisture and are just disposed of once removed at the end of
the day (or more frequently if required).
 
Like I said, this may or may not be suitable, just a thought.
 

I have made multiple crow walker boots for our veterans. Some have been
for patients that have profound lymphedema. Substantial body fluids
weep with the compression of the crow. To prevent / reduce the foot from
the constant exposure to moisture, the veteran is supplied with multiple
synthetic sock ply. The synthetic socks don't soak up moisture but wick
it through the gapping of the fabric weave. Multiple layers of socks are
eventually added to accommodate the volume change. These synthetic socks
are often purchased through Cascade or SPS.
 
Secondly, drain holes had to be drilled through the bottom of the boot,
and the I had to fenestrate the remainder of the boot to allow for the
air flow pumping effect, you previously mentioned. The bottom of the
boot is usually quite thick, preventing moisture from coming up into the
boot when ambulating through a shallow puddle.
 
Hope this helps.
Look into swiftwick at swiftwick.com ask for John, he is very knowledgeable. They have wicking products for amputees and regular socks that work well. I have a real sweater patient and they helped and I actually use the socks myself and no problems with sweat.
Good luck.
-------------------------------
Try cabellas for long sox

Hey,
I have tried drilling wholes all over the front and back. This helps some but I have not found that it completely fixes the problem. Please let me know if you here anything better.
I tried calling your office just now and found you will be only open after I have to leave.
My thoughts on the situation you describe would be using wicking socks. Have you contacted Vittoria Phoenix? They have some wicking socks. 519 426 0046
Orthoactive on Schoolhouse Rd in Coquitlam BC might also have what you need.
Another Pedorthist I would talk to would be Phil Watson. He is at Ambulatory Footwear near Hamilton. Quite simply that man has been a help to many of us.
 

Try the SmartKnit seamless AFO socks from KnitRite. I've had several patient
report improvement when using them. Good Luck

Does anyone have suggestions for perspiration inside a CROW? I have several patients who are experiencing extreme sweating even in winter weather - I am concerned for when it warms up! I have suggested they change their socks frequently and to take off the front of the boot if they are not walking. For the most severe case I suggested trying clinical strength anti-perspirant on the leg to stop the sweat ( I have some reservations about this but the problem is severe!)

I know eventually the sweating should calm down once the leg gets acclimated to the warmth and I know that added holes will prevent the airflow pumping effect when walking - I am wondering if there are any specific design changes people have tried to improve the situation?

Does anyone have a source for long wicking socks or any other suggestions?

As always, the feedback from the members of this list is very much appreciated! I will post responses anonymously.
At minimum, use the silver fiber socks from Knit rite to reduce bacterial
growth inside the boot.
 
Also the anti perspirant, make sure its non-scented
Knit Rite AFO Socks
You might try a silver sock inside the walker .pulled up and over the top. Silver helps with bacteria and fungus but is also thermal dynamic. The x static version is also very good at wicking moisture up and out of the walker.
there are individuals interested in hygroscopic interfacing. I can try and
get them in touch with you if you wish.
Perspiration is an ever growing problem for Amputee's as we use more and more non-breathable interfaces and the amputee's are becoming more and more active. You're right, usually, this reduces with acclamation though not always. Use of anti-perspirants is a concern and I usually advise my patients not to put the anti-perspirant directly on their residuum; but on their hands first then on the residuum and to use it the night before so that it has a chance to work. Alps has developed an anti-perspirant for use under their liners that seems to work and can be obtained through Orto-ped. Here is a link to Knit-Rite who make a Neuropathic Boot Interface which may be what you're looking for, <URL Redacted>
There is an article in the December 2012 edition on pages 40-42. It deals
with 3 different methods for amputee/socket sweating that applies the same
to an orthosis user. We are the ones promoting Alum as a solution, since it
is the cheapest and for us the most beneficial. The use of socks made of
Coolmax will also minimize the sweat and odor issues.
 
 

Cheryl Lewis BSc(HK), CO(c)
Certified Orthotist
Owner, CK Ortho Inc
Ph 519-436-9670
 
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