Custom foot orthotics following treatment of calcaneal fracture

I have treated many patients post calcaneal fracture. There is a trick to their care. After the final cast is removed, and the patient returns to weight bearing, there is invariably swelling on the affected side. I start with a type of temporary orthotic, and follow every 3 weeks. I will often change or at least reheat and remold the temporary device at each visit BECAUSE IT IS TOO LARGE! As the swelling decreases, temps are changed (or remolded) until their is no visible physical change over a 3-6 week period. Making custom devices once this "end of residual swelling" point is reached provides for excellent long term outcomes.

Howard

 

I agree with Howard. It is also important to check the range, direction and quality of motion of the stj. Due to the tendency for pronatory spasm of the foot, we have often used orthoses post calcaneal fracture to apply a supination moment to the rearfoot in order to increase the stj supination rom. Obviously at lot depends on the nature and severity of the fracture. Sometimes it is necessary to use a pronated cast and use serial casting and orthoses to progressively restore supination rom, when possible (per Merton Root, who did not always advocate neutral position casting or neutral position orthoses as some believe).

Jeff

 

I've long wanted to see this measure pre and post orthosis in other pathologies. I've theorized that you would see increased ankle power with orthotic use.

It's remarkable that post calcaneal fracture that you can see improvement with orthosis. When I first read the abstract, and saw displaced intracalcaneal fractures. However, some of those could not involve the joint. If the fractures did involve the posterior facet, or the posterior facet "sunk" into the rest of the calcaneus, then I would think that orthotics would be less effective, because the STJ would probably have no motion and hurt just to bear weight. I wonder if the paper classified the fractures.

Eric

 

Very good point Eric.

Jeff

 

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