Accomodative Orthotic Prescription

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Hi Everyone,
Would appreciate some advice from those whom often make customised accomodative orthotics to geriatric patients and/or the arthritic foot.

In such cases I have been often using off the shelf devices and modifying them but I have a patient whom this just isnt going to work for in terms of shoe fit and comfort. Furthermore she wants to go down the line of something customised.

In terms of her needs; Fat Pad atrophy is the worst Ive seen; metatarsal bones are incrediably prominent; particularly the 1st. Her arch is quite collapsed. To add to it she going to be 90 and her gait is slow, painful and awkward. Her shoes are sandal type with a heel cup due to rubbing on the apex of the digits. Thus I am also concerned about the bulkiness of an accomodative device.

Im thinking a soft cork material is best for the shell. Maximum fill in the arch; as this would lower the arch? Spenco covering. I am thinking of some ppt metatarsal bar or cut out for the 1st met in particular but am not quite sure. I am concerned that a soft ppt metatarsal bar under mets 2-4 would create an unstable gait.

Any advice would be appreciated
Thanks

 

Hi Jo Jo.

Semi weight-bearing cast/foam impression mold/digital scan
total contact device, minimal cast dressing
low density eva or thermocork shell
1-5 poron/ppt met bar immediately proximal to heads
3.2mm poron pmp with u to 1st.
1.6mm poron shell liner to toes
3mm plastizote t/c to toes.

Good Luck.

Scott Shand
Epione Orthotics ltd

 

I'd just use a Duosoft myself.

 

Do you think you will get your custom orthosis into the existing sandal?

For a lot of these clients if you made the TCO to match the foot, the footwear is not wide enough to accommodate it at the MPJ's.

With out seeing of course, but sounds like custom made footwear would be part of the equation

 

Duosoft or similar is the quickest and cheapest

I tend to use direct milled LD EVA with the met bar as part of the shell. A 1-5 sink/trench which can also be accurately done with the CNC machine. Infill the sink with Poron 92 and top cover with Spenco/Pz /ULD Nora depending on how durable it needs to be. Sometimes if I am trying to give a lot of cushioning I use a 6mm Poron 92 midlayer with a 1mm EVA cover.

The extra cushioning makes accommodation in the shoe difficult - a neoprene vamp shoe is lightweight/protects the feet slightly from the elements and can be very comfortable.

By the apex of the toes, do you mean the toe tips or the dorsal surface of the IPJs? If it is the IPJs then neoprene vamp shoes are great. There are also ranges of shoes with stretch "leather" vamps but it depends where you live as to whether the information I give you will be of any use

Good luck

Robin