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I am prescribing a new pair of functional foot orthoses for a patient to control her faulty biomechanics. She suffers with Raynauds Disease, extremely cold feet to touch, chilblains in the winter, constant pain and numbness in the cold. She has requested I cover the orthoses with the "warmest material" or that which has the best insulating qualities. She is a teacher and often stands outside on duty but does wear thick soled footwear and battery operated heated socks but both these only help her a little. I know there are antibacterial specific topcovers but are there any thermal ones? Has anyone heard of any orthotic materials which would help keep this lady's feet as warm as possible?

 

Simples!

Good ole low density plasterzote is hard to beat. You have to make it a modular device and change the plasterzote every 3 months or so but that's easy enough. It's cheap as anything!

If you're looking for a castable material then therrox captures loads of air if you cook it at low temperature, you'll have to layer it and make it shank dependant.

Never seen battery power socks but battery power insoles are great and will hold a steady warm temperature. Should be enough by themselves!

Finally, make sure the boots have cellular soles. Solid rubber conducts heat rather too well no matter how thick!

There's a bunch of tricks you can use.

 

Thank you Robert. Your speedy advice is a great help!

 

Pod2010

Expanded polyethylene (Plastazote TM) has valuable insultating properties and as Robert says is cheap and servicable. There are different densities and thicknesses but medium density and up to 6mm meets most requirements. Other materials such as evazote TM have similar properties and offer a thinnner alternatives. There is no need to preheat the thermoplastic prior to use as it cold moulds against the skin whilist acting as perfect insultaion - ideal for managing peripheral ischaemia. In the dark a dim past there used to be commercially available PlatazoteTM shoes.

Any foot orthoses can be covered with Plastazote TM and I recommend double edged tape for preference. There is a knack to this which I can expend on if required. Twinstick type adhesive allows perfect separation of surfaces even after months of wear whereas cements are less helpful. I replace the Plastazote TM layer as and when required. In the past I have used different coloured Plastazotes as a colour code to myself to remind me there is a serial management involved. The added benefit of the expanded polyethylene is it will plastically deform (at 140 degree c) which gives an isotactic (waterbed) effect against the skin surface. This is idea when managing pressure lesions.

Plastazote TM inlays can be used alone and makes for a perfect cushion inlay which keeps the skin at a constant temperature. (also circumvents the need for traditinal padding).

toeslayer

 

Thank you toeslayer for your help!