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Cam walkers and such, more efficacious in treatment of forefoot lesions than rearfoot?????

Discussion in 'Diabetic Foot & Wound Management' started by markjohconley, Oct 8, 2010.

  1. markjohconley

    markjohconley Well-Known Member

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  2. cwiebelt

    cwiebelt Active Member

    thats a good question!

    just thinking to where we use cam boots or simular.
    It has been mostly for lessions on the plantar forefoot or for active charcot joint in the midfoot area.

    I know thre are orthopedic cAM boots with an adjustable ankle joint to adjust dorsiflexion at the ankle. ( i dont think this is what you mean however)

    i have found there are significant diffrences in diffrent cam boots on the market in particular width around the ankle. Particulary with client who have larger legs to try and fit something on them.
    there is always the issue of compliance, because it is removabe.

    i will be ken to see waht the comments are ?
  3. Orthican

    Orthican Active Member

    We utilize walking boots all the time. Active charcot and forefoot ulcerations are managed very nicely due to the rocker action reduction of GRF but it is more about how the boot is utilized. The critical thing to remember is that your goal is pressure downloading. So the inlay of the boot must be custom and it must be soft. This may go against some of the "hard orthotic" classical thinking but it works very well. We custom wrap intuition foam right on the patient in 12 mm thickness to give the initial shape and remove slightly material at the area of ulceration to give even pressure distribution and avoid peaks in pressure at any point of the plantar surface. Dilligent and frequent follow ups are an absolute must. Very high success with this. For heel/hindfoot we use the DARCO wound sandal and provide similar inlay to re distribute pressure.
  4. cwiebelt

    cwiebelt Active Member

    does anyone use felting to offload the foot as well as using the Cam Walkers?

    i was just wondering if there is any relaible information on the effectiveness of padding
    and some guidelines?
  5. Petcu Daniel

    Petcu Daniel Active Member

    I think it's important to specify the principle of cam/rocker design and the variables of biomechanical assessment. Even if it is from 1991, I found interesting the article MG Hullin and JE Robb, “Biomechanical effects of rockers on walking in a plaster cast,” J Bone Joint Surg Br 73-B, no. 1 (January 1, 1991): 92-95 [ http://web.jbjs.org.uk/cgi/reprint/73-B/1/92.pdf ] because of its conclusion: "Most of the commercially available rockers tested had a deleterious effect on the biomechanics of walking in a cast and only two permitted a reasonably efficient walking pattern.". Of course, meantime, probably, the technical solution for rocker design has changed

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