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Hi there I have a diabetic patient with a neuropathic valgus foot type with an ulcer on the plantum of his 5th MPJ. He has recently had ABs and a angiopasty which has helped some what however now I am left with the task of effectively deflecting the weight from his large shallow ulcer. Any suggestions would be appreciated.
OTS orthotic with a 2-5 valgus pad, winged plantar metatarsal pad, rocker bottom shoe, surgical boot which is best if any?

 

Gold standard is a TCC until ulcer healed then look at a mixture of footwear, orthoses + or - surgery

 

Can I use a total TCC on an ischemic foot ? and any suggestions for best way to defect weight for a valgus foot type?

 

Hi

I would go with a total contact cast-taken off and reapplied weekly. Can you do it or do you have anyone locally that can do them?

Steve

 

Will try and find out maybe they do it at the Tweed hospital, thanks so much for you advise, now I have a bit of a plan, was thinking in the long term to do an ots orthotic with a winged 2-5 valgus but will try to source TCC first-thanks.

 

Often in the "short" long term ie:6-12 months, these patients can do quite well in a CROW, as it will fit like a cast once swelling settles, but is removable, and while expensive to make initially, will work out cheaper than weekly casts over time.
And most acute hospitals will have staff capable of applying a TCC.