Orthoses for diabetes patient with paralysis of popliteal nerve

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Hello,

I would like to read more about the footwear and foot orthoses used for a person with a paralysis of the external popliteal sciatic nerve for 20 years [right foot] and diabetes discovered for 1 month ! This person has developed an ulceration in the area of 5 th metatarsal shaft. Could you be so kind to indicate to me some resources about the general principles and technical solutions for treating these pathologies ?

Sincerely yours,
Daniel Petcu

 

Re: diabetes & paralysis of the external popliteal sciatic nerve

I am not sure there is anything specific that needs to be done if there is a paralysis to the popliteal nerve. I would assume just any sort of foot orthoses and footwer to keep the foot in as close as possible to being in a plantigrade position is what is needed.

Neurological deformities are always the more difficult, as no two cases are the same.

Can you post of picture of the deformity?

 

Thank for yours answer ! I've attached 2 photos. I can send a short video with an Pedar pressure analysis ! Generally I've seen that the technical solution is an AFO or metal orthosis [constructed out of bar stock metal uprights of steel or aluminum with Klenzak-type joint - in "Rehabilitation of the Injured Combatant. Volume 2", Chapter 11 - Orthotics for the wounded combatant by Justus F. Lehmann]. One of my question is if there is any possibilities to avoid these kind of solutions ?

 

And here is a capture from a in shoe plantar pressure analysis with the contact moment on left foot [a pes cavus foot type] and the propulsion for the right foot.

 

Hello,

How do I have to judge the best right foot position in order to take the cast ? The right foot has a marked inversion position in static stance .

 

l think your client needs to be seen to by a Diabetic "at risk" clinic first then l would consider the following

Is there good ROM at the STJ? if so l would put the STJ in to neutral position and make a TCO out of EVA with a plaztazote cover, as for a shoe l would look at a lace Derby with soft leather and a firm heel counter with a double rocker sole aligned to the base of that nasty 5th.

Does this client have a LLD? l know there is nerve damage but there seems to be a lot of load to the lateral boarder of the right foot, is the right leg shorter? if so l would build up the sole to help balance that up, but the double rocker is a must.

But l would like to see that ulcer cleaned up a bit more first before l did any of this