Good Afternoon!
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Have a situation on which I'd LOVE some input.
Pt is 49 y.o. male, 6'5", 225 lbs.
Has Hx of microvascular disorder that mimics that of DM neuropathy (although Pt indicates that hyperbaric chamber therapy has helped greatly with this).
Very low fat pad on plantar foot.
Hx of ulceration on 5th MTH bilateral:
Right 5th MTH resected. Toe still present.
Left osteomyelitis in 5th MT resected to midshaft + 5th toe.
Current open ulceration at Left 4th MTH ~ 5mm open (10-15mm ttl including surrounding hyperkeratotic buildup).
I met with the Pt and his DPM today to discuss how to proceed orthotically. He's used trilaminar inserts with MT bars / relief pockets since '07. Has been casted using foam box as well as slipper cast with not significant difference in results.
NWB Pt exhibits a very high arch with significant inversion bilaterally.
Rearfoot to forefoot on the ulcerated side with pt prone shows a FF varus (flexible).
WB Left heel everts to compensate for the FF varus.
In designing the new insert to into his shoe (with a rocker sole), what suggestions could you make with regard to: intrinsic / extrinsic mod's, materials, would allowing the 1st to drop into a pocket help divert some pressures off?
Any help would be greatly appreciated - and any additonal information I can provide let me know.
Thanks !!
Stephen
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Podiatrists prescribing surgical/orthopaedic footwear
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