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Footwear for spina bifida patient

Discussion in 'General Issues and Discussion Forum' started by LaurenC, May 6, 2014.

  1. LaurenC

    LaurenC Member

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    I have a patient (male, late 20s, spina bifida) recovering from bilateral hallux amputations. His impaired renal function caused oedema in his feet, which rubbed on his shoes and resulted in ulceration.

    He step transfers only (otherwise mobilises via a wheelchair) and says he needs to wear basketball-style footwear to provide ankle support when transferring.

    My ideal shoe would be high ankle cut/basketball–style with neoprene upper and Velcro straps.

    Can anyone suggest an off-the-shelf shoe with the above features that would be worn by a 20-something-year-old? Also, would you issue a pair of customised EVA orthoses to accommodate the defect of the amputations?

    Many thanks,
  2. footplant

    footplant Active Member


    I assume that he has neuropathy in both of his feet? If that is the case do you think he is at continued risk of ulceration? What do his feet look like structurally?

  3. Boots n all

    Boots n all Well-Known Member

    Lauren l cant see your clients foot or his measurements and on that basis its a little hard to say what will or wont work.

    Mostly of these guys are very deep and broad, an off the shelf product is not going to work, you are going to need to go custom or customised at least to relief the pressure.

    Also based on my experience with these clients pressure stockings are out, is that correct for your client or can we get the swelling down to improve his chance to fit into mainstream footwear?

    Get your client off to the nearest Pedorthist for an assessment, maybe even tag along yourself.

    If an existing runner/boot cant be modified enough at least present what you want the end product to look like, bare in mind it needs to represent the shape and need of the foot.

    And yes l would consider and EVA TCO, again l cant see the foot to know, but it would be worth considering
    Hope that helps.
  4. LaurenC

    LaurenC Member

    Thanks for your replies footplant and Boots n all.

    Yes, the patient has bilateral neuropathy from the ankle distally and is at risk of future ulceration.

    See attached photos regarding foot structure (the angle of the photo makes the left foot appear more swollen that it actually is).

    His feet are not that swollen they can't fit into off-the-shelf footwear. The oedema is now more controlled than it has been in the past. I agree custom made shoes are definitely the way to go, but the patient is on a disability pension and as I have other patients waiting over 12 months for government funding for their shoes, I was hoping there might be an off-the-shelf solution.

    Thanks again for your interest.

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  5. Boots n all

    Boots n all Well-Known Member

    An EVA TCO is a definite and l would think he would qualify as urgent, meaning he should get priority for funding, would he come under HARP funding from the hospital as he is at risk?

    We have just had a cluster of approvals this week from SWEP, so give them a ring it cant hurt.

    There is a double depth off the shelf that might work but the seams may just be in the wrong place considering the wound/scare area?

    Best bet is as l said before, refer him off to a Pedorthist.

    As a side note, the funding cluster we have just received range from waiting 13-22 months:hammer::bang: Who plans to get footwear even 3 months ahead of the need?
  6. Darren Pereira

    Darren Pereira Welcome New Poster

    Hi Lauren
    If your client lives in Melbourne, I would strongly recommend referring him to the Royal Melbourne Hospital Developmental Disability Clinic first. This is a multidisciplinary clinic for adult clients with Spina Bifida, Hydropcephalus, etc which provides specialist consultation as they transition from paediatric facilities to adult health care.

    The clinic is staffed by a diverse group of medical/allied health staff and provides various services including:

    Specialised clinical assessment and intervention
    Regular review to monitor health needs
    Liaison and referral to relevant services
    Sexual health counselling
    Seating and posture assessment
    Support in accessing local community services
    Continence advice

    Your client appears to be quite atrophied in the lower limb and it also appears that he has had multiple foot/ankle surgeries from your photos. The RMH clinic will assess his lower limb muscle strength and joint alignment to determine if this has also contributed to the alignment and position of the foot in the shoe.

    I hope this helps.
    Thanks Darren
  7. Dr. Steven King

    Dr. Steven King Well-Known Member


    How about using a light weight combat boot with a zipper added to the laces?

    Reasons, it is high top that offers greater scuff resistance and looks tough which may help the self image of this young gentleman.

    How about using Dynamic Carbon Fiber AFO's that will help replace the loss of toe strength at the MPJ and assist with keeping the ankle at 90 degrees. It will need a good padded top cover and arch support (ie an orthotic on the orthotic).

    This combination has worked better for my Spina Bifida patients than the plastic and foam systems. It is fun to see the improvement in their walking with the extra force produced from the composite materials and leveraging up the leg.

    You could also modify a pair of wrestling shoes instead of basketball shoes because they offer a high top with less weight and they look cool.

    Dr. Steven King
    Podiatrist and Pedorthist
    Maui Hawaii
  8. LaurenC

    LaurenC Member

    Thanks Darren for the recommendation of the RMH clinic. The patient has been under the care of another health service in Melbourne throughout his life where the clinics are also multidisciplinary although I'm not sure to what extent...it is though, timely to reconsider his options of future treatment and a good suggestion. Cheers.

    Mahola nui loa Dr King! Your advice on footwear and orthoses has certainly provided some food for thought and includes ideas I think the patient would definitely consider.

    Many thanks to you both for taking the time to reply.

  9. footplant

    footplant Active Member

    Hi Lauren,

    Have the 1st metatarsal heads also been removed? If that was the case and he was ambulant I might be thinking about pre-fabricated carbon fibre AFOs (underneath foot orthoses and most likely requiring therapeutic footwear to accommodate). However in this case he is step transferring only. I would want to see what his foot and ankle is doing in weight bearing when he transfers... that would guide what kind of forces may be needed to stabilise the ankle during transfers.

    Thanks for sharing this case.

  10. LaurenC

    LaurenC Member

    Thanks Josh...duly noted.
  11. Dr. Steven King

    Dr. Steven King Well-Known Member

    Mahalo Lauren,

    Thank you for posting an interesting case.

    Could you please give us feedback on his treatment choice and results, when can can?

    A Hui Hou,
  12. LaurenC

    LaurenC Member

    ‘A‘ole pilikia Dr. King...I'll try to get an update down the track but I work only in the hospital inpatient setting and once he's discharged from hospital and referred on, I'm unlikely to see his progress.
  13. Dr. Steven King

    Dr. Steven King Well-Known Member


    That is unfortunate.

    We learn alot from the follow up and continuation of care from the sucesses and hopefully more from the failures of our treatments.

    Keep up the caring work,
  14. caf002

    caf002 Active Member

    Dear Lauren,
    I have been following this thread with interest.
    You may be interested in registering and/or presenting at our International Pedorthic Symposium, in Geelong, in September this year. Please visit our website www.pedorthics.org.au for details.
    With kind regards
    Casper Ozinga C Ped.
    General Manager
    Pedorthic Association of Australia
  15. LaurenC

    LaurenC Member

    Thanks Casper...not sure I can contribute much but will keep it in mind.
    Cheers Lauren

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