Off loading for Acute Charcot + Falls Risk

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Hi All,
If anyone can offer some advice in relation to offloading alternatives for a patient with diabetes, p.neuropathy, heart failure, adequate peripheral vascular status, previous amputation of right hallux to mid shaft of 1st met and 2nd toe (2011). He has very poor balance and OA of left knee, uses walking stick for ambulation and has had 2 falls in past 12mths. He is on warfarin. Diabetes is reasonably well controlled on insulin (most recent HbA1c 7%), recent BSLs stable, no fevers/ chills, seems systemically well. Apparently, inflammatory markers (ESR/CRP) were elevated last week (not sure what the values are - i dont have access to blood work).
He has a current chronic ulceration plantar 4th MTP, present since June. Today, there is probe to bone, wound diameter 6mm, clear serous exudate, no malodour. Patient reports it has not worsened recently, and volume of exudate is stable.
He has an acute charcot with dislocation 3/4 MTPs - 5degree temp difference, erythema and oedema to mid-calf.
I have ordered plain X-rays, with view to MRI.
Just wondering if you have any suggestions for pressure deflection in this type of patient who is falls risk. He reports in the past he has tried a CAM walker and was too unstable to feel safe ambulating in it.
Your assistance with this case would be much appreciated.

 

A wheel chair

 

Hi,
If he really can't manage with a device that allows ambulation then a TCC / aircast + wheelchair really is the best way to go.
If he is more unsteady with the height difference rather than dangerous for falls because of the rocker / restricted movement then an evenup on the other foot may help a bit, especially if it's along with a 4 wheeled walker or Zimmer for added stability.