8/30/2011 6:28 PM
I see a fair amount of high risk diabetics in the office, as well as partial foot amputation patients. This morning's patient is a partial 5th ray amputee with a Charcot collapse through the midfoot on his contra-lateral foot. His complaint was that he felt as if he was going to roll his ankle (inversion sprain) while wearing his accommodative inserts, but more so when he was without them.
Since his 5th metatarsal base is still persent, and he is neuropathic, I didn't want to overload the remaining 5th met and cause further problems. I added a full length valgus wedge (yes, he has great STJ ROM) using Korex to his existing custom accommodative, multi-density insert. The insert already has a dell in the region of the 5th met base to accommodate him. Anytime I modify a neuropathic patient's orthotics, I emphasize careful skin checks, several times daily, for the first 1-2 weeks to ensure that calluses/blisters/ulcers aren't forming.
We have a long hallway for gait exams and orthotic "test runs", and the patient happily walked up and down the hall without his cane. He reported immediate relief from the feeling of rolling his ankle.
No modification was completed on the contra-lateral device today.