Rehab doesn't always mean physiotherapy and occupational therapy.
This case study illustrates how a correctly-prescribed custom foot orthotic can mean the difference between normal walking and limping, even in a young, fit client.
An otherwise fit 28 year-old male self-referred for treatment to his left foot.
He had previously been involved in a motorbike accident in which his left heel had been degloved. Clinically, degloving presents as skin and subcutaneous tissue being removed from the hand or foot, in this case by a spinning rear spoke motorbike wheel.
The injury had been operated on successfully, and had healed uneventfully, but with almost complete loss of fatty padding from around the heelbone. This is not uncommon in degloving injuries which affect the back part of the foot. Invariably, as in this case, the client is unable to heelstrike or bear weight on the heel for any length of time. Heelstrike is an important component of normal walking, without which a subject will walk with an antalgic gait (limp). Older people who have lost flexibility in their knees and hips often demonstrate this type of gait very well.
Stock foot orthotics had been issued by the NHS. They were cushioned, but not supportive, and were ineffective in allowing the client to maintain normal gait.
Treatment.
Barefoot computer gait analysis confirmed lack of heelstrike during normal walking.
A plaster cast was taken of the left foot to accurately capture the heel-to-toe profile of the foot. A biomechanical foot orthotic was designed which featured a deep heel cup into which a substantial amount of soft cushioning was incorporated. This was to replicate and replace the natural fatty padding around the heelbone. A small heelraise was also added to the orthotic to replace limb length lost when the cushioning compressed during weightbearing. The orthotic shell was moulded from mildy flexible polypropylene, to which robust cushioning was added from the heel to the forefoot. Specific care was taken with regard to orthotic materials given the age, weight, and likely activity level of a fit young male.
Results.
Once the foot orthotic had been fitted the client found he was able to heelstrike with no discomfort. As his bodyweight moved forwards the foot was cradled and held in a stable position to allow normal push-off to occur. After a few weeks of using the orthotic the client was reassessed. His walking was normal with the orthotic. Without the orthotic he reverted to a laboured limp.
Conclusions.
Because there is no satisfactory surgical replacement of lost fatty tissue around the heel the client will have to wear this type of orthotic for life. The successful orthotic design could also be incorporated into a bespoke shoe or boot, resulting in a low-bulk alternative. This option may be more suitable for some client groups (eg young females) for whom the ability to wear fashion footwear some of the time may be important.
The sometimes quite considerable cost of custom foot orthotics and bespoke footwear should be carefully considered in clinical negligence and personal injury cases which affect the lower limb or foot.
More information or to contact me click here or click on my profile.
This case study illustrates how a correctly-prescribed custom foot orthotic can mean the difference between normal walking and limping, even in a young, fit client.
An otherwise fit 28 year-old male self-referred for treatment to his left foot.
He had previously been involved in a motorbike accident in which his left heel had been degloved. Clinically, degloving presents as skin and subcutaneous tissue being removed from the hand or foot, in this case by a spinning rear spoke motorbike wheel.
The injury had been operated on successfully, and had healed uneventfully, but with almost complete loss of fatty padding from around the heelbone. This is not uncommon in degloving injuries which affect the back part of the foot. Invariably, as in this case, the client is unable to heelstrike or bear weight on the heel for any length of time. Heelstrike is an important component of normal walking, without which a subject will walk with an antalgic gait (limp). Older people who have lost flexibility in their knees and hips often demonstrate this type of gait very well.
Stock foot orthotics had been issued by the NHS. They were cushioned, but not supportive, and were ineffective in allowing the client to maintain normal gait.
Treatment.
Barefoot computer gait analysis confirmed lack of heelstrike during normal walking.
A plaster cast was taken of the left foot to accurately capture the heel-to-toe profile of the foot. A biomechanical foot orthotic was designed which featured a deep heel cup into which a substantial amount of soft cushioning was incorporated. This was to replicate and replace the natural fatty padding around the heelbone. A small heelraise was also added to the orthotic to replace limb length lost when the cushioning compressed during weightbearing. The orthotic shell was moulded from mildy flexible polypropylene, to which robust cushioning was added from the heel to the forefoot. Specific care was taken with regard to orthotic materials given the age, weight, and likely activity level of a fit young male.
Results.
Once the foot orthotic had been fitted the client found he was able to heelstrike with no discomfort. As his bodyweight moved forwards the foot was cradled and held in a stable position to allow normal push-off to occur. After a few weeks of using the orthotic the client was reassessed. His walking was normal with the orthotic. Without the orthotic he reverted to a laboured limp.
Conclusions.
Because there is no satisfactory surgical replacement of lost fatty tissue around the heel the client will have to wear this type of orthotic for life. The successful orthotic design could also be incorporated into a bespoke shoe or boot, resulting in a low-bulk alternative. This option may be more suitable for some client groups (eg young females) for whom the ability to wear fashion footwear some of the time may be important.
The sometimes quite considerable cost of custom foot orthotics and bespoke footwear should be carefully considered in clinical negligence and personal injury cases which affect the lower limb or foot.
More information or to contact me click here or click on my profile.
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