Custom Dynamic Orthoses and Physical Therapist Intervention for Bilateral Midfoot Amputation: A Case Report

Abstract

Objective Partial foot amputation (PFA) is often associated with decreased mobility and function. Recent advances in custom carbon-fiber dynamic ankle-foot orthoses (CDO) have improved gait, pain, and function following musculoskeletal trauma and may benefit individuals with PFA. However, limited information is available related to CDO use outside the military. The purpose of this case report is to describe the course of care and outcomes of a civilian provided CDOs after bilateral transmetatarsal amputation. Methods (Case Description) A 72-year-old man had a blood-borne bacterial infection (septicemia) of unknown origin at 68 years of age, developed limb threatening necrosis of the hands and feet, and received bilateral transmetatarsal amputations with skin grafting. The patient initially used foam toe fillers and cushioned shoes but was functionally limited and experienced recurrent ulceration. He was fit with bilateral CDOs 39 months after amputation and completed device-specific training with a physical therapist. Results After 1 week with the CDOs, ankle ROM during gait was reduced, but greater than 40% increases were observed in bilateral ankle plantar-flexor moments and ankle plantar-flexion push-off power compared with the toe fillers. With additional therapist-directed training focused on gait and activity performance, ankle plantar-flexor moments and plantar-flexion push-off power further increased when compared with results after 1 week of CDO use. The patient reported marked improvement in quality of life with the CDOs due to improved walking ability on level and uneven terrain, marked improvement in confidence, and reduced pain. Conclusion This case reflects the lessons learned and outcomes of a civilian using bilateral CDOs after bilateral transmetatarsal amputation and with poor skin quality. The results from this case study suggest that carbon fiber CDOs and focused training by a physical therapist can result in improved gait biomechanics, mobility and quality of life.

Short-term effect of a carbon fiber custom dynamic orthosis and integrated rehabilitation on self-reported physical function, pain, speed, and agility in civilians

“…[3][4][5][6][7] Limited data are available to suggest similar outcomes can be obtained in a civilian setting. 8 In 2013, a novel CDO and complimentary care program was developed to meet the needs of civilians. Previous research has shown a beneficial effect of a sports medicine-based rehabilitation program in conjunction with CDOs, resulting in improved performance and reduced pain.…”

Orthotic and Prosthetic Options after Diabetic Foot Amputation

“…의족을 사용함으로써 기능을 보상하고 절단으 로 인한 미용적 문제를 해결하여, 신발을 정상적으로 착용하고 편안 한 보행 형태를 보전할 수 있다 [39,40]. 입각기 후반 기능을 보상하기 위해 단하지 보조기 형태의 의족을, 원위 중족부 압력을 감소시키기 위하여 흔들의자바닥 형태의 바닥재를 흔히 사용한다 [40,41].…”