Footwear options / modifications / inserts / orthotic / assistive device
th; O’Sullivan 5 ed. p.1214-1217
; On all shoes, Blucher-type opening with shoestrings or a velcro? closing are better than the “V” or “Bal”
type opening. Blucher allows more “give” across the dorsum of the foot accommodating changes in foot
Non-healing (plantar) ulcer If infected: NWB initially if ulcer gets pressure during gait
; Assistive device when WB (more than a cane)
; Removable walking cast / walking splint (half of a
bivalve) that allows dressing changes
Normally healing (plantar) ulcer ; If no edema and no infection: Total Contact Cast
(TCC) rocker bottom to relieve forefoot pressure. Stop
when re-epithelialization occurs.
; Walking boot/solid AFO.
; Assistive device to reduce pressure, protect opposite
Foot deformities (MTP volar subluxation ; Deep wide accommodative toe box, ?” beyond toe, with claw toes/cock up toes, or hammer plastizote insert custom molded to foot with beveled toes,) cut-out zones as needed for plantar pressures, no shoe (Secondary to DM, RA, neurologic seams on contact areas. Metatarsal Pads, proximal to
deficit, with resulting weakness or heads.
destruction of intrinsics: lumbricals & ; Rocker bottom or steel T-shank for chronic pressure or interossei pain at MTP. Metatarsal Bar (applied to outside of Hallux valgus (pes planus, RA) sole)
toes amputated / transmetatarsal ; Rocker bottom
amputation ; Plastizote conforming shoe filler in toe end of shoe to
stabilize ant shift
; Steel shank in sole of shoe with plastizote shoe filler
might also be suggested, depending on state of
remaining foot. Rocker bottom is more protective.
Charcot arthropathy NWB is rarely realistic, so PWB with an orthosis and
- secondary to diabetes, idiopathic ambulation aid is typical
peripheral neuropathy, alcoholic ; TCC
neuropathy, Hansen’s Disease (leprosy) ; (custom) Arizona? AFO: This is actually a product
line, not one specific AFO.
http://www.aafp.org/afp/20011101/1591.html ; (custom) Charcot Restraint Orthotic Walker (CROW)
is a solid AFO + Boot: polypropylene shell, leather
lined, plastizote insole, bivalved, with rocker bottom.
It provides maximal immobilization.
Rocker bottom (below)
1. Biomechanical principal: during heel rise and toe off, the ground reaction force is shifted
2. Relieves pressure to painful met heads. MTP ROM is lessened during propulsion.
3. Helps provide push off and forward propulsion for persons with reduced ankle motion.
4. Necessary if toes amputated.
(external) Metatarsal Bar (below): similar purpose and function as rocker bottom.
Charcot Restraint Orthotic Walker (CROW): solid AFO + Boot: polypropylene shell, leather lined,
plastizote insole, bivalved, with rocker bottom. It provides maximal immobilization.