Pedorthists managing patients with
partial foot amputations strive to achieve three main goals:
restore mobility, assist in ambulation and prevent skin breakdown, according to
Don Pierson, CO, CPed, vice president of operations for Arizona AFO.
Pierson who presented at the 2010 American Orthotic and Prosthetic
Association National Assembly in Orlando, Fla., talked with O&P
Business News about the benefits of using a gauntlet style ankle-foot
orthotic (AFO) to treat patients stricken with partial foot amputation. The
motion-controlled, total contact AFO is simple to access and the removable
insole is easily replaceable while the filler stays intact, according to
Pierson. Conveniently, the carbon footplated, partial foot gauntlet style AFO
can be worn and used with a variety of footwear.
“There is a lot of movement that is still in the shoe or the foot
orthosis,” Pierson told O&P Business News. “The use
of an ankle gauntlet in conjunction with the partial foot prosthesis to obtain
better results and more management of the limb, makes up for the loss of the
digits. This locks everything into place and into a safer environment.”
Pierson explained that the gauntlet style AFO reduces the risk of skin
breakdown on the foot, which is the number one sign of trouble for a patient
and his or her pedorthist. If a pedorthist notices anything out of the
ordinary, as far as skin discoloration or blisters, they must act immediately.
“Sometimes the patient is completely unaware if there has been any
type of skin breakdown or bleeding,” Pierson explained. “There is a
perfect storm scenario where the patient is obese and can not actually see the
bottom of their feet and they can not feel any discomfort either. Plus, the
patient may have bad vision so they can not see the blisters or the
discoloration. All of those scenarios combined can have a tremendously negative
effect on the health of the patient’s foot.”
Pierson would like to see certified pedorthists take the lead on partial
foot prostheses. According to the ABC Practice Analysis of Certified
Pedorthists, of the pedorthists surveyed in the practice analysis,
48% of their patients were diabetes patients. Of those 48%, 11% had
diabetes along with an amputation.
“I think it is an opportunity to both utilize their full scope and
also to be more active in managing that patient,” Pierson said.
“Certified pedorthists are allowed to go above the ankle and should be
encouraged to do so as long as it fits the rules set forth in their scope of
Leather gauntlets qualify as long as they do not exceed the heights
allowed. By combining the subtalar-control foot orthotic with partial foot
prosthesis, pedorthists are able to offer their patients a device that has had
great results in providing both exceptional function and durability, according
“There are a lot of CPeds who shy away from some of the more
complicated cases,” he admitted. “Perhaps they are more interested in
fitting shoes or diabetic insoles, but when it comes to managing a partial foot
amputee – that takes some skill. It would be beneficial if more of them
would seek the training and gain the experience necessary to treat the patients
with partial foot amputations.” — by Anthony Calabro
For more information:
- American Board of Certification in Orthotics, Prosthetics and
Pedorthics. 2009 Practice Analysis of Certified Pedorthists. Available at:
Accessed Nov. 17, 2010.
Disclosure: Don Pierson, CO, CPed has
no direct financial interest in any of the products mentioned in the article
nor is he a paid consultant for any companies mentioned.
You will have several different approaches depending on why the
amputation occurred. Was the patient in an accident, was this an industrial
problem? When you take a patient who is 28 years old, healthy and lost his
forefoot, he needs to have stabilization because he does not have that lever in
front of his foot. The patient would have a balance problem. I would really
worry about balance.
A pedorthist will look at the diabetic patient just a little more
closely, but you are still dealing with the same issues in stabilization and
balance. They are susceptible to breakdown and ulcerations as well. How brittle
are they? Management depends on how fragile the foot is. It becomes a choice of
materials. I might make them a nice soft plastazote insert with a forefoot
filler and then modify the shoe and put a rigid rocker into the shoe. I am
going to make sure I am using accommodating materials to give the patient the
rigidity that they need. Every case is a little different, but the keyword is
— Richard Harris, CPed
Disclosure: Richard Harris has no direct financial
interest in any products or companies mentioned in this article.