1. 1 Partial Foot Management

2. 2 Introduction Original Presenter: Scott Hennessy, CO National Product Manager Scott.Hennessy@allardusa.com Cell 201-874-1599

3. 3 Introduction Challenge: Ulcers are a leading cause of amputations Ulcers on the residual foot are a leading cause of subsequent amputations

4. 4 Introduction Various techniques…

5. 5 Traditional Interventions Current concepts

6. 6 Comprehensive Management Objectives: Limb preservation –Friction –Pressure –Shearing forces

7. 7 Objectives: Limb preservation Gait restoration –Biomechanical function –Center of gravity –Limb length –Propulsion with proximal stability Comprehensive Management

8. 8 Limb Preservation Friction –Shoe size Too large

9. 9 Limb Preservation Friction –Shoe size Too large –Socket Too large

10. 10 Limb Preservation Friction Pressure –Shoe size Too small

11. 11 Limb Preservation Friction Pressure –Shoe size Too small –Integrity of socket Too small

12. 12 Limb Preservation Friction Pressure –Shoe size Too small Integrity of socket Too small –Break point At shoe break

13. 13 Limb Preservation (Foot) Ball Break Friction Pressure Shearing forces lever arm

14. 14 Limb Preservation (Foot) Ball Break Shearing forces “Normal” functional balance lever arm

15. 15 Limb Preservation Shear Normal Abnormal balance = Shear lever arm

16. 16 Limb Preservation Shear Normal Shear lever arm

17. 17 Limb Preservation Shear Normal Shear lever arm

18. 18 Limb Preservation Shear Normal Shear Partially lengthened lever arm

19. 19 Limb Preservation Shear Normal Shear Partially lengthened Fully lengthened lever arm

20. 20 Limb Preservation TMA pressure analysis Amputation level Carbon footplate Tamarac joints Blue Rocker

21. 21 Limb length –Correlation to calcaneal angle Neutral Plantarflexed Gait Restoration

22. 22 Gait Restoration 20° dorsiflexion Limb length –Normal ankle ROM (1/3 : 2/3 ratio) 40° plantarflexion (1/3) (2/3) Neutral

23. 23 20° dorsiflexion Limb length –Normal ankle ROM –Normal calcaneal angle 40° plantarflexion 40° Gait Restoration

24. 24 Gait Restoration 40° Limb length –Normal ankle ROM –Normal calcaneal angle

25. 25 Gait Restoration 40° Limb length –Normal ankle ROM –Normal calcaneal angle Transmetatarsal

26. 26 Gait Restoration 40° Limb length –Normal ankle ROM –Normal calcaneal angle Transmetatarsal Lisfrank

27. 27 Gait Restoration 40° Limb length Normal ankle ROM Normal calcaneal angle Transmetatarsal Lisfrank Chopart

28. 28 Gait Restoration Closed chain max dorsiflexion Maximum dorsiflexion

29. 29 Gait Restoration Closed chain max dorsiflexion Establish functional ROM 1/3 2/3 Maximum dorsiflexion Functional posture

30. 30 Gait Restoration Closed chain max dorsiflexion Establish functional ROM Create socket Functional posture

31. 31 Gait Restoration Closed chain max dorsiflexion Establish functional ROM Create socket Positive model

32. 32 Impression Puff™ Durometer: 25 Shore A EVA

33. 33 Co-Polymer 1/8″ Black

34. 34 Gait Restoration Closed chain max dorsiflexion Establish functional ROM Create socket Post to casting angle Posted to functional posture Posted to residual LLD Posted for function Kanade RV: Investigation of Standing Balance in Patients with Diabetic Neuropathy at Different Stages of Foot Complications, Clinical Biomechanics, 2008 Nov

35. 35 Socket on ToeOFF

36. 36 Gait Restoration Closed chain max dorsiflexion Establish functional ROM Create socket Prosthesis –Length –Width –Profile

37. 37 Build-ups of Microcell Puff ® Lite ¼″

38. 38 Finished product

39. 39 Closed chain max dorsiflexion Establish functional ROM Create socket Prosthesis Break Reinforce base Gait Restoration

40. 40 Gait Restoration Propulsion with proximal stability Blue Rocker –Open calcaneous –Graded energy reflection –Completed system

41. 41 Outcomes Chopart gait in traditional device

42. 42 Outcomes Chopart gait in traditional device

43. 43 Outcomes Chopart gait with customized BlueRocker

44. 44 Outcomes Chopart gait with customized BlueRocker

45. 45 Gait Restoration An off-the-shelf high definition silicone foot cover with a custom silicone socket fabricated from a modified cast or mold Offers energy return when the foot sole is imbedded with a 0.8 mm or 10.0 mm carbon fiber foot plate Restores function for low to medium activity patients, or household ambulators Regal Partial Foot

46. 46 Gait Restoration Requires casts of sound and residual sides, photos and order forms Trial prosthesis to check for fit and base color Final prosthesis fabricated when ideal fit is obtained Regal Partial Foot

47. 47 Gait Restoration Hygienic and easy to clean due to its sealed interior silicone finish Safe to use in the shower, bath or at the pool For patients desiring a high definition appearance for day- to-day wear or for special occasions Regal Partial Foot

48. 48 Comprehensive Management Summary: Limb preservation  Friction  Pressure  Shearing forces

49. 49 Comprehensive Management Summary: Limb preservation Gait restoration  Limb length  Propulsion with proximal stability

50. 50 Comprehensive Management Socket Shoe Lever arm Integrated Function Foot

51. 51 Acknowledgements Justin Wernick, DPM (Function of foot lever arms) David Carmine, PhD (Neuro anatomy – stretch reflex) Gary Gray, PT, ATC (Integrated closed chain function) Jeff Falkel, PT, PhD (Functional Anatomy/Physiology) Dan Cipriani, PT, PhD (Closed Chain Movement Science) Seamus Kennedy C.Ped (Hersco: Partial foot fabrication)

52. 52 References Primary References Gait Analysis, Jacquelin Perry, SLACK Inc. Muscles Alive, Basmajian & De Luca, Williams & Wilkins Partial Foot Amputations, S Ö derberg, CPF Chain Reaction Seminar Series, Gary Gray, Wynn Marketing SOC Proceedings: The Biomechanics of Ambulation After Partial Foot Amputation, AAOP Primal Pictures

53. Thank You