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Does anyone have any experience of this boot? Is it any better than a Darco forefoot offloading boot? I'd like to know whether it is a viable option to using crutches (as advertised) and whether it helps walking in that difficult post op. period just after coming off crutches. Any thoughts would be much appreciated - many thanks!

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Hi "S"

I'm not familiar with a specific "bunion" boot that Bledsoe may make. They do have several CAM type boots. Like any other CAM boot it limits ankle motion and most have a rocker bottom. You pay a bit more for an adjustable DF angle.

If you are doing a simple distal osteotomy for bunion correction, my "personal" feeling is a CAM type walker is an over kill.

May I ask what your normal post op protocol is for Bunionectomies?

Steve

__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA

Dear Steve,

Many thanks for your reply. I am actually a podiatrist, about to have a Scarfe-Akin procedure myself. I have already had this procedure on my other foot and saw an advert recently for the 'Bledsoe bunion boot' (www.bledsoebrace.com) which claims to enable you to ditch the crutches. Having gone through this before, I would be very keen to try anything which makes walking easier, but perhaps I'm being over-hopeful! I just wondered who was using these boots and whether they had any feedback.

Suzanne

First of all, good luck with your upcoming surgery. Over my years of practice, I've utilized many different items for post operative ambulation following bunionectomies with osteotomies, including all varieties of rigid casts, all the various products Darco makes, etc., and although Steve believes a removable walking cast may be a bit of "overkill", I prefer to use these post operatively.

Although I fixate almost all my osteotomies with screws, I have found that a low top removable walking boot is extremely well tolerated by patients, and off-loads the surgical site due to rocker bottom soles of these boots. I sleep easier knowing that the osteotomy site has some protection.

I'm pretty aggressive post operatively, and if there is minimal edema, I like to have patients back into a sneaker within 2-3 weeks. I've found that the removable walking cast has allowed that to happen quicker than when my patients wore a surgical shoe.

I have always preferred the Bledsoe Boot or the Aircast products due to the relatively low profile (and I use the low type variety). Additionally, Bledsoe made a model with a concave insole to more anatomically "accept" the foot, rather than a completely flat foot bed.

Their new "bunion" model simply has a few new bells and whistles, including additional plantar padding, a built in hallux splint and some pneumatic forefoot compression.

The bottom line is that we all use what works best for our patient population, and I personally prefer the use of a removable walking cast for 2-3 weeks post operatively. My patients don't use canes, crutches or walkers, but I do like some protection at the surgical site. Or at least it makes ME feel better!

Suzanne:

I would recommend walking in a full-length "cam-walker style" boot post-operatively that has a rocker-sole. There are many of these boots available on the market, and we stock them in our office to dispense to patients. I don't like the shorter boots that go to the mid-tibia since they don't distribute the weight over as large of a surface area onto the anterior tibia as the taller boots. However, this is obviously the surgeon's preference. Be sure to match your contralateral shoe with a heel/sole height (i.e. add heel lift or use thicker soled shoe) that matches the thickness of the sole of the brace-boot to reduce the risk of knee/hip/low back pain from unequal leg length. You should be able to be walking in a lace-up athletic shoe within four weeks with this type of bunionectomy, barring any complications with the surgery.

Good luck and be sure to take enough time off work initially after the surgery so that depedency-induced edema won't become a problem. Hope this helps.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Steve,

Here is the link:

http://www.bledsoebrace.com/products/bunion.asp

I do dispense these boots from my office, and dispense them at the time of the pre-operative visit. One of my staff dispenses the boot and makes sure that the patient understands how to use the boot/cast, and we usually also prefer that a family member is also present. It works out well, since the patient is familiar with the product prior to the procedure.

However, I naturally do not bill for the cast until the procedure is performed in case there is a change in plans and the boot is not dispensed (I simply have the patient return the unworn boot).

Similar to Kevin, I often preferred the high top versions for several reasons, but it seemed that patients often preferred the low top variety, and I haven't seen any difference in outcomes with the use of either version.

Dear Dr S Arbes, Dr DSW, falconegian and Kevin Kirby,

Thank you so much for your feedback - really helpful to have your opinion and insights, especially as (probably because of National Health Service constraints) we are rather 'low tech' in the UK. For my previous surgery 5 years ago I had little more than a bandage cover with a sole and found I couldn't get a trainer or shoe on for several weeks after, so the oedema comment mirrored my own experience. This time round they will apparently dispense a Darco shoe, but I will take your advice and try something more robust as well! The protection point is a very valid one - you feel very vulnerable, especially swinging your leg along on crutches!
Many thanks for your comments,

Suzanne Woods

Just a heads up regarding Kevin's comment about attention to iatrogenic leg length difference while in the boot. We use this simple and inexpensive device distributed by RYBO medical and have found them invaluable:

http://www.healthyfeetstore.com/even...ng-device.html

__________________
"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright

David G. Wedemeyer, D.C., C.Ped.

Dear David,

I had seen these but didn't know whether they were effective, so many thanks for the tip.

Suzanne Woods

"Their new "bunion" model simply has a few new bells and whistles, including additional plantar padding, a built in hallux splint and some pneumatic forefoot compression."

Hi David:
I looked up BUNION BOOT on the bledsoe home page but for one reason or another I couldn't find it.
Do you happen to have a link for this boot?

Do you dispense these in your office or through the hospital?

Steve

__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA

hi
I don't think the cam you refer is really different from an Aircast.
I;m using a post op boot made in Italy by Molliter (www.molliter.com). It is very good, ligth and people like it!

bye