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Would be grateful for some up to date advice here. I had a lady pressent in clinic with a charcot foot which took her doctor 5 months to diagnose. It is now inactive and not severely deformed. She is still in a crow walker. She needs to go into shoes and orthotics. What type of rocker sole is best for her? One clinician has suggested a rocker for the affected foot only. Is it not better to have rockers on both shoes?
Also the same clinician has suggested a total contact inlay made for the affected foot only. Shouldn't she have a left orthotic made as well to support and protect this foot and help prevent any complications arising?

Current thoughts on materials used in orthotics for this condition?
Your comments and help appreciated

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I have began using MBTs which give an element of ankle and mtpj rock with an accommodating orthoses with a 3mm plastazote cover. Although this needs replacing periodically it empirically appears to be the best cover for protection and identification of pressure points.

I also do a dermal thermography map at each foot care visit.

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Graham Curryer

None of us know what we are doing, but some of us know more about what we are not doing than others!::

thanks Graham I'm always concerned to use MBT's from a stability point of view and my other patients have got hip pain from using them.

I have found this also. I believe that their stride was relatively short with the fixed MTJ and often hallux rigidus. Hip flexors especially appear to be tight, possible due to a more concentric role in picking the leg up. When using the MBT stride length is increased and not always imediately tollerated.

Fortunatley I work in a physiotherapy clinic and often combine implimentation of the MBTs with a physio program.

I do not use MBTs where ankle and first mtpj roms are "adequate".

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Graham Curryer

None of us know what we are doing, but some of us know more about what we are not doing than others!::

'scuse me: what's an MBT?

BEHOLD THE ANTISHOE!!!!!

http://us.mbt.com/

According to their marketing dept it is the best thing ever.. and we should all be wearing them.

MBT Shoes

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How can a unilateral rocker sole not introduce an LLD? I'm a Cped and tailor every rocker sole to the pts gait. What part of the foot needs offloading? Does the pt walk abducted? what Degree? What is the pts stride length? From my clinical perspective almost all Charcot pts have equinus deformities with limited or no ankle df. They start to compensate with an abducted gait and basically the tight achilles rips the midfoot apart to accomodate the loss of ankle df. Generally the rocker needs to be ground with a line of progression that meets the amount of abduction of the pts gait. While the MBTs have a great rocker, it is a negative heel, and has a 0* lop which I believe is counterproductive to the pts condition. Getting the rocker correct is difficult and I always have the pt walk
(often multiple times) before the final sole is applied. Since Charcot pts are neuropathic an inlay for unaffected side should be provided. It's tedious to do this amount of grinding but the pts really benefit from getting it right. Off my soapbox now

Cavus, if it was me, l would do a TCO (Total contact Orthosis) for both feet, charcot is only present in one foot that is not to say PN is not, something for you to test for, this is a great step in the right direction..protection, as for the materials to use see what is available to you first, l am sure your local supplier will have some great advice for you.

The rocker sole, the Fulcrum, needs to be carefully aligned for these clients, if not this can actually end up causing problems on the dorsum of the foot as more force is needed to get the foot from midstance to the propulsive stage, a MBT style rocker may not suit your clients gait, the actual fulcrum might need to run (for example) proximal 1st MPJ to distall 3rd if they are badly ABducted, only observation or even an Fscan will tell you were that force really is.

l would also do a mild heel rocker, maybe even SACH the heel so as to slow the strike down and to assist in a gentle roll on to the midfoot rather than a slap!

Back to the fulcrum location for a moment, check for wear on the Crow walker's sole, this may give you an idea where that fulcrum might need to go.

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David Sutton
C.Ped.CM.Au
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If it no quiescent and there is almost no deformity there could well be no need to do a rocker at all. A simple total contact orthosis could be all that is required.

This is only a requirement if there is something that requires treatment - n'est pas?

LL

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Remember, it's just a foot.