How to stop a foot healing deformed

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Hi

Can anybody help/advise?

I'm currently treating a young heavy built male who has had the right 3-4-5 digits amputated (diabetic ulceration) and most of the metatarsals. Wound is healing well but I am concerned that he has a strong medial pull on his foot by the remaining tendons and muscles which is creating a banana shaped forefoot. Does anybody have any advice or experience on the best way to stop this healing banana shaped. At the moment I am using vac therapy which is pulling the foot slightly corrected but wondering if anyone has used strapping to assist (pad depending) or good results with total contact casting/orthopaedic bracing for this? The wound is on a weight bearing area as well as dorsally.

Any expertise greatly appreciated.

 

A custom molded AFO with a high medial wall can help reduce forefoot addiction. A forefoot filler can also be added to the foot plate to help fill out his shoe and prevent the vamp from "breaking" over the wound. The full length footplate would also allow for a smoother gait by replacing the leverage that was lost with amputation.