A prosthetic foot is needed if by an amputation at the foot of normal shoes (standard shoes) are unsustainable or walking is difficult or impossible. Even cosmetic deficits are overcome.
Causes and aim of the prosthetic fitting
The following possible causes for amputations in question:
Trauma, for example, an accident
Arterial occlusive diseases, diabetes mellitus
Tumors
Congenital malformations
Various rare diseases
The ultimate goal is the restoration and long-term maintenance of ambulation of the patient.
Problem
There are problems with the scars resulting from the amputation. Here it's much on the skill of the surgeon, to place the scar not on the sole of the foot. Also the shape of the end is important, it should be modeled from very smooth from the skeleton, because prominent bone always lead to pressure sores. Here is the form prior to preservation of the length, since the end of the stump must be primarily good resilient.
At shorter foot stumps, there are problems with the distribution of pressure. The stump is exposed as the healthy foot Yes the same forces, only they are spread over a much smaller area. Also, the bio-mechanical leverage change: shortening the foot lever, the roll-off behavior changed, including the step length decreases.
The strong calf muscles, which prevents the foot down, now has less resistance with the shorter lever and pulls thus the foot down in the so-called Equinus position. Very short foot stumps tend also to the Supination, i.e. the foot tilts outwards.
Aspects of orthopedic service
Various amputation lines, starting at the toe to the hindfoot lead to fundamentally different load situations. The more the distance is shortened, the more limited load capacity and stability.
The main parts of the supply are the bedding of the butt end, the restoration of the mechanical foot length by a partially elastic sole stiffening and as a result, the distribution of soil strength on the heel and lower leg.
The supply shall be the shorter of the foot is transmitted the ground force the higher to the lower leg. It must be noted how much the burden of care will be by the patient, the higher the load, the higher the power supply must go up on the lower leg. A strong strain arises, for example, by physical labor or high body weight.
Forms of supply
For hardly shortened legs, such as amputation of the big toe or all toes, a dressing of the ready-to-wear shoe with sole reinforcement and toe replacement is sufficient. Also measure cast silicone prostheses are possible, mainly cosmetic effect (for example have sandals).
At shorter foot stumps the band extends from the orthosis in the Konfektionsschuh to the orthopaedic shoe with integrated residual limb bedding and the support plate raised on the lower leg. Thereby ensuring the care function and area of application, i.e. the load must be balanced between cosmetic needs of patients of.
At low load E.g. as a slipper, also a high shoe supplies can be risked according to stub length. While a strong tensile strapping to the heel bone must then be integrated, to exclude any heel play and transfer the ground force on the heel and hence the lower leg.
Supply of the diabetes stump
Special measures must be taken when amputations as a result of the diabetic foot syndrome or related disorders of blood circulation and innervation of the lower extremities. In this context the skin responds often extremely sensitive pressure, friction, and injuries, where the patients to the part of it feel nothing because their nerves do not normally work.
The supply of such foot stump is very complicated and expensive, because even here the smaller load area is extremely strained. In conjunction with extremely accurate adjustment is the cooperation of the patient of the utmost importance. For example, it is the most important thing initially that the patient not take off the shoes or brace and barefoot running, because he can inflict as fast new injuries.
Regularly the patient examine his feet on changes or injuries (leave).
Also the patient should be lead by his limited feeling of pain not to, in the months after the amputation the affected foot as before to charge. That would lead to damage to the skin in the majority of cases, can entail in turn serious infections, enabling new amputations to refrain.