1. Frames Footwear and Foot-ups: The Birmingham Experience Mark Raven & Philippa Bridgman
Introduction
The presence of foot wires in circular frame external fixators prevents the wearing of standard foot wear. Custom made footwear for foot frames can be expensive and is not immediately available on the ward. One option is the use of flip flops but this is often not acceptable in winter or to patients with mobility problems.
Where the foot is not fixed within a frame, foot drop is a common injury encountered in the limb reconstruction patient.
In this poster we present solutions developed in Birmingham to these problems which are cost effective, require minimal technical skill and can be immediately available on the ward without the use of external services.
Fitting Process
The position of the wires is marked on the shoe which is cut with scissors to accommodate their position. Straps that are not in an appropriate location are removed and relocated as necessary. Straps are re-attached with the use of glue and staples which are then sealed and the edges secured with iron on sealing tape. Iron on Velcro can also be added as required. On load testing this method of fixation did not fail before the neoprene fabric itself.
Patient Satisfaction
The shoes adapted and foot up splints utilised to date have been well received by patients and therapy staff.
The sole of the shoe has been found to be comfortable and robust and patients find the foot up splints easy to adjust and utilise.
There have been no structural failures in any shoe or foot up over a period of 6 months.
Central attachment, S hooks or circular rings all work well as shoe attachments and individual patient preference is the main factor in choice.
Footwear
The use of the neoprene Reecoedema sandal distributed by Reed medical has several advantages over adapting patients own footwear or standard post operative shoes. The sandal is able to accommodate very oedematous feet, the neoprene construction does not fray or split and can be adapted without the need for stitching. The sole can also be adapted with multiple raises attached with Velcro and removed sequentially to accommodate a limb lengthening procedure.
The shoe alone costs approximately £45 and takes around half an hour to adapt and fit.
Foot ups
There are many solutions available for management of foot drop or contracture in circular frame patients. Here we present another solution that requires minimal technical skill or equipment.
The simple use of self locking carabiners, bungee cord and S shaped lace hooks or rings enable patients to use their regular or adapted footwear. It is fully adjustable in both length and tension and can be quickly produced on the ward for around £ 2.
Shoe fitting equipment
Summary
Delays in mobilising and in discharge have been reduced by technically simple solutions to foot wear and foot up challenges. Both techniques are cost effective, reliable, have high patient satisfaction and are simple to fit. The adapted footwear can be produced for under £50 with out the need for specialist services and adjustable tension foot ups can be produced on the ward for under £2. Both are also easily adjusted by patients as required.
Deconstructed straps
Foot up parts
Adapted shoe