A Guide To Orthotic And Prosthetic Options For People With Partial Foot Amputations

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Author(s): 
Ryan Fitzgerald, DPM, FACFAS

It is estimated that greater than 26 million Americans — over 8 percent of the total population — suffer from diabetes and the literature demonstrates that nearly 25 percent of patients with diabetes will develop a foot ulcer at some point during their lifetime.1 It has been well documented that more than half of these wounds will become infected and require hospitalization, and that nearly 20 percent of these infections result in lower extremity amputation.1

   The partial foot amputation is the most common type of amputation in the United States and occurs nearly twice as frequently as either the transfemoral or transtibial amputations.2,3 In the United States, there are approximately 618,000 individuals who have had some form of partial foot amputation and, considering the current population, that translates to approximately two out of every 1,000 people who suffer with partial foot amputations.4

   This is a staggering statistic, especially considering that the number of people living with limb loss will likely double by 2050 as the population ages and the number of people living with comorbidities, such as diabetes and vascular disease, increases.5 Consequently, clinicians involved in the management of lower extremity wounds are truly facing an epidemic of limb loss.

   There is a clear prevalence of partial foot amputations and the numerous complications associated with these procedures as 30 to 50 percent of partial foot amputees will experience some form of subsequent skin breakdown following partial foot amputation.6 Despite this, there has been little consensus on the type of prosthetic and orthotic intervention after partial foot amputation that patients should utilize to provide the greatest risk reduction for subsequent secondary amputation.

   Sadly, studies estimate that 15 to 45 percent of people with partial foot amputation experience some form of secondary amputation with two-thirds undergoing a higher level of amputation on the same limb.7,8 The mortality for partial foot amputation is significant and studies estimate that of those who undergo partial foot amputation, between 15 percent and 30 percent will die within 12 months.8,9

   Clearly, there is a need to determine the most effective way to limit further skin breakdown and limb loss in this challenging patient population with effective offloading and stabilization via custom prosthetics and orthotics. However, formal study and critical analysis of these modalities is a relatively recent phenomenon and there is little evidence-based medicine to guide the practitioner in the selection of appropriate prosthetic interventions.

A Pertinent Overview Of Prosthetic And Orthotic Interventions

Historically, physicians have utilized a wide variety of prosthetic/orthotic modalities to manage partial foot amputations. Among these devices, insoles, toe fillers, slipper sockets, ankle foot orthoses (AFOs) and clamshell sockets are the most commonly utilized prosthetic interventions.

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