Cath Lab Digest

    “The fact that the laboratory provides sizing devices for in-office use makes it quite easy from a practical point to obtain the proper size for the youngster’s foot,” says Dr. Valmassy, who practices at the Center for Sports Medicine at St. Francis Memorial Hospital in San Francisco.

   Dr. Valmassy says the P3 Kiddythotic allows DPMs to demonstrate to the child’s parents how the orthosis will function. In addition, the child can stand on the device so the podiatrist can determine which changes the child’s foot may go through and plan accordingly for future orthotic sizes.

   ProLab Orthotics says the P3 Kiddythotic can help treat young children with pediatric flexible flatfoot. The company notes that the P3 Kiddythotic is the only functional prefabricated orthotic that offers a rigid polypropylene shell, medial flange, deep heel cup, a 4-mm medial heel skive and 4/4 rearfoot post.

   With the P3 device, Dr. Valmassy notes that he can increase correction by adding forefoot or rearfoot posting. He usually adds the posting via ¼-inch or 1/8-inch Korex. Dr. Valmassy says he can increase the correction by 2 to 5 degrees, making the P3 a customized device without incurring the cost of an actual customized device.

   When it comes to patients with a severe pes planus foot deformity or a residual talipes calcaneal valgus deformity, Dr. Valmassy says prefab orthoses are not aggressive enough to decrease abnormal pronation. For these patients, he will cast the patient for an UCBL device or a functional inverted orthosis that will provide better control of forefoot subluxation.

What You Should Know About A New Ex-Fix Device

   8. Hoffman II MRI External Fixation System (Stryker Orthopaedics). When utilizing flaps and grafts in high-risk patients, David Armstrong, DPM, PhD, says there is a need to keep the flaps and grafts stable and free from micromotion. This has led him to use external fixation devices such as the Hoffman II MRI External Fixation System. He notes one can modify these devices when the patient is no longer confined to a bed or a chair. Dr. Armstrong and his colleagues have developed a construct of the device that is now termed the “SALSAstand.”

   Stryker Orthopaedics says this external fixation system concentrates on two key areas that are of concern in MRI use: frame displacement due to magnetic (mechanical) forces and frame heating due to induced electrical currents (thermal forces). To combat the displacement due to magnetic forces, the company notes the ex-fix system is composed of materials that are nonferromagnetic and nonconductive. In addition, with the Hoffman II MRI External Fixation System, Stryker Orthopaedics says surgeons can build various types of frame constructions without any additional risk to patients in an MRI environment of up to 3.0 Tesla.

   On a recent blog for Podiatry Today, Dr. Armstrong notes a technique in which he used the Hoffman II fixation system in a patient who had end-stage renal disease and a gangrenous forefoot. (See www.podiatrytoday.com/blogged/modified-salsa-goalpost-fixationoffloading...). Using Achilles tendon lengthening and external fixation, he was able to correct the patient’s equinovarus position.

    “We believe this aggressive stabilization and protection of the rotational flap may be helpful in these very compromised patients,” says Dr. Armstrong, a Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine. He frequently uses this technique as an adjunctive aid at SALSA.