prosthetic management of partial foot and syme's amputation is a very challenging task. Now a days the availability of advanced technology some how fulfilling the need of the amputee but not the fully.
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Prosthetic management of symes and partial foot amputation
1. PROSTHETIC MANAGEMENT OF PARTIAL
FOOT AND SYME’S AMPUTATION
BY:- MISS SMITA NAYAK
(MPO), PDUNIPPD, DEMO(P&O)
1
2. INTRODUCTION
Foot is a finely tune module having complex
structure & function. It is the base of support,
shock absorber & weight bearing structure for
entire body.
If the foot get amputed due to some
unavoidable causes it disturb alignment,
support, load bearing structure, cosmesis &
affect the symmetry of the gait.
2
5. Causes of Amputation
Infection with tissue necrosis in diabetic patients
Sensory neuropathy
Gangrene
Ischemia due to Peripheral Vascular Disease (PVD) ,Micro
emboli arteritis, Frostbite
Trauma
-moving machinery
-crush injuries, with or
without fractures
-RTA
- Thermal injuries
Congenital abnormality
5
6. PARTIAL FOOT AMPUTATION
Partial foot amputations of the foot includes:
I.TOES AMPUTATION
II. RAY AMPUTATIONS
III. TRANSMETATARSAL AMPUTATION
IV. TARSOMETATARSAL (LISFRANC)
DISARTICULATION
V. MIDTARSAL (CHOPART) DISARTICULATION
6
7. I. TOE DISARTICULATIONS
A. Inte rphalang e al(IP) Jo int o f the Gre at To e
B. To e Me tatarsalPhalang e al(MTP) Jo int o f the
Gre at
C. Disarticulatio n o f 2nd To e MTP Jo int
D. MTP Jo int o f To e s 3 o r 4
E. AllFive To e s
7
20. Complications
Lateral Ray Amputation:-
Hallux valgus deformity
Bunion Deformity
1ST
& 5th
Ray Amputation:-
ML Instability
Pressure problem in push off phase
Prosthetic goal:-
To Redistribute the pressure
To Avoid problem of shoe fitting
To prevent deformity
For cosmetic Restoration
20
23. FUNCTIO NAL CO NSIDERATIO NS AFTER
TRANSMETATARSAL AMPUTATIO N
Barefoot walking after
transmetatarsal amputation is
impaired because of loss of the
weight-bearing metatarsal heads
and
Elimination of forefoot pronation
and supination during gait.
A rigid rocker bottom (RRB) shoe
may help reduce distal pressure
and shear from a flexible-soled
shoe wrapping around the end of
the residual foot.
23
24. PROSTHETIC GOAL
- To provide maximum
Flexibility to simulate
pronation & Supination
- To prevent shoe hyper
extension during push off
- Cosmetic Restoration
MANAGEMENT:-
Shoe with fillar
AFO with fillar
SCM Foot
Insole with fillar
Modified SMO
24
26. A portion of the fifth metatarsal base is also retained to
preserve the insertion of the peroneus brevis tendon. To
help maintain a balanced residual foot, in addition to the
peroneus brevis, the insertions of the peroneus longus
and anterior tibial tendons are preserved.
26
34. CHOPART PLATE BY
ENDOLITE
Selected by category according to the weight and impact
of the user, this 100% carbon keel is designed to be a
flexible and durable solution for the longest amputation
levels and partial foot prostheses.
Includes a 10mm heel height for compatibility with
standard Flex-Foot® shells and low-heel shoes.
Recommended for Chopart but also recommended for
Lisfranc, Pirogoff, Boyd, and partial foot prostheses
34
35. CHOPART PLATE BY
OTTOBOCK
Available heel heights are 0” (0 mm), 3/8” (10
mm) and ¾” (20 mm)
Available in sizes 22 – 30 cm
Shipped with complete kit of materials and
instructions to perform urethane bonding of plate
to socket
Use in lieu of toe filler for dynamic response,
increased stability and flexibility
35
36. Specifically designed for amputees with Symes,
Chopart or partial foot amputations.
Recommended for amputees who meet Mobility
Grade 3 and 4* of the Otto Bock MOBIS®
Mobility System.
The Chopart foot plate foot shell is available in
two colors – beige and light brown. Delivery
does not include the foot shell, which has to be
ordered separately.
36
37. SCM & Silicone foot By ENDOLITE IND
LTD.
HDSF(High density silicone foot)
HDSF-ER(High density silicone foot
with extra reinforced
37
38. Descriptionandapplications
High definition silicone cosmetic foot cover, fine
handprints, veins and optional: With or without zipper
(metal or plastic zipper)
HDSF-ER: High definition silicone foot cover with
integrated carbon fiber footplate
Size chart is required to order the foot
38
46. SYME’S AMPUTATION
Syme’s amputation is an ankle disarticulation (The removal of the
foot through the joint) with removal of the malleoli (The two rounded
protrusions on either side of the ankle) then forward rotation of the
heel pad over the end of the residual tibia
46
55. FLEX SYME’S by Ossur
Extremely low build height with active heel and
alignment options.
The Flex-Syme’s foot design is based on the
well known Flex-Foot concept - a carbon foot
module connected to an actively deflecting
carbon heel. The improved alignment adapter
now offers angulations and adjustments in ML /
AP planes.
55
57. LPSYME’S By RSL Steeper
The Low profile Syme’s accommodates the
build height requirements of patients with
Syme’s amputations.
The carbon fiber design delivers energy storage-
and-return, smooth and natural rollover, and
durability in a remarkably lightweight design.
The prosthetic foot incorporates a direct
lamination cup, which keeps the distal mass of
the prosthesis as light as possible, reducing
amputee energy expenditure during the gait
cycle. 2” gap required for fitting.
57
58. LPSyme’s Technical Specifications
Sizes: 22-30cm (31cm special order)
User Weight Rating: 365 lbs. (166kg)
Stiffness Categories: 1-9
Build Height (average): 1.9 inches
Product Weight (average): 295g
Connector: Direct lamination cup
Heel Height: 3/8"
Warranty: 36 months
58
60. Genesis II Low Profile Foot Ankle
Systems
With clearances less than two inches, the Genesis Low
Pro Foot and Ankle System provides the only multi-axial
prosthetic foot suitable for long BK and Syme’s level
amputees.
The Genesis Low Pro combines the Genesis System
multi-axial technologies with advanced strength carbons
and composites to create a system of optimum comfort
and durability. This system offers the most natural range
of motion at a minimal height.
60
62. Ability to adjust the foot position during trial fitting as
well as after completion of the prosthesis
Part Weight= 18 oz (520 gm)
Clearance= (43 mm)
The key innovation in this foot is a unique spherical
sliding block that allows you to correct alignment
during trial fitting and even after the prosthesis has
been completed.
1C20 Pro Syme’s
of Ottobock health Care Ltd.
62
63. Positioning of the Foot 1C20 Pro Syme’s
Easy adjustment of the foot in relation to the socket is
possible with the new spherical alignment solution.
A setting aid facilitates the alignment and determines the
direction of the maximum adjustment range in the
anterior/posterior direction.
This provides an infinitely variable setting range
beginning with 12° and accommodates different heel
heights.
A sliding block in the lamination anchor provides
additional movement and allows for the abduction (+6°),
adduction (-6°) and rotation (+/- 30°) of the socket.
63
65. Dynamic foot for Symes amputees
Removeable pyramid adapter for even lower structural
height
Lightweight
Dynamic energy return
Recommended for Otto Bock Mobility Grades 3 and 4*
Part weight = 9.3 oz (265 g)
Clearance = 1 1/8" (29 mm )
1E57 Lo Rider
Ottobock
65
69. Analysis of the distribution of contact pressures
between stump and socket at various times
during the stance phase is useful in the design
of a socket that will be comfortable for the
amputee.
Since pressure distribution varies during each
of the three sub phases-shock absorption, roll-
over, and push-off-each must be analyzed
separately.
ANALYSIS OF STUMP-SOCKET FORCES
DURING THE STANCE PHASE
69
70. ShockAbsorption
If it be assumed that body weight is supported
at the distal end of the stump, it can be seen
that during the shock-absorption sub phase
the major functional forces between stump
and socket occur in the antero distal and
postero-proximal areas.
70
71. During roll-over, the need for postero-proximal
pressure decreases, and the contact pressure at
the end of the stump shifts toward the center of
that area. If the force system is to be in
equilibrium, the paths of the forces P, D and F
must intersect at Mand their vectors must form
a closed polygon.
Use of this principle makes it possible to
estimate the relative magnitudes of the three
force
71
72. Push-Off
The force system that develops as the Syme’s
amputee rolls over the ball of the foot in the
push-off sub phase.
At the instant shown, the hip joint is being used
to help flex the knee against the force acting
upward on the ball of the foot.
Again, the principle of force equilibrium can be
applied to estimate the magnitude of the forces.
A postero-distal and an antero-proximal contact
force between stump and socket are seen to be
necessary to resist the floor reaction against the
ball of the foot.
72
73. Cont..
It is essential that the antero-proximal force
against the tibia be kept at as high a level as
possible.
Shortening of the distance a results in
increased inclination of the line of the postero-
distal contact force and in a transfer of the
force away from areas surgically prepared for
end-bearing.
73
74. REFERENCE
AAOA Atlas of amputation & limb deficiency
,Third edition.
Orthotic & Prosthetic in rehabilitation by
Michelle M.Lusardi.
www.endoliteindia.in
www.ottobock.in
Website of ossur, kingsley symes,RSL stepper.
American journal of prosthetic & orthotic.
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