The L'Nard company makes a splint that does a nice job of supporting and pressure relief for the heel and the toes, as these are free of the splint. However, my first inclination would be to try casting him, serially, first in order to get his foot in a better position if he truly has contractures. This would make it easier to prevent the loss of ROM by use of splints. His overall body position is also very important. He needs to be OOB and in chair with a pressure relieving cushion to promote all the good things that come with sitting (for the lungs, for cognitive stimulation), including a perfect opportunity to have gravity assist with flexion of the knees and hips, with support of the ankle in dorsiflexion by the footrest of the chair.
Hope this helps. Good luck.
Charlotte Chatto, MS, PT, NCS
>>> Renee Cordrey <[log in to unmask]> 01/06 8:48 PM >>>
I have a patient in my sub-acute unit who presents quite a positioning
problem. He has a head injury, with severe tonal problems, and strong flexor
withdrawal. We can position him well, but as soon as we let go, he begins to
move out of that position, putting pressure on his toes. He has ankle,
mid-foot and toe flexion contractures, and dorsal toes are usually on the bed.
Consequently, he has recurrent pressure ulcers on the dorsal toes. Any hard
orthotic would cause a problem.
Has anyone seen an orthotic that could assist with this problem? It would
need to cover his toes, or prevent him fro flexing his leg enough to get them
on the bed.
Renee
--
Renee Cordrey, MSPT, CWS
"He's the best physician that knows the worthlessness of the most medicines."
Ben Franklin, Poor Richard's Almanac, 1733
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