J. EON TUCKER AND ROBERT L. RHODES
M any children with cerebral palsy have ankles with mediolateral instability. They are traditionally managed with the Phelps-type ankle-foot orthosis which is restrictive and uncosmetic. Our objective was to design a system or device to control instability with minimal restriction while being as cosmetic as possible. A shoe developed by John McMahon, C.Ped., Atlanta, GA, having a lateral heel was modified to become the "buttressed" shoe.
A curved piece of exposed x-ray film or waxed cardboard is shaped to conform to the outer border of the shoe, either on the medial or lateral side. The curve of the film should flow from the curve of the shoe to the metatarsal region and should flow into the curve at the heel. The curve should extend proximally to pass at least I cm (1/2 in) proximal to the axis of the subtalar joint. At the sole, it should be curved smoothly, without bulging. The shoe is deglazed and roughened with sandpaper and the film is attached with masking tape. The area is then filled with prosthetic foam. After the foam has cured, it is shaped and covered with leather. The sole is finished with I to 3 mm Neoprene soling material. We have fit the "buttressed" shoe to three patients. One is currently wearing his fourth pair. The technique provides a cosmetic, cost effective, efficient means of controlling mediolateral foot instability.
University of Michigan Medical Center Hospital, 1500 East Medical Center Drive
1D220, Ann Arbor, MI 48109-0042