A Prosthetic Replacement For Congenital Forefoot Meromelia

William E. Gazeley, M.D. William Sampson, CP.


In the February 1967 ICIB we described several prosthetic solutions to congenital forefoot meromelias1. Since then, we have developed another type of prosthesis which seems to be superior. It was made for the child presented on page 19 of the earlier article, who has a Chopart-type amputation. A new approach to her problem became necessary because of continued breakage of the appliances with which she was fitted. After careful study it was our opinion that this breakage was caused primarily by the rigidity of the construction. The stresses of walking applied to this rigid structure caused stump breakdown and/or prosthetic failure. Therefore, flexibility in the affected areas was sought.

Fabrication

A rigid socket, formed of polyester-impregnated nylon stockinette, is elongated about one-half inch beyond the end of the stump. The resulting space is filled with Silastic (RTVS-5370 foam, 100 percent). The socket is then split in half, and relief areas are cut for the malleoli, after which it is rejoined by an innersole of belting material. A shell of the forefoot section is formed by attaching masking tape to the belting. This shell is filled with Silastic (RTV S-5370 foam, 75 percent; RTV 382 firm, 25 percent). The prosthesis is then completely covered and lined with horsehide. An elastic strap is fastened to the top of the socket to hold it firmly on the foot (Fig. 1-3). The patient is able to don the prosthesis easily by flexing the heel cup portion of the socket backward.

Fig. 1

Conclusion

It is premature to draw long-range conclusions concerning the effectiveness of the present construction. However, this prosthesis has proved durable and the patient has been quite satisfied with it. She is able to change shoes easily and finds the prosthesis comfortable when walking.

Fig. 2 and 3

William E. Gazeley, M.D. and William Sampson, CP. are associated with the Child Amputee Clinic Sunnyview Hospital and Rehabilitation Center Schenectady, New York

References:
1. Gazeley, William E., "Congenital Foot Deformities Requiring Surgery and Prosthesis in Lisfranc1s Amputations," ICIB, February 1967.