1111 - Use of an Ankle-Foot Orthosis with a Silicone Toe Filler in a Pediatric Patient with a Chopart Amputation

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

SK

Swaramsi Katragadda, MD

Resident Physician
Marianjoy Rehabilitation Hospital
Wheaton, Illinois, United States

Co-Author(s)

SM

Sarah Macabales, DO

Resident Physician
Marianjoy Rehabilitation Hospital
Wheaton, Illinois, United States
LP

Larissa Pavone, MD

Attending physician
Northwestern Medicine Marianjoy Rehabilitation Hospital
Wheaton, Illinois, United States

Case Diagnosis: A 2-year-old male who was diagnosed with nonmetastatic fibrosarcoma in left foot at 4 months old and is status post Chopart amputation of left foot at 7 months.

Case Description: The patient recovered with minimal complications after Chopart partial foot amputation (PFA). He was able to ambulate barefoot, but unable to wear shoes due to the shape of his foot and inadequate fitting. When out in the community, the parents would not allow the child to walk barefoot therefore they used a stroller. The patient presented to gait clinic at 28 months and was fitted for an AFO with silicone shoe filler. The full prosthesis was not chosen due to its bulk given the patient’s size. Prior to AFO and shoe filler, the patient's gait was notable for left knee hyperextension with increased weight-bearing on lateral left calcaneus. Minutes after being fitted with the AFO and shoe filler, gait analysis showed decreased hyperextension of the left knee, a more symmetric gait pattern, and similar velocity with improved step length.

Discussions: Adult patients with Chopart amputations are typically fitted with either high-profile or low-profile prostheses that aim to restore limb length while providing gait assistance. In our pediatric patient, his size and expected growth posed barriers to using these full prostheses. The combination of plastic AFO and silicone shoe filler is both less bulky and more accommodating to a growing limb. The patient demonstrated improvement in gait symmetry and step length with immediate use of the partial prosthesis.

Conclusions: This case suggests that use of partial prosthesis is effective for gait assistance in pediatric patients with a PFA. Further investigation could compare the use of partial versus full prosthetics in children with PFA stratified by age groups and/or activity levels given that their needs may differ from those of adult patients.