Orthomerica Whole Limb Solutions

The History

Photo of Dr. Larry SuecofI have successfully incorporated the OWLS program into my diabetic wound practice as a viable alternative to total contact casting in patients with plantar heel and forefoot ulcers. The custom orthoses reduce shear forces to the foot while stabilizing the foot and ankle complex and reducing pressure to the affected site.

Larry A. Suecof, DPM, FACFAS, CWS

Successful treatment of the diabetic foot ulcer depends on many medical variables. One thing that remains constant — the pressure, trauma, or deformity that caused the wound must be corrected and relieved.

When the patient with Diabetic Peripheral Neuropathy exhibits gait deviations due to ankle instability, foot deformity or contracture, repeated micro trauma may cause ulceration to a particular part of the foot. Contractures of the achilles tendon can often lead to midfoot, forefoot, or digital ulcers. Likewise, ankle instability or a lax achilles tendon can contribute to heel ulceration in the insensate limb.

Most diabetic ulcers are secondary to an orthopedic anomaly and neuropathic foot. Healing success and healing time depend on medical factors such as a patient's general health, controlled A1C, vascular health, and weight, to mention just a few. Maximal correction and unloading of the anomaly is imperative for the fastest possible positive outcome.

In 2005, Jeff Miller C.O. began providing orthotic wound care to what became a large segment of the diabetic population in Hartford, Connecticut. The attending surgeon challenged his staff to develop an orthotic wound program that would complement the ongoing wound therapies and post-operative care being offered at the Wound Center.

The Goal: To keep our patient population ambulatory while stabilizing the foot and ankle and supporting or correcting the limb to promote all of the health benefits associated with mobility.

The OWLS™ Program is a culmination of ten + years of clinical orthotic development — accommodating diabetic ulcers classified Wagner 1-4 with custom orthoses while correcting and stabilizing the ankle complex.

As a Wound Center team member, Jeff had the opportunity to develop close professional relationships with the other team members including Podiatric, Vascular, and Plastic Surgeons.

Not only is wound care interesting and rewarding, it is an effective way to network your Practice! Orthotic care is a very important component of a comprehensive wound care/limb salvage program.

Any questions or inquiries regarding any of the Custom Wound Orthoses or our treatment plans can be directed to Jeff Miller C.O., Clinical Services Manager. (800) 446-6770 x207

WHO™

WHO — Heel or Forefoot Relief

Heel or Forefoot Relief Wound Healing Orthosis

Custom to Cast or Scan from all industry standard file formats. Features: Liner made from ¼” aliplast foam, outer shell constructed of polypropylene for maximum control of the foot and ankle complex. Molded anterior internal shell to limit shear forces and lock the leg in securely. Tri-laminated foot bed consisting of two densities EVA and one layer of P-Cell® to help protect the foot during treatment. The forefoot design may be constructed as a solid ankle or with articulated ankle and plantar-flexion stop in patients where ankle motion is desirable.

Indications

  • Any orthopedic anomaly that requires stabilization or support for ambulation
  • As a stage two device when daytime ambulation is desired
  • Used as a post-operative walking orthosis
  • Post TAL Procedure
  • Wagner 1-3 wounds where un-weighted ambulation is desired

WHO — Midfoot/Walking AFO

Midfoot/Walking AFO

Custom to Cast or Scan from all industry standard file formats. Features: Liner made from ¼” aliplast foam. Outer shell constructed of polypropylene for maximum control of the foot and ankle complex. Molded anterior internal shell to limit shear forces and lock the leg in securely. Tri-laminated foot bed consisting of two densities EVA and one layer of P-Cell® to help protect the foot during treatment. The foot bed may be designed to provide wound relief at the midfoot or forefoot. An outer sole has a rocker at the forefoot to provide transition to toe off during ambulation. Distal plastic guard helps protect toes.

Indications

  • Any orthopedic anomaly that requires stabilization or support for ambulation
  • Relief for midfoot ulcer during ambulation
  • Post-TAL with plantar ulcer
  • Immediate post-op forefoot or midfoot amputation
  • Post Charcot support and Rocker Foot support
  • Post-Calcanectomy

WHO — Chopart/Lisfranc Relief

Chopart/Lisfranc Relief

Custom to Cast or Scan from all industry standard file formats. Features: Liner made from ¼” aliplast foam. Outer shell constructed of polypropylene for maximum control of the ankle and amputated site. Molded anterior internal shell to limit shear forces and lock the leg in securely. Tri-laminated distal end pad with an extra 3/16” P-Cell® cushions amputation site during ambulation.

  • Immediate post Chopart or Lisfranc amputation
  • Protection of amputation site during ambulation
  • Delayed closure at amputation site
  • Relief for ulcer/wound which develops post Chopart or Lisfranc amputation

 

shark-o™

Charcot Orthosis

Charcot Orthosis

Custom to Cast or Scan from all industry standard file formats. Features: Liner made from ¼" aliplast foam. Outer shell constructed of polypropylene for maximum control of the foot and ankle complex. Molded copolymer anterior internal shell to limit shear forces and lock the leg in securely. Tri-laminated foot bed consisting of two densities EVA and one layer of P-Cell® to help protect the foot during treatment.

Indications

Used for the prevention and management of pressure ulcers caused by ischemia, direct trauma and/or repetitive stress often found in persons with:

  • Diabetes Mellitus
  • Charcot deformity
  • Decreased sensation and/or paralysis
  • Foot fractures

 Learn more about what makes the shark-o unique here.

ADO™

Advanced Diabetic Orthosis

Advance Diabetic Orthosis

Custom to measurements. Features: Inner lining made from soft foam to help protect the skin. Outer liner constructed of firm EVA to maintain shape while accommodating volume changes of the leg. Rigid posterior shell constructed to allow full heel relief in every plane while maintaining the ankle angle at 90°. The extended foot section extends beyond the toes to help protect the toes from ulceration. ADO has a non-skid sole to allow patients to ambulate short distances in the home.

Indications

  • Wagner 1+ ulceration of the heel. (Can be constructed to accommodate malleolus and forefoot wounds).
  • Post-operative wound care. ADO easily accommodates a wound vac.
  • Post-Calcanectomy

EvenUp™ Shoe Balancer

The EvenUp Shoe Balancer may be worn over existing footwear to level height of the contralateral limb.

Features & Benefits

  • Two height adjustments: 1.0cm with 1 layer or 2.1cm with both layers
  • Four Universal (left or right) sizes to accommodate any foot, while reducing inventory.
Size Model # Women’s Size Men’s Size
SM 136.41 6 – 8½ 6½ – 8
MD 136.42 9 – 11½ 8½ – 10½
LG 136.43 12 – 14 11 – 13½
XL 136.44 14½+ 14+

 

Testimonials

I am pleased to let you know my second OWLs patient, who was a bilateral fore foot and heel, is officially healed in both wounds after 2 months and 20 days. It had been suggested, strongly, on numerous occasions, that he have his toe amputated due to osteomyelitis. The patient refused every time and I believe he is no longer at immediate risk for an amputation. He will continue in both boots for a while and then transition to diabetic shoes.

Thank you for a wonderful product. It is changing how we manage our wound care patients and truly saving limbs. Wounds are healing faster than expected and patients are tolerating the AFOs well. Please send my thanks to Dr. Suecof, as well.

Lisa D. Rubrich M.S., C.O.
Mercy Health System Orthotic and Prosthetic Center

In my brief use of the OWLS Boot I have seen over 45 patients with various Wagner Scale planter grade neuropathic diabetic ulcers. The results have been remarkable, with 80 percent of the patients healed and discharged; the remaining 20 percent are successfully progressing. Because of the unique characteristics of the OWLS Boot adjustability, its use with edema and infected wounds, the various boot profiles for wound site locations makes the OWLS Boot an excellent choice for wound care management.

As a remarkable example, I fitted a woman who had not walked in three years due to bilateral heel ulcers. After being fitted with the OWLS Boots she stood on the first day with her walker and left the clinic walking. Her heel ulcers have totally healed after 8 weeks with the use of this boot.

I can with full confidence recommend the OWLS Boot to all who work in Wound Care Management.

Riccardo Gonzales, LPO
Hanger Clinic, Inc.
Tyler Texas

Education

The ABC Accredited Distance Learning course Latest Advances in the Orthotic Management of Diabetic Patients worth 2.5 CEUs is available for free, here.

Patient Ambulation Video