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To evaluate the use of an immediate postoperative prosthesis (IPOP) for transtibial amputees, we compared patient outcomes from a prospective clinical study of 19 patients managed with an IPOP with those of a retrospective review of a matched historic control group of 23 patients managed with standard soft dressings. Data were analyzed with the Student's t-test, and significance was set at P=0.05. The IPOP patients had no surgical revisions, whereas the patients with standard soft dressings had 11. This was a significant difference. IPOP patients also had significantly fewer postoperative complications and shorter times to custom prosthesis than did controls.

Custom-made orthotic devices are beneficial as preoperative and postoperative modalities. At the outset of treatment, a combination of casting and bracing may be instituted. The decision to employ a brace or cast is generally determined by the pathologic condition the patient presents with and whether a conservative or surgical course of treatment will follow. In many cases, the decision to treat conservatively is the first option to assess the response of the patient and allow the pathologic condition to become stable. When dealing with soft tissue injury or breakdown, casting is optimal because of the fluctuation of tissue mass and the consequent changes in the condition of the tissue. Casting allows the physician to examine the patient at regularly scheduled intervals and to observe the progress being made. It is likely that the patient will remain compliant with the suggested treatment when a cast is applied because of its restrictive nature. When the patient is stable and the soft tissue is normalized, more permanent immobilization or support may be introduced. When addressing tendon injuries, it is important to determine beforehand the course of treatment so that immobilization, healing time, weight-bearing status, rehabilitation, and return to function are entered into in a timely manner. Early immobilization with weight bearing and application of load to the injured tendon is more beneficial to the patient, resulting in an earlier return to function and activity. Frequently the physician prescribes specific duration of casting, intermediate bracing, weight bearing, and range-of-motion therapy to optimize the return to

We evaluated the ability of seven devices to immobilize a prosthetic ankle-foot complex against plantarflexion, dorsiflexion, inversion, and eversion forces: two casts (plaster of Paris and Fiberglas®) and five removable braces (molded ankle/foot orthosis, composite boot brace, pneumatic boot walker, nonarticulating fracture boot, and ankle stirrup). Each device was applied to a prosthetic ankle-foot complex and evaluated on a test frame for resistance to sagittal motion and coronal torque. Results showed that casts offered significantly (P ≤ 0.05) more resistance to motion in all directions tested than did the braces. The resistance offered by the devices tested depends on the conformity of the device to the shape of the foot in that plane and the material properties of the device. Braces offer the advantage of being easily removed and reapplied. Different braces offer specific advantages and disadvantages in different planes tested, and immobilization selection should be individualized based on this information.

We evaluated an adjustable pneumatic prefabricated prosthesis and a rigid custom-molded prosthesis for immediate postoperative use. Twelve transtibial amputations were performed on cadaver limbs. Differential variable reluctance transducers were placed subcutaneously across the wound edge medially and laterally. The limbs were then placed in either the pneumatic prosthesis (five limbs) or the rigid prosthesis (seven limbs). The specimens underwent static and cyclic loading to simulate weight bearing. The strain readings for static and cyclic loading were greater in the rigid prosthetic group. Only the mean medial strain measurement after cyclic loading was statistically significant. The results demonstrate that the pneumatic prosthesis places less strain across the wound than a rigid prosthesis.

PTT dysfunction is the most common cause of adult acquired flat foot deformity. The aggressive nonoperative approach has become accepted more widely, in part because of the advances in orthotic and bracing technology and options. Many patients with a PTT dysfunction can be treated effectively with conservative management protocols. The goal of alleviating pain and correcting deformities is being accomplished with the proper application of the wide spectrum of orthotic modalities available today.