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8 ::  L. Perry
Lee is a 60-something fellow who, one year in January, went on a cross country ski trip one evening to visit some friends who were staying in a remote mountain cabin. On his way in, a blizzard descended, Lee lost his way, and spent the night under a pine tree. He located the cabin the next morning. Nobody was there, and in time Lee discovered that both feet were severely frostbitten. It was only through good fortune that Lee was able to get out of the woods to medical assistance. Both feet were partially amputated about half way between the arch and the ball of the foot (bi-lateral transmetatarsal amputation.) Also the skin on both heels was dead so good skin was harvested from his back in the scapula area and transplanted onto the heels.

Lee survived a life-threatening incident, and his feet were healed. But he was far from the end of his problems. As a geologist, Lee needs to walk in the woods. With his "new" feet, his gait was very limited. With half of each foot amputated, the normal function/bio-mechanics just wasn't working. His feet were unstable and very appropulsive. Plus, the leading edge of the skin graft on the heels was giving him trouble. If he would walk for 20 or 30 minutes, the graft would break loose, bleed, and he would be "laid-up" for several weeks to allow the skin to heal.

While Lee's work took him all over the west, he continued to search for someone to help him with his dysfunctional feet and footwear. The only footwear available for him was a pair of tennis shoes several sizes smaller than he previously wore. The shoes did not fit, so essentially he just stuffed his feet in. When he looked for help, a few people offered suggestions, most would just say "sorry." After three years of literally limping along with his disability, a rather unlikely series of events brought him to me.

After a careful exam and evaluation, we cast both feet to make anatomical lasts over which I could make appliances for his feet. These appliances functioned like an orthotic under-foot to compensate for the congenital varus condition that was increased by the amputation. The appliances had a toe (shaped like the toe of a shoe) that stuck forward from the stump increasing the length of the foot to give a more normal gait. This toe more or less functioned like the ball of his foot. I also constructed a tongue up the front of the foot.
As Lee strode forward this tongue would bear against the foot giving the appliance leverage for the new ball of the foot to work.

We also altered a pair of off-the-shelf hiking boots correcting for a leg-length issue and giving the boots lateral flares to provide stability to the feet. Last but not least, we added rocker soles to further improve the gait. His feet fit into the appliances and the appliance slipped into the boots.

Lee was delighted to say the least. He could now walk pretty much pain free and without fear of the graft breaking loose and bleeding. His gait was much more normal, which allowed him to get back to prowling the woods as he needed to do.

Every couple of years, we make a new pair of appliances for Lee and each time we modify them as we go. And while it is not as good as before the accident it is far, far improved over the non-fitting tennis shoes.
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