title: Hindfoot containment orthosis for management of bone and soft-tissue defects of the heel.
abstract: BACKGROUND
  Bone, soft-tissue, and nerve deficits of the weightbearing surface of the foot are frequent sequelae from foot trauma or diabetes mellitus and present challenging treatment issues. Injury to the specialized, shock-absorbing, heel-pad tissue containing spirally arranged fat chambers is particularly difficult to manage. Appropriate footwear modifications and shoe inserts for protection of this skin are essential to the long-term management of bone and soft-tissue defects of the heel. This study evaluated the performance of a new custom total contact foot orthosis (Hindfoot Containment Orthosis, HCO) which was designed to contain the soft tissues of the heel, reduce shear forces, redistribute weightbearing load, and accommodate bone or soft-tissue deformity of the heel.
  
  
  METHODS
  Twenty-two patients treated with HCO were retrospectively reviewed. Followup averaged 26 months. The effectiveness of the orthosis was assessed by how well the integrity of the soft tissue was maintained (e.g. the number of ulcerations since dispensing the orthosis), the number of refabrications of the orthosis that were required, and whether or not revision surgery was required.
  
  
  RESULTS
  Ten patients had superficial ulcerations. No patient required revision surgery. A total of 62 refabrications of the orthoses in 22 patients were required over a 2-year period. Overall results were good in 17 (77%) patients, fair in four (18%), and poor in one.
  
  
  CONCLUSIONS
  The HCO is effective for preservation of soft-tissue integrity of the heel pad after bony or soft-tissue injury. Important factors in achieving success with the HCO are patient compliance and periodic monitoring for refabrication of the orthosis to accommodate skeletal growth, change in foot size or shape, and compression or wear of insert materials.
authors.affiliation: Department of Orthopaedic Surgery, Washington University in St. Louis, School of Medicine, 660 S. Euclid, Campus Box 8233, St. Louis, MO 63110, USA. johnsonje@msnotes.wustl.edu
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
authors.forename: Jonas R
authors.initials: JR
authors.lastname: Rudzki
authors.forename: Erick
authors.initials: E
authors.lastname: Janisse
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Janisse
authors.forename: Ray R
authors.initials: RR
authors.lastname: Valdez
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Hanel
authors.forename: John S
authors.initials: JS
authors.lastname: Gould
mesh_terms: D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006365:Heel / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices / Q000009:adverse effects; D012189:Retrospective Studies; D012883:Skin Ulcer / Q000209:etiology