The number of times a patient walked into my surgery and asked, ‘can I have a new foot?’ was a common occurrence. Perhaps this is no longer a joke? However was of the appearance of your foot after amputation? Michael Le-Rouse opens up options here at The Silicone Centre. Most people who experience mild foot problems can cope either by selecting shoes more carefully or just accept that odd anomaly. However, that odd look could well be due to a forced amputation and so the problem is much greater if you cannot overcome self-consciousness. While the bones of the foot are complex, the length of the forefoot is determined by five long bones called metatarsals (see figure above). Under normal circumstances these develop in such a way that each bone is slightly shorter and smaller than the next (see picture)

A Syme’s amputation ( top figure ), named after a Scottish surgeon in the 19 thcentury removed the foot at the level of the ankle. The objective behind these types of amputations will allow weight bearing on the remaining part of the foot, which means that the person can put weight on the bottom of the foot and be able to walk short distances, stand in the shower without the assistance of a prosthesis. The word prosthesis means an artificial body part. For this reason, and associated with better balance, this type of amputation is advantageous. Unfortunately, because of a congenital condition, disease or by accident these types of conditions are more common than is thought.

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I would like to talk about 3 types of Silicone devices to support foot care to provide functionality, comfort and appearance. Silicone is a great way to support foot drop. The best way to describe this is to imagine you cannot lift your foot upwards at the ankle. The drop foot is associated with some type of muscle weakness which arises again due to congenital defects often associated with nerves after injuries and may include the undesirable effects following surgery

I started my business ‘The Silicone Centre’ in 2016 to produce silicone prosthetic/orthotics for all types of limb loss and limb correction. As well as creating a successful business, through my talent and passion I would really like to raise the awareness and get the message out there to patients and individuals to highlight the life changing solutions available. While accidents might be rare, the majority of amputations across the foot arise due to circulation problems, infection and poorly controlled diabetes. An amputation to the forefoot (metatarsal) or middle part of the foot (midfoot) is often used at each level and has various names such as Chopart amputation (l ower figure ). One of the main benefits is that the patient is able to feel confident in open toe shoes, sandals or flip flops. I t has been 12 years now since I discovered the amazing way silicone can be used to benefit many orthopaedic solutions. The huge growth of social media is making people more aware, but to be honest I didn’t know much about it until I began my discovery in 2007. Before then I’d worked as an orthotic/prosthetic technician without realising its beauty. Even now I see patients that are so amazed it exists and wish they had known about it years ago.A single short metatarsal creates a short toe and so one solution is to lengthen the metatarsal. While we can do this there is an option to extend the toe itself. While it can be corrected, there are risks involved as with any surgery as well as the patient being left with an obvious scar. The condition of the shorter bone goes by the fancy name brachymetatarsia or hypoplastic metatarsal. This can affect one or more bones leaving them abnormally short so the toe is very obviously deformed and may overlap. Although this condition may result due to a congenital defect it may be an acquired condition. It most frequently involves the fourth metatarsal. An alternative solution is to use a silicone extension. These silicone toe extensions are made to measure, they are sculpted with fine detail to appear realistic and they also fit well with suction. We as a company during the past 6 months have had more requests regarding silicone toes than any other silicone device. It can be life changing for a person wanting to feel nobody will be drawn into staring at their defect. It helps with self-esteem and for most patients they feel they can walk along the beach/poolside barefoot for the first time in a long time. A cast of the ankle and foot is taken and rectified ready for the silicone to be applied. Unlike an ankle foot orthosis or A.F.O, the rigid support is applied in silicone across the shin and top of the foot (dorsum). This kind of silicone support is made to measure for maximum support and comfort. It can be worn with or without footwear and even used in water. I made a silicone foot drop support for a successful Paralympian and the results were amazing to see. Michael says, “Silicone is a great way to overcome so many solutions” As a former podiatric surgeon I came against some patients who were genuinely concerned about how their foot looked. While for the most part this might fall to the ladies, it certainly was not exclusive to the female gender. Surgery can offer some solutions but this comes with risk and sometimes disappointment. I came across Michael Li-Rouse, a specialist in silicone prosthetics and orthotics, and so his article is dedicated to some of the options available. In his article, he will discuss three methods of how crafted silicone can help feet. It is appropriate to advise that in many cases this highly technical work is outside traditional NHS provision. Let me introduce you to Michael and his wife Sarah, both Directors of The Silicone Centre . His story focuses on supporting patients their anxiety and fears, overcoming self-loathing after living with an abnormality. Michael’s story covers the subject of your foot after amputation…