Orthotic Management of the Charcot Foot

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Interim Results of Relax Sock Audit
Prepared by Elaine McCurrach BSc (Hons), MBAPO,
SRPROS/ORTH Senior Prosthetist RES, NHS Lothian
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Phantom Limb Pain

• Reported Incidence varies - rare to 80
• Generally decreases postoperatively
• Severe chronic phantom pain 0.5-5
• Wide range of treatments
• Drugs -mirror box
• TENS -surgery
• Massage -psychotherapy
• Heat -hypnosis

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Literature Review

• The Efficacy of Farabloc in the Treatment of
  Phantom Limb Pain Conine et al (1993), Canadian
  Journal of Rehabilitation Vol 6, No. 3, 993, pp
  155-161
• 34 subjects
• Double Blind trial -placebo sock without metal
  threads.
• 21 showed some improvement but authors
  questioned clinical significance
• Only 2 reported near complete pain relief

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Literature Review contd

• Medipro study -20 patients
• 10 male 10 female, 10TT 10 TF
• Only 10 patients feedback was reported
• reports 83 had significant improvement

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Relax Sock Theory

• Umbrellan Material
• metallic threads
• Shield from Electromagnetic influences
• Faraday Cage

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Aim of Study

• To monitor the provision of Relax night socks
• To audit their effectiveness in the treatment of
  night-time phantom limb pain.

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Sample Frame

• Consenting adults who present with lower limb
  amputation night time phantom pain
• ability to understand study, questionnaire and
  use of sock experiencing night time phantom pain
• excluded phantom sensation, stump pain and
  primary patients.

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Pre-procedure Data Collection

• Initial Questionnaire session
• Form to determine suitability and consent for
  trial
• Patient information sheet
• Questionnaire with multiple choice and visual
  analogue scale to determine frequency and
  severity of pain

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Procedure

• Supplied with sock and instructions
• Used sock for 5 nights

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Post-procedure Data Collection

• Follow up questionnaire
• Determine whether used sock
• multiple choice and visual analogue scale to
  determine change in pain

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Results

• 4 participants (male, average age 55) completed
  trial so far
• 1 felt sock had no effect at all
• 3 reported a reduction in perceived pain at night
  (1 still took painkillers)
• All reported sock easy and comfortable to use

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Discussion

• Low numbers
• Placebo?
• Contact with Stump?
• Warmth?
• Future work -primary patients with healed wounds
  monitor pain medication

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Acknowledgments

• Sincere thanks to
• Francine Mitchell,
• Morag Marks,
• Yvonne Cuthbertson and
• the Prosthetic and Admin staff for their help.

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References

• The Efficacy of Farabloc in the Treatment of
  Phantom Limb Pain Conine et al (1993), Canadian
  Journal of Rehabilitation Vol 6, No. 3, 993, pp
  155-161
• Amputees and Phantom Limb Pain a literature
  review (Mouratoglou, Physiotherapy Practice
  1986, 2, 177-185)
• Phantom Pain a Natural History and Association
  with Rehabilitation (Houghton et al, Ann R Coll
  surg Engl 1994 76, 22-25
• Chronic Pain after Lower Extremity Amputation
  (Czerniecki et al, Critical Reviewa in Phys Rehab
  Med, 2003, 15 34 309-332

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