Overview
A personal and tailored approach to every Claimant is central to Scott Frame’s ethos. This young mother had been struggling for four years after a car crash. These recommendations have the potential to offer a clear, orthotic treatment plan, to maximise her recovery and quality of life.
Instruction requirements
Condition and prognosis to:
Provide a full and detailed report on the Claimant’s orthotic needs on short, medium, and long-term basis with appropriate costings.
Background
The Claimant, a mother in her mid-twenties, was a rear-seat passenger in a road accident where a vehicle collided with a stationary object, experiencing significant forces. As a result, the Claimant’s injuries included multiple fractures at her pelvis, and, most significantly, a severe injury to the right sciatic nerve.
The Claimant underwent multiple rounds of surgery to repair the nerve damage, which were unsuccessful, and therefore continued to present with a drop foot and subsequent clawed alignment in her toes.
The Claimant had received orthotic provision from the NHS to help with mobility, including two drop-foot devices and insoles. She also received insoles from private provision. The Claimant did not report any benefit from these devices, and disposed of them in favour of selecting well-fitting, cushioned ‘retail’ footwear.
Scott Frame’s assessment findings
- Loss of sensation of dorsal aspect of mid-foot and toes.
- Claimant’s injured foot was more pronated (lower arched) than the unaffected contra-lateral limb.
- Marked retraction of the toes (rest in a high, clawed position) on the injured limb.
- The Claimant has a ‘drop foot’ on the injured limb; being unable to articulate the ankle into a safe and efficient position to gain ground clearance during swing phase.
- Odema of the affected foot and ankle.
Scott Frame’s recommendations
Based upon the Claimant’s four-year history of unsuccessful orthotic use and her reported lack of desire to use an external device to manage her ‘drop foot’, I have recommended treatment be focused upon managing her foot shape with footwear. However, I am of the opinion, that she would likely consider reviewing the use of orthotic treatment later in life, due to a need to manage symptoms associated with hyper pronation (low arched) and the risk of trips and falls due the ‘drop foot’.
Recommendations for the next 5–10 years:
- Allowance for purchasing suitable retail footwear – A small allowance to enable the Claimant to source wider and deeper fitting footwear, with appropriate footwear design features
- Compression hosiery
- Annualised clinical review
Recommendations (only if) Claimant decides to engage with Orthotic treatment; estimate, 10-years onwards:
- Suitable retail footwear
- Compression hosiery
- Ankle foot orthosis (a lower leg splint) to manage the drop foot
- Prescription insoles
- Annualised clinical review
Costs
As a rough guide, the annualised costings for the recommendations made within this case were:
Years 0–10
Annualised costs: £150–350
Years 10 onwards (if Claimant engaging in treatment – clear rationale provided in report)
Annualised costs: £800–1200
Life expectancy: Full
