Crow Boot
(Charcot Restraint Orthotic Walker)

The C.R.O.W. is a combination of an ankle foot orthosis and a custom boot. The C.R.O.W. was developed for patients with severe charcot changes of the foot and ankle where a more traditional means of treatment was not satisfactory. The device is in essence a bivalved copolymer full foot enclosure ankle foot orthosis with a rocker bottom sole built on the device.

The orthosis is fully lined with a custom foot insert and custom formed to a plastic impression of the patient's affected limb. Appropriate modifications are performed to the impression, which permits for equal weight distribution through the limb and foot. The C.R.O.W. can be modified within limits to accommodate changes by flaring, adding padding and trimming where and when appropriate. It is very useful in protecting the patient from further breaks but not 100% as patients can and do fracture in plastic and fiberglass casts.

The C.R.O.W. is easy to don and doff. Patients can bathe daily and maintain proper hygiene. Many patients learn to drive with the C.R.O.W. Over all the acceptance is good due to availability of colors in the copolymers. The ability to bathe and sleep with freedom from a cast makes the C.R.O.W. a great asset.

Casting for the C.R.O.W

Casting
Casting a patient's foot at an angle of 90 degrees or as close to that position as possible is imperative for proper modification in the construction of the C.R.O.W. boot, as importantly, is the casting of the knee to the relationship of the foot.

Casting Preparation
Before casting place stockinette from the proximal section of the knee to the distal end of the toes.
A cutting strip of appropriate material at least 1" wide should also be applied. Place "T" foam covered with a plastic sheet in position under patients foot.

Positioning
Toes need to be slightly hypextended causing a natural rocker of the forefoot. The placement of "T" foam under the patient's foot will cause this when pressure is applied on the foot.

Weight Reduction
When the foot is casted in a rocker position, less material will be needed to create a walking sole on the C.R.O.W. boot itself, therefore a significant reduction in weight.

Casting Procedures
Place plaster strips over the distal end of the toes.
A clear reference by means of plaster strips will give you the exact starting point for the toe build up and modifications.
Mark bony prominences and potential problem areas with indelible pencil
Wrap leg using standard procedure of casting.

Posted: 10/9/2006