Orthotic/Prosthetic Case Study
Robert Schiff
Description
Collection
Title:
Orthotic/Prosthetic Case Study
Creator:
Robert Schiff
Text:
Hello all,
I came across a very interesting and challenging case today and
thought I would share it with the community and see what the general thoughts
were.
Pt. is Rt. Trans-femoral amputee(still with sutures) and Lt. severe
equinovarus contracture. Pt is relatively in good health NOW but has been
through the mill causing her to severely decondition and is overweight. Pt.
has natural history of hyperextension of both elbows and knees of about 10 or
15 degrees. Before the amputation, an MRI was done on the Rt knee that
revealed very little cartilage left. She and I inferred that since both
knees were bothering her at that time the Lt. knee is in about the same
condition. As far as the equinovarus, it is severe. About 25 degrees or so
plantarflexion contracture and the plantar fascia is so tight that her first
three toes curl down when I passively dorsiflex her foot. Very rigid
contracture. Odd that her 4th and 5th toes aren't curling as well? Anyway,
she also supinates and inverts to the degree that when standing she is
practically on the lateral side of her foot.
No diabetes, No tone, No PVD, Only painful on lateral border of foot
when standing, No pain in knee presently, Sensation is 100%. All MMT are
WNL. Obvious compromises to ROM.
I have begun fabrication but was curious as to other practitioners
thoughts and experiences. Obviously, the Rt. leg is not going to be
addressed for now. But the Lt. leg will and hopefully we can work toward the
Rt. leg someday. Thanks for the input.
Robert Schiff C.O., L.P.O.
P.S. Oh, and when she stands, her hyperextended knee allows for some of the
plantarflexion but she begins to supinate and inverts so much because of
tightness(not tone) that she gets the pain on lateral border of foot. And
she can only presently stand in her deconditioned state for about 30 seconds
to 1 minute at best.
I came across a very interesting and challenging case today and
thought I would share it with the community and see what the general thoughts
were.
Pt. is Rt. Trans-femoral amputee(still with sutures) and Lt. severe
equinovarus contracture. Pt is relatively in good health NOW but has been
through the mill causing her to severely decondition and is overweight. Pt.
has natural history of hyperextension of both elbows and knees of about 10 or
15 degrees. Before the amputation, an MRI was done on the Rt knee that
revealed very little cartilage left. She and I inferred that since both
knees were bothering her at that time the Lt. knee is in about the same
condition. As far as the equinovarus, it is severe. About 25 degrees or so
plantarflexion contracture and the plantar fascia is so tight that her first
three toes curl down when I passively dorsiflex her foot. Very rigid
contracture. Odd that her 4th and 5th toes aren't curling as well? Anyway,
she also supinates and inverts to the degree that when standing she is
practically on the lateral side of her foot.
No diabetes, No tone, No PVD, Only painful on lateral border of foot
when standing, No pain in knee presently, Sensation is 100%. All MMT are
WNL. Obvious compromises to ROM.
I have begun fabrication but was curious as to other practitioners
thoughts and experiences. Obviously, the Rt. leg is not going to be
addressed for now. But the Lt. leg will and hopefully we can work toward the
Rt. leg someday. Thanks for the input.
Robert Schiff C.O., L.P.O.
P.S. Oh, and when she stands, her hyperextended knee allows for some of the
plantarflexion but she begins to supinate and inverts so much because of
tightness(not tone) that she gets the pain on lateral border of foot. And
she can only presently stand in her deconditioned state for about 30 seconds
to 1 minute at best.
Citation
Robert Schiff, “Orthotic/Prosthetic Case Study,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/219319.
