Follow up on Achilles Pain
John D. Hatch
Description
Collection
Title:
Follow up on Achilles Pain
Creator:
John D. Hatch
Date:
2/14/2003
Text:
Here is my original post:
I have a 78 year old male with a long history of peripherial neuropathy resulting in bilateral drop foot. He considers his left leg the weaker one. He has been wearing bilateral posterior leaf spring AFO's and walking with a cane. He was only able to walk four blocks.
He presents with flaccid drop foot, ROM's within normal limits except for dorsiflexion which is limited to 3 degrees. He has minimal sensation from mid calf and distally. Dorsiflexion strength is 2/5, plantar flexion 3/5. Knees are essentially within normal limits for motion and strength except his left quads fatigue with extended use causing him to feel like his left knee will give away This occurs once a week.
I fit him in August 2002 with bilateral solid ankle AFO's in 2 - 3 degrees of dorsiflexion to control his drop foot and stabilize his knee's in neutral. He immediately discarded his cane and began walking with a heel toe gait without fear of falling. He has since increased his walking to 3 miles a day at what he terms and aggressive speed.
In the last week he has developed proximal achilles pain that is greater on the left than the right and is eliminated if he returns to his posterior leaf spring AFO's and cane. His feet are contained securely in the AFO's without slipping up and down during gait. His heel's are all the way down in the AFO's.
The solid ankle AFO's should prevent achilles motion and irritation while the poster leaf spring AFO's allow motion that would seem to aggravate an achilles problem.
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Thanks for the responses. They can generally be grouped into two suggestions.
1. The pain is produced by constant maximum stretch on the achilles.
2. The pain was exacerbated by his rapid increase in activity level.
I refabricated the AFO's at 90 degrees, suggested that he reduce his activity level and slowly increase it back to where he would like it to be. He has now slowly returned to his desired level of activity and maintained it for one month without reoccurrence of the pain.
Thank you for the thoughtful and learned suggestions.
John D. Hatch CPO
Englewood, Colorado
I have a 78 year old male with a long history of peripherial neuropathy resulting in bilateral drop foot. He considers his left leg the weaker one. He has been wearing bilateral posterior leaf spring AFO's and walking with a cane. He was only able to walk four blocks.
He presents with flaccid drop foot, ROM's within normal limits except for dorsiflexion which is limited to 3 degrees. He has minimal sensation from mid calf and distally. Dorsiflexion strength is 2/5, plantar flexion 3/5. Knees are essentially within normal limits for motion and strength except his left quads fatigue with extended use causing him to feel like his left knee will give away This occurs once a week.
I fit him in August 2002 with bilateral solid ankle AFO's in 2 - 3 degrees of dorsiflexion to control his drop foot and stabilize his knee's in neutral. He immediately discarded his cane and began walking with a heel toe gait without fear of falling. He has since increased his walking to 3 miles a day at what he terms and aggressive speed.
In the last week he has developed proximal achilles pain that is greater on the left than the right and is eliminated if he returns to his posterior leaf spring AFO's and cane. His feet are contained securely in the AFO's without slipping up and down during gait. His heel's are all the way down in the AFO's.
The solid ankle AFO's should prevent achilles motion and irritation while the poster leaf spring AFO's allow motion that would seem to aggravate an achilles problem.
_______________________________________________________________________-
Thanks for the responses. They can generally be grouped into two suggestions.
1. The pain is produced by constant maximum stretch on the achilles.
2. The pain was exacerbated by his rapid increase in activity level.
I refabricated the AFO's at 90 degrees, suggested that he reduce his activity level and slowly increase it back to where he would like it to be. He has now slowly returned to his desired level of activity and maintained it for one month without reoccurrence of the pain.
Thank you for the thoughtful and learned suggestions.
John D. Hatch CPO
Englewood, Colorado
Citation
John D. Hatch, “Follow up on Achilles Pain,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/220608.
