Re: Questions on a case

Re: Questions on a case

Paula Martinek

11/21/2008

To give you a little more detail: in gait she starts with the right leg and drags left leg to, not through. She seems to be unable to flex the knee and hip of left leg, so she is not swinging the left side through. She keeps the left foot in about 7 degrees of plantarflexion, so that she is bearing weight on the ball of the foot in stance. She can swing right leg through, still plantarflexed on the left. If she concentrates she can get her heel to the floor while standing, thus bringing ankle to nearly neutral. Her foot can be brought to neutral while sitting and with knee in extension and sitting. There is no heel rise in the AFO. When she is wearing the AFO she can't drag the foot through in swing phase. She steps with the right and then it seems as if her left foot gets 'stuck' and she can't move. As far as muscle strength, hamstring strength is poor, along with hip flexion on left side. Quad strength on left is fair. Dorsiflexion is poor. So besides having weak hamstrings her knee is tightening up with weightbearing making it almost impossible to flex the left knee.
  It's the fact that her left leg is getting 'stuck' with the left AFO on that is odd to me. I would imagine the brace would allow clearance and facilitate swing phase, but the opposite seems to be happening. I have to assume that in bringing the foot to neutral is stretching the achilles and the gastroc muscle too much, thus adding to the spasticity of the knee and the hip.Paula Martinek, LPO> Subject: RE: [OANDP-L] Questions on a case> Date: Fri, 21 Nov 2008 15:34:03 -0500> From: <Email Address Redacted> > To: <Email Address Redacted> > > What is happening at her foot and ankle during stance? Can she stand> flat on the foot but chooses plantarflex left ankle to clear the Rt leg?> If she is standing on left foot, assuming it is in 90 deg at ankle, is> the foot loose or hypermobile? If her body feels unstable on a loose or> unsteady foot, is there some overcompensation more proximal?> > Pat Peick CPO> > > > > OANDP-L is a forum for the discussion of topics> related to Orthotics and Prosthetics.> > Public commercial postings are forbidden. Responses to inquiries> should not be sent to the entire oandp-l list. Professional credentials> or affiliations should be used in all communications.