Questions on a case

Questions on a case

Paula Martinek

11/21/2008

Hello all I have a client I would like to get opinions on. She has some type of spastic muscle disorder. When she walks she has a dropfoot, locked knee and hip, so basically she is walking on the ball of her left foot and drags the left leg behing the right. The right side is also stiff, but less so. We made her an AFO with adjustable joints and stop set in neutral, which she can obtain with knee extended in sitting. However, and completely opposite of what we expected, she was unable to move her left hip at all. She couldn't drag the foot through. I thought that being in neutral was making the knee and hip too tight, in a kind of chain reaction, so we reduced the stop and dropped the foot into 3 degrees of plantarflexion. This seems to help, but on standing the knee is locked and really does not flex at all to allow swing phase. This is whether she is wearing the AFO or not. Wearing the AFO seems to affect her ability to move her left hip. We have tried a heel lift in the right shoe, did some gait training, and recommended therapy for stretching exercises. We were also thinking of a knee brace or a KAFO on left which would lock out extension, set in 10 degrees flexion, allow full flexion. That way we could relax the achilles tendon and hamstrings in stance phase. If you have any other comments or suggestions they would be appreciated.
Paula Martinek, LPO