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Eric O'Guinn, CPO

4/5/2010

Hello List,

 

I would like some input on a problematic orthotic/prosthetic case. See
below:

 

I have recently seen an 85 year-old female of slight build and quite active
given her condition. TTA on the right and shortened/weakened left LE
stemming from polio. Additionally, she suffers from RA and has some large
nodules on the plantar aspect of her left MTH’s 2 and 3(symptomatic). She
presented in our clinic one year ago with a symptomatic right TT residuum
(erythema and localized edema about the distal tibia) and symptomatic MTH’s
of the left foot caused by pressure as she bore weight on the non-padded
full length foot plate of her solid ankle AFO.

 

She was subsequently re-fit with a suction TSB socket on the right and a
high profile Arizona style circumferential wrapping solid ankle AFO with ¾
foot plate and accommodative insert to relieve the pain the left forefoot.
These new appliances succeeded in improving function and eliminating the
painful symptoms. I will also note the addition of a lateral flair to her
left shoe to increase frontal plane stability as she tends to weight shift
to the left side, leading to increase genu varum and unstable gait.

 

At a recent follow-up(one-year), she notes that it appears to her that she
is now in-toeing more. At my initial eval I noted a marked in-toeing at
approximately 8 degrees. I do not feel it has increased, but the patient
does and I want to ensure that the orthosis or contralateral TT prosthesis
are not contributing to progression of the in-toeing. I believe the hips
are level and there is no functional LLD at present.

 

Additional info: S/P left THA 20 years ago. MMT of the left hip induced
pain upon abduction and flexion. Hip function rates 4/5 in
flexion/extension/adduction. 3/5 hip adduction. The left LE presents with
rigidity in the talocrural and ST joints and severe weakness in all planes,
hence the AFO. No recurvatum. Assisted by single point Canadian crutch. I
have made a referral back to the prescribing ortho.

 

Any thoughts from the list on either changes/additions to the current
appliances, other ideas, other considerations?

 

Eric O'Guinn, CPO