Question on spina bifida patient

Question on spina bifida patient

Paula Pivko

3/13/2013

Hello all I have a young Spina Bifida patient, currently wearing floor reaction AFOs. He has a crouched gait, and knee valgus of about 25 degrees when standing, along with tight hip adduction that almost gives him a scissor gait when walking. The AFOs are about 5 years old so I plan to replace them, he is 30 years old. In addition to a functionally fused ankle his forefoot is in about 7 degrees of supination on the left, 4 to 5 degrees on the right, and his heel can be held in neutral. His current AFOs have a wedge on the bottom and outside of the footplate to accommodate this supination. I was thinking for patient comfort it might be better to form an insert from pelite or other material onto the cast, do a buildup on the insert to come to neutral, and then pull the plastic for the AFO portion. This patient has stated discomfort in the arch area of the current AFOs. I call upon your vast experience to give me any insights into what has worked for you. Thank you very much as always, Paula Martinek, LPO