Monday, May 23, 2022

Arizona AFO– too much brace?

Gretchen Wellman

Hello everyone,

I’m a little torn about this patient I just evaluated yesterday. Petite 81 year old female, lives alone, reports she was diagnosed with RA years ago but never put on meds. She presents with normal left side, long-time right knee genu valgum with slight pes planus. She already wears bilateral foot orthoses from a doctor that seem to be doing well. She reports to me diffuse knee pain (along with her shoulders, her hands) and what sounds like nerve pain in the foot-when asked for detail, she explains that it is mainly the distal arch just proximal to the 1st met head but combines with toe pain. (She initially thought she was diabetic because of it, but that has been ruled out.) The toe pain is the same for both feet but on the right she occasionally gets shooting pain up the foot and into the leg. The pain is not aggravated by movement or walking, she says; it hurts most at night. Swelling is occasionally an issue but not typically.

Examination shows little play about the knee; her manual muscle tests were all surprisingly very good for her age. Range of motion is good. Frankly, she looks better than I would expect, especially considering the long-term deformity at the knee. The physician has requested an Arizona AFO but I am concerned that is overkill. No real deformity at the foot/ankle, without a lot of motion or laxity, don’t know how much it would do at the knee, particularly since everything seems to hurt. Also, she only wears “house shoes” or, when outside, men’s slip on shoes.

Thoughts? I’ve put in a message to the referring physician but haven’t heard back yet.

Thanks in advance,

Gretchen Wellman CO
Northern Orthopedics

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