Friday, May 24, 2024

Challenging case question.



I am posting this for a colleague of mine feom the office.

Thanks in advance for all responses.

Keith M Smith CO LO FAAOP

Thank you to everyone in advance for your time. I recently had a patient that I would like input on. Patient is a 19 year old female with Osteogenesis imperfecta. Patient has a history of receiving multiple surgeries to the femurs and tibias bilaterally. Due to the surgeries, patient has developed a leg length discrepancy of 6” on her left leg. Per patient, patient has never worn a shoe lift. Patient believes she can stand on her left side and would like to become more independent out of her wheel chair. Patient is weak on her left limb with MMT of 2+ at the hip and knee, and MMT of 2- at the ankle in regards to PF, DF, inversion and eversion. Patient’s subtalar joint is flexible, and gets to +5 R2 ROM with the knee extended. Patient states she no longer has a knee cap on the left lower limb, and presents with knee laxity, allowing for up to 5 degrees of hyperextension.Patient has refused Physical Therapy due to the cost associated with her visits.
After discussing with the doctor, two orthotic options were considered. The first option was a left custom AFO with a 6” crepe lift with a rocker and tread on the bottom. The second option was a left custom AFO with a distal prosthetic adapter, a pylon and a SACH foot. The patient and doctor both preferred the second option, which is more of a “prosthesis” design. This makes sense as well for the patient since patient is weak at the hip and concerns were present about advancing such a large shoe lift. Has anyone had any experience with this type of orthotic/prosthetic design? What is your experience with fabrication and coding?
Please let me know your thoughts and I appreciate your time. Feel free to email me directly at [log in to unmask]

Alex Dieckmann

Sent from my iPhone


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