I would like to thank everyone who responded to my AFO situation.
Question:
I am presently working with a 8 yr. old girl diagnosed with Cerebral Palsy.=20 =A0=A0This young lady presents with severe pes plano valgus (navicular on fl= oor=20 and head of talus exposed upon weight bearing) on her left side coupled with= =20 a moderate amount of crouching. =A0However, on her right side she is quite a= =20 bit stronger and only presents with a mild/moderate form of pes plano valgus= =20 and very mild crouching (may be caused by a compensatory gait deviation due=20 to LLD and left leg deformity). =A0Her balance is good and does not need any= =20 assistive devices to ambulate. I am comfortable recommending a Floor Reaction AFO for her left side but I a= m=20 not sure about her right side. =A0On the right, she is flexible in all range= of=20 motion and grades at least 4- in all MMT. =A0Isolating her right side, an=20 articulating AFO may sound like the best choice.=20 However, my question is this: If I was to apply a FRAFO on her left, and an articulating AFO on her right,= =20 would the significant difference in the control of the AFO’s significantly=20 compromise her gait? =A0She is presently wearing SMO’s and in my opinion, ar= e=20 of little benefit to her. =A0I would appreciate any feedback from anyone who= =20 has had experience with this type of case. Thank you
Patti Larkin
Answer:
As to your question: “Brace to the minimum.” Use the least restrictive brace that deals with the problem, don’t worry about “uneven” bracing. The alternative would be to over-brace the right in an effort to “balance” the orthoses. However, locking the ankle unnecessarily does the child a disservice, making it more difficult to get up from the floor.
Have you tried valgus correction extensions on her. I suspect that if you=20 align the foot your patient has a plantar flexion contractureas the primary=20 cause of the other symptoms. have you tried to muscle test for hamstring=20 contractures. the combination of these two problems is exactly what you=20 discribed. look also for hyper lordosis and or hip flexion contractures. I=20 currently have a patient with distal spinal muscular atrophy that presents=20 the same way. =A0check for these things and let me know what you find.
why not make a FRAFO & let her walk with that on the left side & her SMO on=20 the right – then the question of whether two different designs will=20 negatively affect her gait will be answered without costing you anything
interesting post – let me know how it works out
First buy the following videotape and do a Preparatory AFO. You need to get the foot ready for an AFO!=A0 If you do the AFO well then the foot will chan= ge in a very short time, and you can make it over under your warranty provision. Or you can use a Preparatory AFO idea that takes only 20 minutes to create a new one. Flexcast Video Web Site
Just a thought regarding the mild crouching on the stronger side….It may b= e=20 reasonable to go with the left FRAFO and continue to use the SMAFO on the=20 right so you can assess how more flexibility on the right with better left=20 control works out.=A0 I find that even mild crouchers sink into free DF and=20= I=20 haven’t been very satisfied with DF stops.=A0 This suggestion assumes that y= our=20 child lives within an easy distance to allow for extra visits.=A0 Good luck
I no longer worry about the consequences of significant variations of orthoses design for bilateral applications.=A0 A long time ago I was introduced to the phrase “the anatomical function lost is equal to the mechanical function replaced.”=A0 It still works for me today. You may wish to look at the Cascade family of products for your little girl
It sounds to me like the biggest problem is a contracture of her Gastroc.= =A0=20 Check her range of motion with her hindfoot and forefoot in neutral, with he= r=20 knee flexed then extended.=A0 I think you will find a plantar flexion=20 contracture which must be accommodated for in the AFOs.=A0 If you do not=20 address the deforming force the foo t will still collapse.
why not make a FRAFO & let her walk with that on the left side & her SMO on=20 the right – then the question of whether two different designs will=20 negatively affect her gait will be answered without costing you anything
interesting post – let me know how it works out
