Dear List,
I am working with E.S. E. S. is a fifty year old, Caucasian woman with
lupus. She presents walking with care and the right L. E. in ext. rot. due
to pain. Her hx includes a fall on the ice one year ago sustaining fractures
of the tib-fib. and talus. The recent MRI reveals several nonattached
fragments on the ant. medial aspect of the talus. The area corresponds to a
clinically observable localized swollen, warm area on her ankle. She has
cavus feet. Plantarflexion and eversion are painfree. Dorsiflexion and
inversion are limited and painful. She does not tie her shoes all the way up
since any compression on the proximal dorsum is intolerable. E. S. reports
she wears high top shoes to bed to immobilize the foot and ankles. At present
she is limited to short distances of ambulation.
It is my assumption her pain is from the talus accepting an increasing load in
stance as DF proceeds. She is limited to neutral. Therefore, I have
recommended an orthosis to stop DF at the point of pain, or earlier. I
discussed a lt. wt, carbon graphite type of low profile AFO with free PF and
DF stop. The biomechanics of the pain and of the orthotic intervention has
been explained and understood by E. S.
Understandably, E. S. was not prepared for intervention of this extent. She
had expected a small little “whatever.” She has tried ankle wraps but her
dorsum is too painful.
The only other type of intervention I thought may help and be minimal was
rocker bottom soles.
My question is there something other than my ideas to satisfy the persons
requirements.
Thank you for your time and effort.
Don McGovern CPO
