Thanks to all who responded to my query about foot spasm. I post the
original to clarify and all of the responses.
Thanks again, Richard.
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I worked with the same problem recently and tried a wraparound type
orthosis trimmed to allow full PF/DF. It controlled the MILD hindfoot
varus and forefoot adduction during swing. I extended it to the end of the
toes and molded in support just posterior to the MT heads with the idea
that I could
increase this support as necessary. I extended the toes slightly just
ahead of the MTP. This individual, in addition to clawing of digits 2-5,
had a tonal great toe extension which was controlled during WB in this
orthosis.
Problems: difficulties fitting it into a sneaker, non-acceptance of an
appropriate shoe. She is to have a Botox treatment shortly and if this is
effective, she certainly won’t need the orthosis. I used 3/32 PP pulled
thin around model as my goal was to try to make this as thin as possible.
Looking
forward to the responses to this ?. Molly Pitcher CPO
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Hello,
we have made good experience with toe ortheses made of silicon. We make a
form of the toes with a silicon paste. With this form we make a positiv wax
model, so we can correct the toes position. In the begining of the
treatment it is important not to correct the clawing totaly, because this
would increase the spasm.
After finishing the wax model, we form a special silicon paste with 20
Shores over this model. After hardening we grind and smooth the toes
ortheses.
It is been worn under the socks and can be combined with a conventional
AFO.
If you need a more detailed description, please send a mail.
Greetings
Michael Maier
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I have used the Dynamic overlap AFO design. I use 1/8″ pp for an adult –
pulled thin over the dorsum. I also include all of the standard tone
reducing lumps and bumps….just for the heck of it. This system has worked
very well for controling intrinsic foot tone for me. good luck .
– Stephanie Langdon-Bash CPO, FAAOP
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>At the Queen Alexandra Center we use a molded silicone elastomer to make a
sulcus crest or sometimes called a toe separator. This creates a block to
keep the toes streached out and prevent painful pressure to the distal ends
of the toes. Warning-it is not easy to mold to a spastic foot.(Product
available from Berkman in 250g container called Berkoplast).
Seth Locke CPO
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Hello! This is a contraversial issue amoung orthotists. I imagine you
will recieve variable responses. I have two thoughts, or maybe three. A
solid ankle AFO with tone reducing modifications or a rigid/ semirigid foot
orthosis with tone reducing modifications. There are journal articles
supporting both of these two situations. You first would have
to determine if ankle motion in the saggital or coronal plane is
eliciting the spasticity. If ankle motion alone is aggrivating the
tonic/spastic response in the absence of knee and hip extension then the
foot orthosis would be indicated. If ankle motion is causing the
spasticity to increase or be elicited the solid ankle AFO would help. Also
check into a UCB type orthosis with tone reducing modifications.
This is better indicated when the spasticity occurs without ankle motion.
Good Luck Debra M. Auten
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I would try the patient in a “dynamic AFO” design to control the end ranges
of dorsi and plantarflexion and would hold the foot in a stable neutral
position. I have made them for adults out of 1/8th inch copolymer. The
proximal height would be at the widest part of the gastroc. Posterior
trimline would be
similar to a dorsiassist trim but then the plastic is left at the
supramalleolar level and wraps around the forefoot. The footplate would be
well-molded to support all the arches of the foot including the peroneal
arch, longitudinal arch, and metatarsal arch. The toes should be supported
in an
extended position but not hyperextended–more like a supported shelf for
them to rest.
This is a common design used with CP kids and some MS and hemiplegic
patients. They like it because it allows mobility in dorsi and
plantarflexion but gives their foot a very solid and appropriate base of
support. I have often reinforced the posterior aspect with parachute cord
at the point where the
orthosis tends to flex. I have had some breakage through the ankle flexion
point but most patients do not have trouble with this. Parachute cord has
worked better for me than carbon fiber reinforcement.
Good luck!
Dulcey Lima
NovaCare
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I must confess I find your post regarding the CVA a little confusing. If
the spasticity is in the pre tibials it would be unusual to have a
plantarflexion contracture and also an inversion problem. It sounds more
like either a flexor withdrawal pattern or a typical equino varus extensor
spasticity problem the reasoning being that the varus is created by
spasticity in Tib post which is of course a posterior compartment muscle.
Assuming that it is the latter then an AFO which partially corrects the
problem would be appropriate. If the equinus is not correctable to neutral
then an AFO moified to accomodate the position would then require heel
wedging with a similar wedge on the contralateral side. There is also some
evidence which shows that Met domes may help the toe clawing and of course
if you control the overall pattern it will almost certainly help the
clawing. It sounds like a big challenge. Good luck.
Phil Francis.
email [email protected]
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I suggest a good podiatric physician in your area might give you some
insights into the functional biomechanics of the patient with an unstable
foot. If one can control the subtalar joint with a rigid functional foot
orthotic with a negative cast taken in subtalar joint neutal yuu have a
good chance in reducing this myofascial contractures. If a polypropelene
device is
fabricated I would then suggest an eva or ppt topcover with extension to
the distal aspect of the toes.
Someone schooled in “Root” biomechanics certainly can be of help.
Richard Stess
President STS
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Richard, as we Americans would say, “You hit the nail right on the head.”
This is not a case where orthotic intrevention will solve the problem.
There is need of pre-orthosis intervention of either surgery or chemical
treatment.
Terry Supan, CPO
Associate Professor
Director, Orthotic Prosthetic Services
SIU School of Medicine
