Friends,
A physio asked me to see a patient today who has an unusual presentation. A
CVA 5 years ago has left very few residua apart from increased tone in the
pre-tibials on the affected side. This results in clawing of the toes and
inversion. It almost appears to be “intention spasm” because the tone
appears to increase as she moves her foot but it can be quite relaxed at
rest. My patient complains that this problem is painful.
The usual physio regime is followed (stretches, tone reducing patterns
etc) with little cumulative effect.
The Physiotherapists’ question was “Is there an orthotic treatment which
might assist?”
My thoughts: the plantarflexion is not enough to warrant an AFO for the
usual ‘footdrop’ reasons; a standard AFO will help to re-align the foot but
would not prevent the toe clawing and designs which attempt to hold the
toes in neutral would probably create new problems because of the tone. I
am tempted to suggest that the isolated nature of the spasm warrants means
other than orthotic, such as Botox but I would like to have your opinions
on this one please.
Richard Ziegeler (P&O, OT)
