Don,
If this patient crouches more than 20 degrees, a floor reaction AFO
will help to hold him in as much an upright position as he can
achieve. This should help to prevent knee contractures from
increasing. I suspect that his ankles are also collapsing into
over pronation. If so, an attempt should also be made to control
this collapse.
I have followed a young man about the same age as your patient for
about 6 years. He was unable to tolerate complete control of his
over pronation nor full correction of his crouch(to the angle of his
contractures). His gait with his AFOs appeared very similar to his
gait without them. However, his AFOs allowed him to walk more
efficiently, using less energy and he didn’t tire out as quickly with
them on.
Harold Anderson, CO
> Date: 20 May 1998 17:15:23 -0700
> From: Don Freeman
> Subject: AFO’s used with Knee Flexion Contractures?
> To: [email protected]
> Reply-to: [email protected]
> Priority: NORMAL
> To O and P Community,
>
> I am interested in your experience with using orthoses on
> patients with knee flexion contractures.
>
> Specifically, I have an active 14yr old male with
> myelomeningocele with 20 degree bilateral knee flexion
> contractures. Surgery is not an option to decrease the knee
> flexion contractures.
>
> ROM: Hips
normal,Knees
to 140,Ankles
normal
> MUSCLE TEST: Hips and knees
normal, Ankles: Dorsiflexiors
zero, Plantar flexors
trace
>
> Questions:
> 1) Has any research been done on the use of AFO’s with knee
> flexion contractures?
>
> 2) What has been your experience fitting AFO’s with 20
> degree knee flexion contractures?
>
> 3)If a Floor reaction AFO is used does it provide an
> adequate knee extension moment throughout the gait cycle to
> improve their gait?? If so what position is the ankle best
> set in?
>
> 4 What is the maximum knee flexion contracture that can be
> accommodated with a floor reaction AFO?
>
> 5) Any suggestions, Titles of journal articles(source and
> author), or clinical experience would be helpful and
> appreciated! I will post the responses I receive.
>
> Thanks for your assistance,
> ———————–
> Don Freeman,CP
> Shriners Hospital for Children, Portland,Oregon
>
>
