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Ankle equinus from compression at L4-L5-S1

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Vernon Lever, Aug 24, 2009.

  1. Vernon Lever

    Vernon Lever Active Member


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    Hi, I have a 78 year old male who has had an MRI that shows compression of the sciatic nerve roots at the L4-L5-S1 levels. He has no pain, but walks with what we call a "clunk foot" or slapping gait. The left foot is in equinus, and there is weaknes of the tib ant muscle. Do you think a standard drop foot splint would help? Regards, Vernon
     
  2. efuller

    efuller MVP

    What you have described is a drop foot from ant tib weakness. From your description I'm not sure whether it is a drop foot. In gait, during swing does the patient lift the knee really high so that he can clear his plantarflexed foot and does the forefoot strike first? In this case a dropfoot brace would be more helpful. A "clunk foot or slapping gait" sounds more like the heel hits first and there is rapid plantarflexion of the ankle after heel contact. This would imply that there is some ant tib strength that is dorsiflexing the ankle in swing and then the weakness is not slowing plantar flexion. In this situation fatigue may be a factor. After walking for a while the ant. tib may lose strength and a true foot drop may develop. At some point a patient will look at the tradoff between strapping this thing on and walking a little better versus just making do and decide that it's not worth it.

    An equinus is when there is limited range of motion of dorsiflexion of the ankle. Nothing in your post makes it look like he has an equinus.

    Regards,

    Eric Fuller
     
  3. Hi Vernon, definently a good place to start. Especially if he has developed balance problems as well.

    The gait will improve, balance and propulsion.

    Michael Weber
     
  4. Graham

    Graham RIP

    If he has some active dorsiflexion but this is weak I would use a Richie Brace with a tamarak dynamic dorsiflex assist joint. Of course I would also add a sgittaly oriented foot plate also.

    This works well
     
  5. Vernon Lever

    Vernon Lever Active Member

    Yip he definatly has balance problems. I think I will try the drop foot splint and see how we progresses. Thanks for your help. vernon
     
  6. Vernon Lever

    Vernon Lever Active Member

    Thanks for your reply, surly if he cannot dorsiflex his ankle to 90 degrees (due to tib ant weakness) one can say that the ankle is in equinus. As per your definition
    "An equinus is when there is limited range of motion of dorsiflexion of the ankle."
    Maybe my terminology is incorrect, but thanks for your post. Regards, Vernon.
     
  7. Vernon Lever

    Vernon Lever Active Member

    Thanks for your reply.
    Can you assist me in describing what exactly a "tamarak dynamic dorsiflex assist joint" is?

    Regards,

    Vernon Lever.
     
  8. efuller

    efuller MVP

    My definition was off. An equinus would be where no one is able to dorsiflex the ankle. (Active or passive.)

    regards,

    Eric
     
  9. david3679

    david3679 Active Member

    Another brace I have used that may be a good start is a Footup I think
    made by Ossur
    http://www.ossur.co.uk/pages/10372/

    have had good results and also a cheaper start point

    Regards

    Dave
     
  10. Sammo

    Sammo Active Member

    Also, consider having a look at the Toe Off products from Allard: http://www.allardusa.com/

    I've dispensed a couple of these and the patients really like them. Maybe better than the polyprop ones, but you'll pay more for them.

    Regards,

    Sam
     
  11. david3679

    david3679 Active Member

    Sam

    Have never seen that device before looks good

    dave
     
  12. Sammo

    Sammo Active Member

    Hi Dave,

    I have a couple of patients that have gone into it in the last few weeks, and we have another at the hospital that has been in one for a year. All of them love it. It weighs next to nothing and the springyness/energy return system (or whatever mumbo-jumbo they call it) allows a more natural gait pattern that a rigid polyprop AFO (IMO).

    Expensive though....

    S
     
  13. Graham

    Graham RIP

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