Members do not see these Ads. Sign Up.

Hi All,

Question: a patient presents with extremely restricted AJ through tight Achilles Tendon (equinus approx 25-30 degrees) causing an abducted gait, and you have referred for surgical opinion to lengthen said Achilles Tendons only to be informed by Orthopedic Surgeon they are not willing to perform the surgery (no other reason given) Should I seek a second opinion? If the answer is still no to the surgery any suggestions as to the type of CFO this patient would need?

NB: all his previous CFO have proved unsuccessfull as they haven't addressed the AJ restriction.

Cheers
Steve

 

Why is his AJ dorsiflexion limited?
When you say his Achilles is tight do you mean that his gastrocs and/or soleus is tight?
Can you attempt to make his AJ dorsiflexion better without surgery?
Is he symptomatic?

 

Hi Lorcan,

Thanks for your reply and great questions. I saw this patient over 18 months ago and from memory (moved locations so no access to the file) the AJ limitation is caused by both Gastorch and Soleus tightness caused by some form of spasticity. Hence why I sent for surgical opinion.

I believe he was symptomatic with pains in both feet

aside from massage, stretches, perhaps ART, Accupuncture and shoes with a gradient along with significant heel raises to his CFO what other things could I try to increase AJ dorsiflexion?

Cheers
Steve

 

Hi Steve

Is it a true spasticity due to neuro input or lack of?

If you think its just a basic tight calf you could try doing a autonomic inhibition exercise.
Any good physio should be able to help with that. I have the luxury of having a physio in the next room. This is the video of the calf release we give our patients. Really need find reason for calf tone before knowing what to do the release it.

https://www.youtube.com/watch?v=Xlj3RPPxR94

 

hi
i have a question on the video that was posted on autonomic inhibition exercise.
Does the patient have to actively dorsiflex the AJ or is it passive dorsiflexion by the patient?
and also
why is it important that the patient has their shoe on?

here is the video i am reffering to
https://www.youtube.com/watch?v=Xlj3RPPxR94

 

It's active dorsiflexion initially for autonomic inhibition of the calf followed by passive ie pull the rope. The shoe is so the patient doesn't hurt their foot with the rope.

 

If its caused by spasticity, there is not much point lengthening as it will only tighten again. Botox would be more approriate through a neuro physio or Rehabilitation Consultant.