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Help with rigid, fixed ankle

Discussion in 'General Issues and Discussion Forum' started by kemplr, Dec 20, 2012.

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  1. kemplr

    kemplr Member


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    Hi All,

    I am hoping for some advice on an 83 year old gentleman I am seeing. He has bilateral 'collapsed' ankles. Both are fixed in a valgus/everted position with no movement in any direction. There is no weightbearing on the lateral forefoot and lateral digits.

    The patient is a little vague and unsure how long they have been like this. He complains of pain but cannot describe the quality of pain. He denies numbness, pins and needles, shooting pain or tingling pain. The doctors (he is currently an inpatient) have diagnosed him with painful peripheral neuropathy. Currently has no sensation to 5.07 monofilament and reduced reflexes. Has not been for a nerve conduction study and they are not likely to refer him for one. I have tried opsite tape and stockings to see if that reduces any neuropathic pain.

    He is currently wearing an extra depth/width orthopaedic shoe with off the shelf vasylis - not sure who issued these or when. However I think they are causing extensive blistering to the medial border of the foot and I have since removed the orthotics.

    I have tried palpating the post tib tendon but the patient describes his pain 'just around the ankle'. The doctors are reluctant to send him for scans as they feel that it won't change his management and he has too many other co-morbidities. I don't think he would be suitable for calipers as he is too weak/frail.

    Is there anything else I could do for this gent?

    Cheers, Lauren
     
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Sounds like end stage PT dysfunction.

    Weaight bearing x-rays will be helpful to establish how much secondary OA is present.

    If it is a fixed rigid deformity, then accomodate the position with an orthosis or Richie brace.

    LL
     
  3. Boots n all

    Boots n all Well-Known Member

    Total Contact Orthosis, to cradle, not correct and an ankle boot(not pull on) with rocker toe and S.A.C.H

    This should be an easy concept for him to come to terms with and easy enough to don whilst giving cushioned/firm support.

    Cushioned = T.C.O & S.A.C.H
    Firm support = Rigid sole, firm heel counter
     
  4. kemplr

    kemplr Member

    Thanks LL and Boots. I was leaning towards end stage PTTD but my colleague felt it could be peroneal spastic flatfoot/tarsal coalition but obviously can not tell unless we had scans. The doctors are reluctant to scan as they feel that this would not change to outcome.

    I have never heard of a S.A.C.H heel modification but just checked it out and it looks like it would be beneficial. I will refer him to the orthotics/prosthetics department at the nearest tertiary hospital.

    Many Thanks for your advice.

    Cheers, Lauren
     
  5. Lucy Best

    Lucy Best Member

    I am an orthotist and agree with both suggestions. It would depend on how much walking/weight bearing this gentleman is doing and how much intervention he could tolerate. The boots with SACH heel and AFO can also be combined.
     
  6. Admin2

    Admin2 Administrator Staff Member

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