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Discussion in 'General Issues and Discussion Forum' started by Ian Linane, Jan 31, 2005.

  1. Ian Linane

    Ian Linane Well-Known Member

    Members do not see these Ads. Sign Up.
    A simple query.

    Mid 60's male who had polio at 5 years age that affected the left low leg and foot. No deformity of the foot but no foot extension capability and weakened musculature all round the foot but a very tight Tendo Achilles.

    Comes regularly for chiropody treatment and over the last 6 months I've taken to mobilising the joints and putting stretch on the muscles. This was done as a part of the treatment, from my own curiosity but without him knowing why. From the outset he claimed to have been tripping up less with this affected foot.

    I can think of some reasons why but wondering if any others who have done this can comment. He has booked in for 3 once weekly sessions with a view to massage from just above the knee and mobilisation of the joint downwards. The aim is to see if this improves things further.

    Any comments welcome, so too any input.


  2. Atlas

    Atlas Well-Known Member

    I am no polio or neuromuscular dysfunction expert, but what you are trying makes sense to me.

    I am assuming that the patient was tripping up because of a foot-drop impacting on toe-clearance. :confused: So what we have had here over a long period is a relatively plantar-flexed ankle due to (neuro-muscular) weakness in ankle dorsi-flexors, resulting in (Davis' law?) short constricted tight ankle plantar-flexors.

    So instead of just "fighting" gravity, these weak ankle dorsi-flexors must now overcome tight antagonists. That is why your treatment makes sense, and appears to be working. While not directly helping the polio neuro-muscular issue, you are reversing the secondary changes, and reducing the torque needed to dorsi-flex the foot.

    For the same reason, many physio/physical therapist who apply evidence-based practice, are infatuated with stabilisation/strengthening; not that there is anything wrong with that. The problem is that they are ignoring the plethora of secondary problems including tissue-length, alignment, underlying joint dysfunction, compensations etc.
  3. Orthican

    Orthican Active Member

    I have worked with many polio patients over the years and what Atlas has indicated regarding agonist/antagonist relationship is spot on with what I have noted. In addition, it is fairly important for that patient to recieve such treatment because as time goes on there may well be further changes regarding neuron loss from attrition that will further weaken the affected groups.

    And I unfortunately have to agree also with what Atas has indicated regarding physiotherapist interventions. This is something I see far too often in my stroke survivors as well. Physiotherapy will release them from hospital considering them "done" because certain treatment parameters were met. The patient is sent back home with fairly serious gait deviations and no help getting around save for the walker they were told to get. Also the patient is most often not told about other things that can be done to help regarding an orthosis. When the patient figures out this it is usually a year or more later and considerable equinovarus with tone has taken place. Makes it far more difficult for me at that point and leaves me wishing I had seen them right away.
  4. NewsBot

    NewsBot The Admin that posts the news.

    Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome.
    Vreede KS, Henriksson J, Borg K, Henriksson M.
    J Rehabil Med. 2013 Aug 27.

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