Hi Kevin
Members do not see these Ads. Sign Up.
Hope you don't mind me putting your name at the top on this thread but it is really a divergence from another thread in which you have spoken about adapting orthoses and low dye tape approaches. However I am using a question to you as a possible Kick start for this one. :D It is really an open question.
From the outset though I would say that whilst I am interested in the EBM that people will possibly throw at this I am also putting equal value onto repeated clinical based experience regards the main theme below.
Aside from your orthotic (prefab or custom), which in this instance I would refer to as hardware mechanical intervention, I would be interested in having:
1. Some idea of what level of value you place on hands on soft tissue work you possibly include in your treatment of, e.g., PF.
2. Further to that it would possibly be of interest to get some idea of the level of significance other practitioners hands on therapy plays in their treatment rationale.
If I can give an example:
Male, slim build, mid 70's
Slight CVA 12 years ago but healthy for age apart from that
Reasonably active for age
No medications
Presents with:
i) Pain to right foot diagnosed as PF by GP and other Pods. Further pain also occuring around the anterior and medial aspects of the right knee. Problem be present for over six months.
ii) Been through a polyclinic approach and had several pod sessions that provided OTC devices that have been modified (not the calibre of vasily types though).
iii) After no improvement the pod resorted to a couple of ultrasound sessions. No success and so the patient was discharged.
O/E
i) Would be classed traditionally as a pes cavus foot type, very limited eversion rom at the STJ beyond vertical, reduced stiffness in the tarsus with concomitant MTJ in roll at heel lift.
ii) Right foot much more externally rotated than left.
iii) No pain to the PF on grade 1-3 palpation but grade 4 and 5 levels elicit acute discomfort on palpation at the FDB proximal to the met heads ( I know this can be difficult to differentiate).
iv) Very acute pain to grade 1 palpation to the abductor hallucis of the right foot from slightly distal of the origin up to and including the insertion point.
v) Although his stroke was slight all those years ago it is certainly now apparent in the action of his right low limb and the way this function at ground contact and beyond and is a clear contributor to his knee pain.
Whilst I can see a place for "hardware" intervention and this is in process I would want to suggest that in this instance it will have been the soft tissue and gait re-education that will have achieved most before the orthoses even arrive.
This is my example but it is selected with the above points 1 and 2 in mind. I am not concerned about help with this person but the example illustrates the soft tissue role and hence my questions above.
Of course this may be a dead duck thread :boohoo:
Cheers
Ian
<
Ankle Brace
|
Cast Corrections
>
<
Ankle Brace
|
Cast Corrections
>
Loading...
- Similar Threads - Values intervention
-
- Replies:
- 7
- Views:
- 1,144
-
- Replies:
- 0
- Views:
- 5,514
-
- Replies:
- 4
- Views:
- 5,888
-
- Replies:
- 19
- Views:
- 9,522
-
- Replies:
- 1
- Views:
- 2,826
-
- Replies:
- 5
- Views:
- 7,306
-
- Replies:
- 39
- Views:
- 11,273