Hereditary Spastic Paraplegia

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64 y/o female presenting with HSP and bilateral foot problems, primarily ankle equinus, instability and overloading of lateral aspect of foot. Would appreciate advice and management guidelines for foot orthoses and surgery, in particular TA and soft tissue release.

Thanks in anticipation

MR

 

How rigid is foot deformity?

 

Not sure what the Ashworth scale values are for the ankle flexors, but in dynamic passive dorsiflexion there is approx. minus 10 degrees which suggests there is shortening of the triceps surae. No recuvatum of the knees.

 

My guess is that you are heading towards the need for a AFO with some accomodations for the pressure areas.

 

Thanks Craig. Thought as much for conservative management, but what is your view on performing a Z tenotomy of the triceps surae?