Case Study
Post-Polio Syndrome
Background
75 year old female who contracted poliomyelitis at the young age of six. She underwent multiple surgeries and having tried callipers when she was younger but choosing not to use them, she has relied on her custom made boots and foot orthoses to give her the required support to undertake her daily activities.
Paralysis of the Right lower limb with foot drop, Right ankle equinovarus with forefoot adduction, cuboid has been subject to subluxation over many years which caused pain.
The Left rear and mid foot are in a valgus position with the forefoot abduction, a displaced navicular bone has been the subject of callous formation over a period of years. The left hallux underwent surgery many years ago which saw a metal pin inserted in the metatarsal-phalangeal joint , which has immobilized the joint resulting in a hallux rigidus.
Circumduction of the right lower limb during her gait cycle, requires the patient to concentrate on the elevation of the right hip and rotation of the pelvis and the “throwing’ of the limb forward to achieve the momentum required to ambulate effectively. Also the hyper-extension of the right knee during the swing phase of the left limb is required, locking the knee in a hyper-extended position allows the limb to accept the body weight allowing the left limb to swing through.
Treatment & Outcome
A Certified Pedorthist produced and supplied a pair of custom made above-ankle boots with bilateral custom made foot orthoses. A lateral low rabbit ear with internal lateral flare on the Right foot orthotic provides support at initial contact of the heel and mid foot, with a rocker component built into the foot orthotic, allowing for adequate toe clearance during the swing phase of the patient’s gait cycle, reducing the chance of falls due to catching of the toe of the boot.
The subluxated cuboid on the Right foot and calloused skin on the Left navicular are supported and offloaded with the custom foot orthotics. A reduction of the distal plantar surface of the Left orthotic allows the toe to push off without forcing the hallux into a dorsiflexed position during toe off, which without the reduction saw the patient experience sharp pain in the fused metatarsal-phalangeal joint.
