AFO Update

AFO Update:
Kevin's AFO has a very large heel wedge to accommodate his left foot. He also has had 2 small removable heel lifts in his left shoe. In mid-June, PT took one of the removable heel lifts out and two weeks later he removed the other heel wedge. This gives me hope that the brace is making some very gradual change in that left foot.

PT's Notes:

Back in December of last year Kevin was demonstrating about -10 degrees of ankle dorsiflexion (upward movement of the foot), in other words you could not bring Kevin’s foot within 10 degrees of a neutral position. Very limited weightbearing was present in his left foot in stance and no weightbearing with sit to stand transfers. We set his AFO (the brace) in 15 degrees of ankle plantarflexion (foot down), with a shank to vertical angle of 15 degrees. Additional ¼ in heel wedge was added to the left shoe to increase angle and decrease effort needed to achieve full heel contact. When ambulating with left AFO, gait pattern improved minimally with gradual increase in stance time of left lower extremity and increasing hip extension during ambulation. Heel strike of left lower extremity occurred < 50% of steps. At this time We have removed removable heel wedges reducing the plantarflexion angle, as Kevin has improved his ability to achieve heel strike (>75% of steps) and hip extension with near equal stance time left and right lower extremity. Most notably Kevin is demonstrating increased ankle dorsiflexion, initially -10 degrees improved to about -2 degrees. Although 8 degrees may seem small, Kevin met his goal to improve by 5 degrees and is now prepared to possibly reduce shank to vertical angle in AFO as it has become easier for Kevin to get his heel down when ambulating.

Stair Exercises:

Jon had to put a handrail on the right side going up the basement steps so Kevin can hold on with his right hand. The object of our step therapy is to get him to alternate his feet instead of always leading with his right foot. This is going to help him use some muscles in his left leg and it's also a good cross pattern. When we first started this exercise, I had to gently hold his right leg back from jumping ahead of the left when it was the left leg's turn to lead. After a week, I only had to tap the right leg to hold it back. Now I only have to tap his leg a few times and then he alternates his feet independently. Luckily he has always enjoyed going up and down the steps.

Standing Exercises:
weight shifts; anterior trunk lean (we like to call it "knocking on the window"); & squats