Splinting/bracing of the hemiplegic ankle that plantaflexes inverts with supination of the foot.

[sibbles53]

Does anyone have any experience splinting the hemiplegic ankle and foot that plantaflexes,inverts and supinates at heelstrike and in stance.My patient is 21 and has had Bobath therapy since her stroke 1year ago.She
is able to walk independently with a wheely frame and ASO(ankle brace wih eversion control)but hates the frame and will not go out with her friends until independent with crutches or nil aids! The ASO does not adequately prevent inversion and supination to allow safe gait with crutches or nil aids.I have trialled an "off the shelf" AFO with taping of the foot to prevent supination and this worked well enabling a good gait pattern with crutches and facilitated gait with nil aids.The patient liked it because she felt confident positioning her ankle and foot.Iam sure she will regain her independence quicker with an AFO-however 'how it looks' is also very important ie:no calipers or T-straps! I have had other patients who have done well with a Ortholan AFO(dark skin colored )but I am not sure whether it would control the supination of the foot.Any ideas much appreciated! Thanks!

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[sabah]

Hey why don't you try the tone reducing AFO that is specially designed for the hemiplegic patients. Try that. It will solve the problem of inversion and supination.
Sabah

[perfphysio]

Try a product called the foot flexor. This is a fantastic device used by elite sprinters to encourage dorsi-flexion without statically fixing the ankle. I use it all the time with neuro patients however do not know of anyone else that does. All my patients have done extremely well with this device. It seems to me that she sounds like a bit of a "pusher" and probably needs more proximal stability work arount the hip joint with regards to her long term progress. I do agree with short terms assistive devices as long as the medium term goal is to do without them. :-)

[perfphysio]

The website for the foot flexor is Http://www.speed-fitness.com. Cheers richard

[kateDonegan]

can the muscle tone be changed by perhaps giving her more stability proximally to allow distal control and therefore increase her selective movement? Maybe also desensitisation techniques may help to directly reduce the tone and allow selective movement. I have had some luck using a device called a malleoloc which mimics a figure of 8 strapping technique to increase ankle joint stabiltiy and prevent inversion/eversion. Strapping I find is good in the interim but as a longer term measure its not the answer. I think also perhaps the device called a "toe off" similar to the one Richard is talking about may be worth trying. It aid the swing phase of gait and give some dosiflexion support. E mail me if you want any of the suppliers.

[sibbles53]

Dear NARSTR,
Can you tell me which company supplies Softcast by 3M ? I have never heard of it! (I am in Australia)
Also thanks to everyone who has e-mailed suggestions-much appreciated!
Has anyone seen Botox used to relax the ankle and foot in a case like this? I believe it is used more with C.P.children. Cheers sibbles53.