Biomechanical Inefficiencies in Post Polio Patients
Gait modifications and disabilities are common in survivors of the infectious disease poliomyelitis; the calf muscles and stability of the ankle and knee are the most frequently compromised in the lower extremity of these individuals.
In order to compensate for these functional deficits, patients adopt altered gait strategies to avoid their centre of pressure from progressing anterior of the ankle joint which diminishes external dorsiflexion moment at the ankle joint.
Drop foot or the inability of an individual to adequately dorsiflex the foot is also commonly observed in this population; this is indicative of weakness in the muscles controlling dorsiflexion of the foot namely, the tibialis anterior, extensor hallucis longus and extensor digitorum longus.
Orthotic treatment of drop foot, as described by clinical prosthetist Jeremy Farley, typically involves bracing with an ankle-foot orthotics to provide toe clearance while the affected limb swings and stability while the affected foot is on the ground.
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There is limitation placed by the orthotic on the speed at which the foot plantar flexes during loading response and prevents the foot from dropping during the swing phase of gait to decrease the risk of stumbling.
While discussing therapeutic care of post-polio patients’ gait, Genêt et al. advocate focusing on the prevention of falls and fractures in this population by maintaining proper knee joint range of motion and by monitoring foot deformities such as pes cavus, pes valgus, flat foot, flaccid foot and talipes calcaneus foot deformity.
The authors list out classic gait patterns observed in polio patients as shoulder swing limp pattern, Duchenne’s gait pattern, locked knee, walking with the hand on the thigh to lock the knee, isolated knee recurvatum, 4-step and pendulum gait patterns – all of which can be detrimental to the musculoskeletal system if left untreated.
Depending on the severity and extent of the individual’s condition, the use of MASS4D® customised foot orthotics would be recommended as a means of managing aforementioned foot deformities while promoting stability of the ankle and knee for the prevention of falls and fractures.
MASS4D® foot orthotics can help to minimise compensatory movements and normalise gait patterns in post-polio patients in order to enhance mobility and to protect these individuals from the onset of several other conditions related to the lower extremity.
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Related Links
Prevention and Assessment of Fall Risks in the Elderly
Managing Stress Fractures with Orthotics
Orthotic Therapy for the Pes Cavus Foot
References:
- Genêt, F., Schnitzler, A., Mathieu, S., Autret, K., Théfenne, L., Dizien, O., Maldjian, A. (2010) Orthotic Devices and Gait in Polio Patients. Annals of Physical and Rehabilitation Medicine: 2010, Vol. 53, No. 1, pp. 51-59. DOI: 10.1016/j.rehab.2009.11.005
- Farley, J. (2009) Controlling Drop Foot: Beyond Standard AFOS. Lower Extremity Review: October 2009. Retrieved from: http://lermagazine.com/
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