Hemiparesis patient orthoses help!
I have a patient with right-sided hemiparesis following meningitis and CVI as a child. Due to the developmental delay on this side, she also has an LLD with associated scoliosis.
Her barefoot gait is of a spastic dropfoot (in essence) with ground contact occuring first on the forefoot with the toes going into extreme plantarflexion, making barefoot walking extremely painful as the toes curl right under the forefoot. The heel does not appear to make ground contact and the ankle is unstable into inversion / eversion, causing tib post dysfunction (which is her problem and pain).
My quandry is how to cast her and wether an AFO would be any better than an orthotic (perhaps plus shoe modifications). Just to explain, she has no control over the spasticity and could go into spasm at any point during the casting procedure.
Has anyone been here before? Perhaps custom-made is not the way to go, thereby avoiding the casting procedure altogether?
Any help would be appreciated!