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A simple query.

Mid 60's male who had polio at 5 years age that affected the left low leg and foot. No deformity of the foot but no foot extension capability and weakened musculature all round the foot but a very tight Tendo Achilles.

Comes regularly for chiropody treatment and over the last 6 months I've taken to mobilising the joints and putting stretch on the muscles. This was done as a part of the treatment, from my own curiosity but without him knowing why. From the outset he claimed to have been tripping up less with this affected foot.

I can think of some reasons why but wondering if any others who have done this can comment. He has booked in for 3 once weekly sessions with a view to massage from just above the knee and mobilisation of the joint downwards. The aim is to see if this improves things further.

Any comments welcome, so too any input.

Thanks

Ian

I am no polio or neuromuscular dysfunction expert, but what you are trying makes sense to me.

I am assuming that the patient was tripping up because of a foot-drop impacting on toe-clearance. So what we have had here over a long period is a relatively plantar-flexed ankle due to (neuro-muscular) weakness in ankle dorsi-flexors, resulting in (Davis' law?) short constricted tight ankle plantar-flexors.


So instead of just "fighting" gravity, these weak ankle dorsi-flexors must now overcome tight antagonists. That is why your treatment makes sense, and appears to be working. While not directly helping the polio neuro-muscular issue, you are reversing the secondary changes, and reducing the torque needed to dorsi-flex the foot.

For the same reason, many physio/physical therapist who apply evidence-based practice, are infatuated with stabilisation/strengthening; not that there is anything wrong with that. The problem is that they are ignoring the plethora of secondary problems including tissue-length, alignment, underlying joint dysfunction, compensations etc.