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Dear Colleagues

I have recently seen a 32 YO man who developed Guillaume Barre syndrome in 2001 with rehab finished in 2002. He was issued FFOs at this time.

He has grossly pronated feet to end range, although this corrects moderately. He has weakness of all lower leg muscles L>R with visible atrophy of the lower leg muscles. I am able to passively dorsiflex the ankle joints to 90 degrees (i.e. not fixed in plantarflexion) although this results in eversion and abduction so some STJ motion to get to this point

Gait examination reveals excess L/knee flexion in swing phase to compensate for L/drop foot, limited heel contact of L/foot and end range pronation.

He complains of medial and lateral ankle pain as well as forefoot pain on weightbearing, this worsens when he takes out the FFOs. He feels his "feet are getting flatter" and hence the FFOs are less effective. In relaxed stance the FFOs reduce some of the pronation but there's room for more control.

My question is would this patient be better off with an AFO for left side to reduce the passive plantarflexed position at Heel strike and improve medial stability rather than just an FFO, which may improve symptoms but not achieving optimal function for this patient?

Any thoughts on this would be greatly appreciated.

Sas Ahmadi
Podiatrist

I am no expert here, having involvement with just one case over time...but I believe you can expect further neural degen over time with increasingly poor proprioceptive return so at some point they pass beyond the realm of the foot orthosis into the zone of Ankle foot orthosis for the gains in increased neural return from the presence of the AFO higher up the leg....the patient should be able to offer you some logical feedback here about what they feel etc....and of course you can more solidly influence ongoing bony remodelling with things like UCBL or closely contoured AFO.....maybe a job for a prosthetist at some point?
Regards Phill Carter