Compensating Weakness of the Quadriceps Muscles Due to Poliomyelitis Using a Custom-Made Orthopedic Shoe
By Fengler, Reinoud K.B.; Holtslag, Herman R.; Journal of Prosthetics & Orthotics, Volume 23, Number 4, pages 199-201Publication Date: October 2011
Case study outlines the design of a custom made orthopedic shoe for the purpose of optimizing gait in a patient with severe quadriceps weakness resulting from poliomyelitis. The case describes a woman 37 years of age with poliomyelitis who developed a peculiar way of walking, in which she wore a slipper only on the front part of her right foot, making her heel hang down over the back edge of the slipper. Examination of barefoot walking showed that there was no first or third rocker on the right side; the patient landed on her whole foot sole with her heel staying in contact with the floor during stance phase while her toes were clawing. Walking with the slipper, which prevented the clawing of the toes, probably moved the center of pressure anteriorly and created a greater extension moment on the knee to compensate for weakness of the quadriceps. An initial attempt with a knee-ankle-foot orthosis proved unsuccessful. Observation of the patient’s gait pattern and compensating strategy led to the development of a custom made orthopedic shoe. This shoe was built in a slight dorsal flexion position of the ankle, and a padded ridge was made to allow the heel to hang down in the shoe in order to passively lengthen the calf muscles and long toe flexors. A rocker bar placed distally from the metatarsophalangeal joints was provided to increase the extension moment of the knee. The shoe doubled the patient’s walking distance and enabled her to walk outside.
Published by: Lippincott, Williams, & Wilkins (Website:http://www.lww.com)
This publication is included in the library of the National Rehabilitation Information Center (NARIC), accession number J62061
