Friday, May 30, 2008
Thursday, May 29, 2008
Wednesday, May 28, 2008
RX: Tuberous sclerosis.
HISTORY: This 19-month-old male has no allergies, has not had any surgeries and currently takes phenobarbital. He receives physical therapy 2 to 3 times per month at home. The patient reports that he has a rotating therapy schedule with occupation and speech therapy also. The patient is cruising and pulling to stand. He has not had previous devices.
EVALUATION:The patient presents with pronated feet bilaterally. His heels are in valgus and his forefeet are abducted. This is exaggerated upon weightbearing. He has mild tone and no clonus. Range of motion at his ankles is to 90 degrees with his knees straight. His knees and hips are normal. He has no gait to evaluate.LAB: Fabricate bilateral AFO-Wrap Arounds
Tuesday, May 27, 2008
RX: Bilateral Solid Ankle AFO’s
DIAGNOSIS: Dandy-Walker Syndrome
HISTORY: Patient is an 8 ½ year old male with no allergies. He has had brain surgery along with multiple shunts. He walks with minimal assistance. He receives PT 3x weekly, and he has worn SMO’s in the past.
ASSESSMENT: The patient is a moderate pronator bilaterally with normal tone. His calcaneus is everted and his forefoot is abducted. These abnormalities were corrected as much as possible during the casting procedure. Our orthotic goal is to maintain the ML plane at the ankle as well as stabilize standing.
PLAN: Fabricate bilateral SAFO’s
Saturday, May 24, 2008
Wednesday, May 21, 2008
Tuesday, May 20, 2008
Monday, May 19, 2008
RX: Bilateral solid-ankle AFO's
HISTORY: 14-year-old female has no known allergies, and is not taking any medication. She has not had surgery and receives PT at school. She currently has bilateral AFO-SA's with compcore reinforcement at the ankles, and ambulates using a forearm-supported walker.
ASSESSMENT: Presents with fairly neutral feet bilaterally. Her heels rest in neutral and her forfeet are adducted; however, upon weightbearing she pronates mildly with her heels in valgus and her forfeet to neutral. ROM at her ankle mordus is to 90 degrees with her knees flexed. She exhibits mild tone and no clonus, Bilaterally she internally rotates greater on thre right than on the left. Casted her today for bilateral AFO's.
ORTHOTIC GOAL: Maintenance of patient's foot alignment in a neutral position and to prevent him from falling into pronation attempting to relieve left knee and bilateral ankle pain.
PLAN: Fabricate bilateral AFO's SA with compcore reinforce.
Saturday, May 17, 2008
RX: Shoes and insoles
HISTORY: 58-year-old female no known allergies, diabetic 5th toe amputation due to infection. Patient presents with residual Charcot joint with a history of previous ulcerations. Her skin integrity is good. She has neuropathy below the knee bilaterally. Patient can dorsiflex to 90 degrees bilaterally, but the left foot only dorsiflexes to 90 degrees through pronation by pronating. She has pitting edema bilaterally.
ORTHOTIC GOAL: To protect the foot from mechanical stresses and shear forces.
PLAN: Fabricate bilateral total-contact insoles with custom shoes. Custom shoes chosen because of the difference between the left and right feet.