Monday, June 30, 2008
Crouched Gait - HKAFO's Ineffective- PT Upset
Friday, June 27, 2008
Bypass Surgery -Conventional AFO's with Double Action Joints
Thursday, June 26, 2008
P W Minor Orthopedic Shoes for Irregular Heel
The patient is in the office today for new shoes. I will order style #1079 from PW Minor for him. I will
increase the size from 11A D to 8 D. I will also modify the posterior aspect of the left shoe to
accommodate his irregular heel. This will be done after the prefitting of the shoes. I will order the
shoes 3-day and see the patient in 1 week for prefitting of the shoes.Wednesday, June 25, 2008
Tibial Torsion and Genu Varus
Tibial torsion and genu varus.
This 15-month-old female has no known allergies. She is not taking any medication on a daily basis. She is an active independent community ambulator, and she has not had any surgery. She has previously had a Denis-Browne bar and straight last shoes with an 1/8 inch lateral wedge.
The shoes that she is currently wearing measure a 6 D. I measured her at an 8 D or E. She began walking at 9 months old. She did not have abnormalities at birth in regards to being born early. Tracings and measurements were taken of her feet today.Tuesday, June 24, 2008
Below Knee Prosthesis
The patient has returned to the office today complaining of pressure on the posterior aspect of her
socket. At today's visit we find that the modification for the popliteal area is causing pressure and
discomfort to her. As I cannot change this in the socket itself, I will remake the socket. At today's visit 1 have replaced her original socket back on to her prosthesis and will remake the socket with appropriate modifications. We will follow up with her in 1 week.
Monday, June 23, 2008
Preparatory Prosthesis
Friday, June 20, 2008
Clubfoot
Thursday, June 19, 2008
Wednesday, June 18, 2008
Cerebral Palsy - Swash Hip Orthosis
SWASH hip orthosis
Cerebral palsy.
This patient will be 7 years old in a few more weeks. She will be receiving Botox injections in the adductor muscle groups in both legs in the next couple of weeks.
Measurements were taken of the patient today and an appropriate SWASH hip orthosis was fit to the patient. Proper donning and doffing instructions were given to mom. Several adjustments were made to properly fit the patient. Growth adjustments can be made to this orthosis. While she was wearing the orthosis, standing and attempting to take steps, she could adequately clear her feet without scissoring. When she was sitting, she had very good sitting balance. Mom informed me that the therapist also wanted her to sleep in this orthosis. I instructed the mom to begin the patient on a gradual wearing schedule starting with 2 hours today, 4 hours tomorrow, 6 hours the next day and 8 hours the following day. Once she has reached the 8-hour point, she was told to allow the patient to sleep in the orthosis. I encouraged her to allow the patient to wear something snug fitting under the orthosis, possibly tights. The patient appeared to tolerate the device well. I gave mom the Alien wrenches if changes needed to be made in therapy. I marked the initial spots of the settings. I told mom if she has any problems or questions, or if she did not feel comfortable making changes, or if the therapist did not feel comfortable making the changes, to please return. The patient will be seen as needed.
Evaluation, measurement and fitting.AFO-Free Ankle
Tuesday, June 17, 2008
C-5 Tetraplegic - Spinal Cord Injury
Spinal cord injury C-5 tetraplegic.
This 21-year-old male is allergic to AMOXICILLIN. He takes Neurontin and medication to control his bladder muscles. He had a motorcycle accident in July 2000. He had spinal fusion of C-4-5 and a trach. He is nonambulatory and will begin physical and occupational therapy after he receives the braces, and his parents stated they have changed insurance companies and are working out the details with the prescriptions with the insurance. He has bilateral dorsal WHOs.
The patient was left-handed but his right arm now has greater strength. He is able to raise his arms at the shoulders, the right to 90 degrees and the left to 75 degrees. He has bilateral elbow flexion on the right. On the right it is grade 4, and on the left it is grade 3. The patient requests black straps with his orthoses. I have contacted the occupational therapist, and have received a complete description of the type of brace that she wants. She requested a tubular-type static WHO with C-bars bilaterally.
Fabricate tubular-type WHOs with C-bars bilaterally. Casting and measurement. In several weeks for fitting.Monday, June 16, 2008
WHO with Tool Attachments
Shoe Fitting
Soto's Syndrome and Planovalgus
Bilateral UCBs.
Planovalgus and Sotos' syndrome.
This is a 9-year-old female with no known allergies. She is taking Ritalin. She is an active community ambulator, and she does not us any assistive devices. She had bladder reconstruction in 06/2000 and she had 2 hernias prior. Her previous devices were bilateral SAFOs made by Muilenburg Prosthetics.
The patient presents as a pronator. Her heels are in valgus but correctable bilaterally. Her forefeet are abducted and correctable. She presents with no knee recurvatum. Range of motion at the ankles with the knees flexed is to +10 degrees. With the knees straight, the range of motion is to +5 degrees bilaterally. The casting procedure went well. Mom knows what to expect in regards to overall design of the braces.
Fabricate bilateral UCBs.Friday, June 13, 2008
Cauda Equina Syndrome - Hypotonic No Clonus
Bilateral AFOs. – Orthopedic Surgeon Referral
Cauda equina syndrome with bilateral drop-foot.
This 71-year-old male has no allergies. He is currently taking Xanax and is an insulin-dependent diabetic. He has had many surgeries, spine surgery in December 1999 and June 2000 to relieve pain in his lower limbs. However, his wife reports that this was unsuccessful and they discovered a syrinx at this time. He also had surgery for a broken hip. He has had the 2nd toe on his left foot amputated. He has had surgery for cataracts and glaucoma. He also has a history of an ulcer on the 2nd toe of his right foot and on his right heel. He has had no ulcers on his left foot. Today the patient has a small sore on the middle of his right tibia. The patient is a limited household ambulator, uses a walker. Out in the community, however, he does use a wheelchair. He will begin physical therapy after he receives the braces. He has had no previous braces.
The patient's feet present as pronated bilaterally. He is hypotonic with no clonus. Range of motion at his ankles is to 90 degrees with his knees straight. His heels are in valgus and his forefeet are slightly abducted. His right foot is flaccid, and his left foot has a trace of dorsiflexion. His quads are 3+. His skin appears to be somewhat thin. He has some peeling of the skin over his left heels. He has pitting edema in his feet and lower legs. The sensation stops at the top of the left calf and at the middle of the right calf. Traced the patient's legs for conventional AFOs, took impressions for custom inserts, and measured his feet for extra-depth shoes to be attached to the conventional AFOs. I observed the patient's gait with a walker in the office today. He has a very crouched gait and he takes small shuffling steps and drags his toes.
We will order Drew men's doubler shoes for the patient and fabricate custom inserts and bilateral conventional double-upright AFOs with double action ankle joints and an extended stirrup.Thursday, June 12, 2008
KAFO with ShearGuard - Flexion Contracture
Wednesday, June 11, 2008
Loose Rivets - Replace with Copper Rivets
The patient is here today because the rivets have become loose on the graphite reinforcement that we
had placed on the orthoses. To repair it, I will replace these with copper rivets. She will pick this up
tomorrow at approximately 10 am. I will do this at no charge.Tuesday, June 10, 2008
Bilateral AFO Wrap-Arounds - Ortho Referral
Monday, June 9, 2008
Cerebral Palsy - Bilateral Solid Ankle AFO's
Bilateral solid-ankle AFOs. Cerebral palsy. Orthopedic Surgeon Referral
This is a 13-year-old male has no known allergies. He is taking baclofen. He requires maximum assistance when ambulating, and he has not had surgery since his last visit. He receives physical therapy at school, and his previous devices were solid-ankle AFOs with Compcore reinforced at the ankles. The patient brought the braces with him today. He was getting pressure on the right side at the medial malleolus, and on the left at the base of the 5th metatarsal. These were both heat relieved. He has outgrown the footplate and they are also too short. He can wear them until the new braces are complete. This was explained to the mother.
The casting procedure went well. The patient's heels are in valgus bilaterally and they are not correctable. The right is worse than the left. Range of motion at the ankles is to 90 degrees bilaterally with the knees bent.
Fabricate bilateral solid-ankle AFOs.Friday, June 6, 2008
Bilateral Equinovarus Contractures
Bilateral free-ankle AFOs with inhibitive footplates. Bilateral equinovarus contractures. Orthopedic Surgeon Referral
This 5-year-old male has no know allergies. He is not taking any medication and is an active community ambulator. He receives physical and occupational therapy. He receives speech therapy at home. He previously had bilateral free-ankle AFOs and did well in them, but has outgrown them.
The patient is a toe walker; however, he is able to come down on his heels when asked to. He slightly pronates bilaterally. Range of motion at the ankles with the knees flexed is +15 degrees, and with the knees straight it is +10 degrees bilaterally. His heels were in a slight amount of valgus but correctable, and his forefeet are slightly abducted but correctable. The casting procedure went well. Mom knows what to expect as far as overall design. NOT footplates will be added. He has mild tone when relaxing or sitting. His tone is more dynamic in nature. When he walks he gets up on his toes.
Bilateral free-ankle AFOs with inhibitive footplates.
Bilateral Equinovarus Contractures
Bilateral free-ankle AFOs with inhibitive footplates. Bilateral equinovarus contractures.
This 5-year-old male has no know allergies. He is not taking any medication and is an active community ambulator. He receives physical and occupational therapy. He receives speech therapy at home. He previously had bilateral free-ankle AFOs and did well in them, but has outgrown them.
The patient is a toe walker; however, he is able to come down on his heels when asked to. He slightly pronates bilaterally. Range of motion at the ankles with the knees flexed is +15 degrees, and with the knees straight it is +10 degrees bilaterally. His heels were in a slight amount of valgus but correctable, and his forefeet are slightly abducted but correctable. The casting procedure went well. Mom knows what to expect as far as overall design. NOT footplates will be added. He has mild tone when relaxing or sitting. His tone is more dynamic in nature. When he walks he gets up on his toes.
Bilateral free-ankle AFOs with inhibitive footplates.Thursday, June 5, 2008
Short AFO-Posterior Entry & UCB
Wednesday, June 4, 2008
AFO-Free Ankle
Tuesday, June 3, 2008
Calcaneal Valgus Orthotic
Calcaneal valgus. Orthopedic Surgeon Referral
This 5-year-old female has no known allergies. She is not taking any medications, and she is an active community ambulator. She has not had any surgery, and she has previously worn foot orthotics for the past 3 years according to her father. These were made by another company.
The patient presents as a pronator. She has normal tone and no clonus. Her heels are in valgus and correctable. Her forefeet are abducted bilaterally and correctable. Range of motion at the ankles with the knees flexed is +15 degrees, and with the knees straight it is +10 degrees. I think this child will do well in foot orthotics. I think that they will control the calcaneal valgus very adequately. The casting procedure went well. The parents are aware of what to expect as far as design.
Fabricate bilateral foot orthotics upon receipt of a prescription for the physician and upon insurance authorization.Bilateral KAFO Braces
UCB Foot Orthotics
Monday, June 2, 2008
Left Hemiparesis-Traumatic Brain Injury
Left free-ankle AFO Ankle Brace. Orthopedic Surgeon Referral
Traumatic brain injury and lefthemiparesis.
This 58-year-old male has no known allergies. The medications that he is taking are unknown at this time. He requires maximum assistance when ambulating. He has not had any surgery except after the initial accident, which occurred in 04/2000. He was riding his bike and was hit by a car. His wife was present during this, and she is unclear in regards to what was done. He did not have any fractures from the accident. He is receiving physical, occupational and speech therapy. He has not previously worn a device.
The patient has moderate tone on the left. His clonus is not sustained, and his alignment appears neutral. Range of motion at the ankle is to 90 degrees with the knee bent. This patient is very physically fit. Due to his tone and general strength that he continues to have, I was unable to obtain an accurate assessment of range of motion at ankle with the knee straight. I did not have this patient stand, as he requires maximum assistance to do so. The casting procedure went well. I spoke with his wife regarding the design of the device.
Fabricate left free-ankle brace AFO.Sunday, June 1, 2008
Thoracic Myelomeningeal - AFO Braces
RX:Bilateral solid-ankle AFOs. Orthopedic Surgeon Referral
Diagnosis:Thoracic myelomeningeal paraplegia and equinovarus contractures.
History:LATEX PRECAUTIONS were taken on this 4-year-old male today. He is taking Ditropan and a medication for an infection. He does not ambulate and sits by himself. He has not had surgery since his last visit, and he receives physical therapy at school. His previous devices were bilateral wraparound AFOs. I think that he would benefit more from a solid-ankle system with an anterior panel due to swelling. His feet are very chubby. Mom stated she had difficulty with the wraparound AFOs. She stated they pinched the front portion of his foot.
Evaluation:The patient has a scab and a cut on his left great toe. Mom stated this occurred approximately 1 month ago. It is healing. Range of motion on the left is 90 degrees. On the right, he is tighter, and range of motion is -5 degrees. He presents as a supinator on the right and pronator on the left. He has no clonus on either side. He has moderate tone on the right. He has no tone on the left. The orthotic goal today is to cast him and fit him with devices that will hold his foot in neutral alignment to give him support when he begins to stand.
Fabricate: bilateral solid-ankle AFOs.