This is part 2 of a 2 part post; with the video from the case previously discussed
please note the following in the video:
- body lean to left during left stance phase (to clear right longer leg)
- circumduction of right lower extremity (to clear right longer leg)
- lack of arm swing bilaterally (cortical involvement)
- patient looking down while walking (decomposition of gait)
- shortened step length (decomposition of gait)
- increased tibial varum bilaterally
ASSESSMENT: This patient’s short leg and internal tibial torsion impediments to her full recovery. She has increased tibial varum noted which is complicating the picture. This is causing pathomechanics and an abductory moment not only at the knee but also in the lumbar, thoracic and cervical spines.
WHAT DID WE DO?:
- We attempted to do the one leg standing exercise. She needed to hold on and did not feel stable on the left hip while performing this. This is probably more of confidence rather than ability issue.
- We gave her the stand/sit exercise to try to improve gluteal recruitment.
- We also gave her the lift/spread/reach exercise to attempt to strengthen her feet.
- A full-length 5 mm lift was cut for the left shoe She felt more stable when walking on this.
- She was treated with IC, PIR and manipulative therapy and neuromuscular stim of the knee as well as left hip area above, below and at the joint line of the knee as well as gluteus medius and minimus.
- We may need to consider building a more aggressive orthotic with a forefoot varus post depending upon her progress and response to care
The Gait Guys. Making it real, each and every post here on the blog.
special thanks to SZ for allowing us to publish her case, so others can learn