Clinical Question from Holly Leigh:
For the past month I have been seeing a 13 year old who has a pretty typical gait of spastic diplegia; crouch+toe walking who is about 12 weeks out from bilateral femoral derotation osteotomy. Prior to surgery he played basketball and ran track (his mile speed is about 8 minutes, and his longest distance has been 8 miles in about an hour per his report). He used bilateral floor reaction AFOs most of the time but not when running because he kept breaking them (carbon fiber). He has progressed well and has learned how to find a neutral position at the pelvis, spine, hips, and extend knees fully while standing, but simply cannot shift weight onto his heels. He has very poor gastroc/soleus strength. He also has quite a bit of knee pain with terminal knee extension. Not at first, but as the session progresses and he spends more time weight bearing on extended knees instead of crouched knees, his pain gradually increases to unbearable. Taping has helped some.
Wondering if anyone has advice for helping him figure out the weight shift, or does he have so much strength to build that I’m expecting him to learn this sooner than he is able?
And any advice for the knee pain? He says that his knees have never been this straight before, so I almost wonder if after 13 years of crouch there is a structural issue causing pain in extension.
Please offer your suggestions and thoughts.
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