Therapy Session #2 - the good, bad, and ugly

Good news is that Ethan’s left ankle has passed neutral and is finally flexing toward the goal :)  Great news that I can actually see the surgery paying off.  We are now teaching him how to use his new found flexibility.

Bad news is that Ethan’s right ankle is still tight but is at neutral.  It needs more help than the left and it is still turning out.

Ugly news is that upon looking at Ethan’s right leg compaired to his left leg. The right leg is just about 2cm longer than his left.  It appears that he does have the same calf muscle mass in both, but the right calf muscle is bowing outward (creats a curve) and the left muscle is growing straight.  What concerns the PT more is that he can’t straighten his leg out.  If he is sitting on the floor, he can’t touch the floor with the back of him knee.  This could be the cause of his foot turning outward and the PT said that we could see a “whipping” around motion when he runs.  I will have the doctor take a look at our next appointment.

One Response to “Therapy Session #2 - the good, bad, and ugly”

  1. Unfortunately for Ethan, when we bend our knees while standing, we have to simultaneously dorsiflex our ankle to keep our foot flat on the floor/ground. So if Ethan’s right hamstring is so tight that he can’t straighten his right knee completely, he needs even more ankle flexion (=calf-and-AT length) than if he could.

    Mind you, MANY people — especially MALES — have trouble sitting on a floor, back straight and knees straight. When I was a kid, I could stand straight-kneed and touch my toes or even touch the floor below my toes, but I couldn’t sit like that. (I had two older sisters who both found it silly easy, but not me.) That particular inflexibility never seemed to hurt me in sports or walking, but it was there.

    If Ethan now has either fair right-calf strength OR a relative freedom from pain in the right leg, I think he should be able to walk with his right foot straight, just by lifting his right heel off the ground/floor a bit earlier than others.

    Have you tried adding some skinny heel lifts to his shoes, until he can walk straight? I do know you want to lengthen his calf-and-AT, but if it’s so hard now that he’s compensating by gimp-walking in ways that are harmful (like right toe splayed out), then adding (and gradually withdrawing) heel wedges might be a more gradual, comfortable, “user-friendly”, and successful option. Just my $0.02, from a technically savvy non-health-professional who’s spent WAY too much time thinking about ankles and ATs. . .

    One more question, that you may well have answered already: Has Ethan ever tried sleeping in a boot or a splint, that would hold his ankles at neutral — or even a bit dorsiflexed, if that wasn’t too uncomfortable? Many of us had discomfort or pain when our casts or boots were adjusted from “equinus” (= “ballerina” or way plantar-flexed) toward neutral. Many of the people who made that transition easily did it at bed-time, so their leg had ~8 hours of NWB to get used to the “stretch”. Especially if Ethan’s right ankle is harder to dorsiflex in the morning than later in the day, keeping it from tightening (plantar-flexing) overnight might help, and might be worth the nuisance of sleeping in one or two gizmos for a while.

    Good luck to both of you.

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