The August edition of Lower Extremity Review has just been published online, and features Peacocks Senior Orthotist Paul Charlton. Paul is featured for his work on the use of AFOs for balance issues with patients with peripheral neuropathy.
Earlier this year, Paul presented his work at the International Society for Prosthetics and Orthotics (ISPO) World Congress, which resulted in a programmed debate among academics as to consider a theoretical underpinning to his clinical solutions
What is the issue for patients with Peripheral Neuropathy?
People with severe neuropathy typically have trouble with balance and gait, partly because they receive little or none of the sensory information the rest of us get from the plantar surfaces of the feet. That input helps most people manage the body’s ever-swaying center of mass, much of which is controlled at the ankle. If the ankle lacks the necessary plantar feedback, the whole kinetic chain is destabilised, and people must compensate with movements at the knee, hip, and trunk. The result is often difficulty maintaining balance while standing and walking, making getting out and about and completing simple daily tasks very challenging.
Paul has developed his own method of assessing his patients. He starts by asking them to stand still, to establish a baseline of their stability. He then asks the patient sit. He sits opposite them and positions his knees just below theirs, at the top of their tibias. He grasps the back of the patient’s calves near the top and pulls them toward him, so the tibias are slightly inclined. He has the patient stand as he does this—essentially mimicking the effects of a rigid AFO. From this assessment, Paul is then able to establish whether rigid AFO's will be able to help his patient's stability.