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1168317 tn?1330262837

gait problems and feet problems

i have just recieved a copy of a report from the podiatrist i saw last thursday following a referal from my gp and pt
she gave me a full examination of my feet and wached me walking up and down.
she is making me some insoles for my shoes she said ????
can anyone explain what this report means ???

on examination bothe sub-talar joint range of motion is good and ankle joint range is slightly limited in dorsi-flexion,
slight increased muscle tone was noticable on examination and there is clonus to the right leg when the heel is not in plantar grade.
there is weakness to the left foot and ankle in dorsi/plantar flexion, inversion/eversion.
i measeured a 2cm shortness to the left tibia but from umbilicus leg lenght was near enough equal. (but ther is a functional scoliosis).
there is excessive stj pronation with calcaneal evertion to both feet throughout gait but more so to the left.
the hips remain reltively level when bringing the left limb through swing,
because of this i am not incorperating a heel raise to the anti-pronatory, supportive insoles that are being made
any thoughts would be good as to whats happening to me i am due to see the neuro on oct 5th
regards bairdy!!!!
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Avatar universal
Hey, Bairdy. This is a very technical report and I'm strictly in the amateur class when in comes to understanding feet, even though my own aren't so great.

Did this podiatrist explain her findings to you during your visit? Since you will be getting insoles, I'm assuming you have another appointment scheduled. Be sure to ask then, and also ask your GP and PT.

MedHelp has a foot care/podiatry expert forum, and you might check there. Don't know how active it is.

Good luck,
ess
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1168317 tn?1330262837
hi
no the padiatrist just said it was good to be seeing another neuro cos she said its something neurological thats causing my foot and gait problems.
and to carry on seeing my neuro physio a copy was sent to her too
regards bairdy
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1168317 tn?1330262837
bump
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1394601 tn?1328032308
I hope the neuro runs a good MRI of your spine and brain.  Foot and gait problems sometimes are caused by lesions in the spine.  Just a heads up.
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1168317 tn?1330262837
bump
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147426 tn?1317265632
Hi, Bairdy.  I saw your bump and will do what I can tomorrow to interpret.

Just figured out the stj - sub-talar joint

She notes things that are neurological in nature, like clonus (super-reactive reflexes) and muscular weakness.  The problem is that the run of the mill MD does not repect the podiatry profession.  I trained with some and they do go through  rigorous training.

Talk tomorrow.

Quix
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1168317 tn?1330262837
thanks for your response
regards bairdy
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1168317 tn?1330262837
bump
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147426 tn?1317265632
I'm sorry Bairdy.  I used up everything I have on the response to vaccines.

But, the Talus is the large bone that the two bones of the lower leg (the tibia and fibula) rest on.  It sits on top of the long heel bone, the calcaneous.

The sub-talar joint is the joint between the talus and the heel bone.

<<  ankle joint range is slightly limited in dorsi-flexion"

This means you can't bring your toes up toward your knees very well.  The report states that this is true for both ankels.  Reasons for this could be a tight Achilles tendon or spasticity in the calf muscles which act to pull the toes down.  Do you tend to stumble over your toes when you walk?

<<  slight increased muscle tone was noticable on examination and there is clonus to the right leg when the heel is not in plantar grade.

This indicates the podiatrist found evidence of slight spasticity  in your lower legs and/or feet on exam.  This may explain the resistance to pulling your toes up.

<<  There is weakness to the left foot and ankle in dorsi/plantar flexion, inversion/eversion.

When she asked you to point the toes up or down and roll your ankle inward (inversion) or outward (eversion) the muscles were weak.  This would most likely be due to neurological impairment or disuse (like if you had had both feet in a cast)  Did you notice any time when both feet were casted?  This can happen to the best of us and sometimes we don't notice, lol.  

<<   there is clonus to the right leg when the heel is not in plantar grade.

This a pathologically hyper tendon reflex and is caused by a lesion in the spinal cord - whether or not a lesion has been seen.  These two Health Pages discuss evaluating the Muscle Tone, Spasticity, and Tendon Reflexes.  The heel being in "plantar grade" means the foot is in a position that points the toes down.

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Measuring-The-Tendon-Reflexes/show/157?cid=36

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Muscle-Tone-And-Spasticity/show/159?cid=36

<<  i measeured a 2cm shortness to the left tibia but from umbilicus leg lenght was near enough equal. (but ther is a functional scoliosis).

I'm a little unsure about this.  It sounds like your left lower leg is shorter than the right by 2cm (this is a lot) but, by assuming a posture that bends the back sideways you compensate for it.

<<   there is excessive stj pronation with calcaneal evertion to both feet throughout gait but more so to the left.

When you walk your ankles roll inward to the center.  This is often associated with flat feet and weakness of the side ankle muscles.  The left is worse.

<<   the hips remain reltively level when bringing the left limb through swing,
because of this i am not incorperating a heel raise to the anti-pronatory, supportive insoles that are being made

You are able to keep your hips level, especially the left leg as you swing it forward as you walk, so she is not going to compensate for the shorter left lower leg by giving you a taller portion in the shoe insert (the orthotic) she is making.

Now, the part to take to the neuro is that the podiatrist found slight spasticity in both lower legs which was accompanied by the clonus.  The clonus was when she jerked the forefoot upward and the toes bounced back down one or more times.  Do you rmember this happening?

Along with the spasticity you can't bring your toes upward well enough.  this could cause you to stumble on flat ground as your toes drop and catch the floor/ground.  If this happens to you it should definitely be mentioned to the neuro.

If you notice that your foot "bounces" up and down in certain positions under pressure, you should tell the neuro.

I hope this helps.

Quix

good night :))
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1168317 tn?1330262837
hi
thanks for your fantastic interpretation it makes so much more sense now!!!
sorry that you spent all your enegy lol!!!
i will try to answer your questions!!
i got knocked down by a car when i was sixteen and sustained many injuries
ie compound fractures to both legs fib and tib (metal plate repair to right fib and tib)
taken out a few months later , a fractured left arm in two places , and fractured my skull with nasty wound on forehead. so yes two full leg casts and an arm cast!!!
the accident left my left fib 2cm shorter than my right ,
everyting heald well and it never caused me any pronlems.
but the last eighteen months or so my hips have become displaced and have dropped on the left side by about two inches" and this is caused they think by scoliosis i lean to my left and gets worse as day goes on. but my spine is in normal vertabral allignment according to my gp following a lumber mri scan report.
so he thinks it is because of muscle weakness on my left side.
which has been documented by another neuro two years ago???
yes i do stumble catching the floor so i tend to watch my feet when walking!!!!
and my legs go tight after a few hundred yards walking.and my left foot slaps on the floor when walking when tired.
and my right foot bounces when sat down when heel off the florr also when stood up sometimes when wieght on my left side.
hope this helps to answer your questions??
if you have any more questions plaes ask
thank you som much
bairdy
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1168317 tn?1330262837
bump
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147426 tn?1317265632
No, actually I asked those questions so that you would mention these things to the neuro.  They are all indicative of neurologic damage, as opposed to the physical trauma of your multitude of injuries.  Whoaaaa, boy, you only get one body!

Q
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1168317 tn?1330262837
hi
thanks once again then i will make sure i point these things out and will let you all know about the outcome from my neuro visit next week.
regards bairdy!!!!!!
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147426 tn?1317265632
You actually do NOT have true scoliosis according to both what the report says and what you say.  However, you compensate for the short leg by holding your back in a curve.  This is called a "functional" scoliosis rather than an "anatomic" scoliosis.   Just so you understand the difference.

Q
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