Rolling Feet

[BJ]

My husband has a c5/6 injury 28 years post. Is now - inspite of x2 daily rom having his knees rotate out from hips and ankles roll out putting pressure on the little bone under his little toe.

After fighting through 3 rounds of cellulitus in 2 years numerous consults with PT and SCI doc, cushion changes, posture changes, back adjustments all of this being done over a 5 year period. Thinking we have the darn thing healing and the rolling problem being compounded by the 'moon boots'. We have finally found a solution - MPO2000 Active Foot Orthosis by RCAI. The foot with the actual sore has had the boot on 24x7 at night the 'kick stand' is folded out to keep legs in right position, and the foot with just a pressure point has had the boot on only at night. It has taken 5 months but definite progress is visible.

When I asked the PT and Doc why we hadn't tried this 4 years ago they told me that these just came out in the last year. Cost insurance 200.00 each but if these problems are solved then it is worth it. Certainly cheaper than 30 days of 20.00 per day of antibiotics.

Any way this is just posted as a learning experience for anyone else who might have a similar thing going on

[SCI-Nurse]

There have been many different devices for prevention of external rotation of the hip, which usually occurs when lying flat on your back due to the weight of the feet. There have been devices such as you describe available for at least 15 years that I am aware of, and previous to this we often used a towel roll called a trochanter roll under the thigh to bring and keep the leg in good alignment.

As you stated, if this is not prevented and the person gets contracted with external rotation, when the hips and knees are flexed (as in sitting in a chair) the knees will be wide apart and it is nearly impossible to get a good chair or cushion fit (plus it looks awful). It is important to prevent contractures with good positioning...simple ROM alone is not enough. (KLD)

[BJ]

Yes - we have gone through all the rolls, pads, pillows etc. Hubby somehow spasams out during the night and froglegs. If it doesn't wake him he won't wake me to reposition. So we are in a sense the cause of our problems. I was ready to superglue him to the sheepskin. (ha ha) But I guess overall haveing this be the only problem he's had in 28 years we have managed pretty well. I'm sure if he was willing to up his valium some the spasams would be cut back but he feels like if he can live with some spasams he will. Doesn't like the dopy feeling from increased meds. And at 10mg a day he's happy.

I just thought I would mention these boots incase the traditional 'moon boots' were a problem for anyone else

[Noel]

Preventative therapies now will save you from anguish later.

I rolled out of rehab over 26 years ago packing de-rotation leg splints. They prevent rolling of the legs, foot drop, toe curling, and reduce the chance of spasitity and mild AD.

I was tempted to cast my splints aside, but all I had to do is look at the quads and paras that never used them (with problems related to the legs and feet), and I was ready to have them straped back on each night.

Its a question of common sense folks, use it.

Noel