tendon lengthening

[Jimi5]

I was wondering if tendon lengthening would be beneficial to the position of my left foot which turns inward and it's pretty hard to do ROM on that ankle. Although I do stand everyday and my left foot hurts sometimes like there's something under my upper foot but there isn't. I do have some foot drop on my left foot. Would getting an AFO keep my foot in proper position?

[Wise Young]

I was wondering if tendon lengthening would be beneficial to the position of my left foot which turns inward and it's pretty hard to do ROM on that ankle. Although I do stand everyday and my left foot hurts sometimes like there's something under my upper foot but there isn't. I do have some foot drop on my left foot. Would getting an AFO keep my foot in proper position?

Jimi5,

What level is your injury?

A foot drop results from weakness of your anterior tibialis muscle (in front of the tibia) which is innervated by the deep peroneal nerve and controlled by the L4/L5 spinal cord segments. Foot inversion is mediated by the posterior tibialis muscle (in the back of the tibia) which is innervated by the tibial nerve and controlled by the L4/5 spinal cord segment. This is puzzling and unusual because both muscles are controlled by the same spinal segments. According to your description, the anterior tibialis is weak while the posterior tibialis is abnormally active.

I can think of two possible explanations for this pattern. First, you may have an injury above L4 with spasticity below that level and you have an injury to your deep peroneal nerve (hence the foot drop) but the tibialis nerve is intact. Second, you have an injury that partially damaged gray matter in your L4/L5 spinal cord. The second is less likely because the motoneurons for the posterior and anterior tibialis should be relatively close to each other. Is it possible that you had peripheral nerve damage?

Regarding therapy, you may want to consider botox first before a tendon lengthening. It seems that you have an isolated muscle that is overactive and a weak muscle that is close by. A tendon lengthening would require that you cast the foot and this may cause additional weakness of the muscle. In addition, there are some orthopedic surgeons who use botox to weaken the muscle whose tendon is being lengthened. You need to see an experienced orthopedic surgeon and get your foot fully evaluated. The pattern that you are describing is unusual, in my experience.

Wise.

[Jimi5]

I'm full quad from encephfilitous. My spinal cord is fine. Thanks for your info. Specialists will deal with it.

[Jimi5]

I forgot to tell you that I have a baclofen pump and this and my suprapubic catheter problem started just after I got the baclofen pump. I'm only on 46mcg's a day of baclofen. It's all weird. Does the baclofen pump affect different muscles differently?