Wednesday, January 27, 2010

Sans AFOs Featurettes

E spends most of her days with her AFOs and shoes on. So, on some weeknights and/or weekends, we spend time in shoes without AFOs (we call these shoes "sneakers") or barefoot. It's a nice break, and it's good to work/strengthen her muscles that are normally immobilized in her braces.

I've seen some changes, for the better...I think. But to see how far she's come, you have to understand where she started--when Elena started weight-bearing on her feet, she pronated so badly--particularly on her right side--that she was standing ON the ankle (standing on her navicular bone) rather than the sole of her foot. Bracing her has greatly diminished this foot deformity, but due to her pronation and tone, she still has issues called "rockering". (I think I have this right) This is where the arch of the foot is basically broken down, and it's her "default position" due to her tone (knees caving in, legs slightly bent) her center of gravity is over the arch of her foot (instead of in-line over her heels, like you and me). When she's in her sneakers or barefoot, this pronation is easy to see, especially on the right side--right foot caves in, and the rest of the leg follows suit. Still, I think the benefits of ankle strength and overall balance are worth keeping the braces off from time to time.

I asked our orthotist about arch supports for her sneakers. In his opinion, he thought E's rockering situation was so bad that arch supports probably wouldn't help much. But, he said it wouldn't hurt. My guess is it's probably better to have them than not. Still, I don't know how to measure a difference, if they help or not. I guess I'll have to compare pictures/videos of before and after.

So, here are some featurettes of E without AFOs (or arch supports):

Wearing Mommy's Old Tap Shoes (seriously--the insoles of these are completely falling apart--but she did get her heels down to hear the tap! I'm sure it would be more comfortable with socks on, too. She liked the sound, and I think it made a lot of sense to her when I said "heels down to make it tap".

Walking at Mommy's Work with her crutches and sneakers--E moves slower without her AFOs in general. We practiced being "turtles", which worked very well. This clip shows her moving a little faster than she did the majority of the time that day.

She also has started taking more steps at home while barefoot. Normally this is "three and down"--three steps on tiptoe and then falling to her knees. Her gait is very pronounced when barefoot, a high-knee-prancing type of gait, but since trying the tap shoes, she really tries to put her whole foot down from step to step. At last count she can walk 12 steps, which gets her from one side of the room to the other. It's still more of a "controlled fall" at this point, but she is able to navigate a little around objects (ball, toy on the floor) not impale herself on any furniture corners, and she can also slow down while in motion.


Anonymous said...

We've been trying the same thing with Ashlyn (going without AFO's on the weekends)- her balance is really poor but without stronger ankle musculature, it won't get better. "Normal" balance comes from tiny adjustments made largely at the ankle so we are trying to work in that direction. Thanks for posting the videos.

mom to Ashlyn

Katy said...

WE do lots of standing both in and out of braces. The braces help, but I can't help but think that it's good to spend some time out of them as well.