|History: The patient is a 33 year old female school teacher with a long history of Systemic Lupus Erythematosus. Her subjective complaints include bilateral ankle stiffness, bilateral elbow contractures, bilateral wrist stiffness/ankylosis. The goal of this evaluation was to determine objective functional disability and recommend appropriate bracing intervention, if necessary.|
Analysis: Kinematic data exhibited gait parameters asymmetry. A slight limping pattern in the right lower extremity with a shortened step length of two inches compared to the left foot was found. A right knee terminal extension deficit of 2-3 degrees during the terminal stance phase was detected. A dysfunctional weight-bearing pattern was also noted for the stance phase of the Left Knee [Graph I].
Analysis of multiple trials of left and right foot ground reaction forces indicated a prolonged period for the loading response. The initial force peak of weight- bearing is narrowed, indicating rapid transfer of weight to the forefoot. This is true for both the right and left stance curves [Graphs II and III].
Discussion: The patient ambulates with a right side limp and the right knee demonstrates a terminal extension deficit. Her bilateral ankle stiffness translate into a narrower heel strike and a prolonged loading response on the force platform. This finding is compatible with functional heel cord contractures.
It is noted that the dysfunctional heel strike has a minimal effect on gait quality. The subject's center of gravity passes over the weight-bearing point on center for the left stance. The right stance exhibits a somewhat more forward center of gravity neutral point as demonstrated by an anterior skewed post anterior shear force [Graph III]. These ankle dysfunctions were deemed minimal and did not warrant orthotic intervention at the time of the test.
Recommendation: Stretching and strengthening exercises were recommended for the right knee with emphasis on vastus medialis and terminal active extension. A Pro Stretch home exercise device was recommended to increase bilateral heel cord flexibility.
Outcome: Biomechanical testing resulted in great savings in unnecessary orthotics and braces in a chronically ill yet very active and functionally young patient.