Dilemma foot orthoses

Working in a center for children with neuromuscular diseases I see twice a year a boy (15) suffering from Morbus Duchenne. Is is not able to walk nor any weightbearing on his feet. His feet tend to go into plantarflexion/suppination contractures- as in any other patient with M. Duchenne. State of the art of treatment is to make them wear ankle-foot-orthoses, but there is no evidence for less problems or pain. This boy really feels unconfortable to wear those orthoses. They reduces his qualitiy of life- so he says.

So what shell I recommend? Nowing his reduces life expectancy, thinking that QOL are highest values to achieve and doubting about effects of the orthoses I would recommend not to wear the orthoses. But treatmentprocedures tell me something else and how knows if he will not suffering from pain in his feet in a few years?


3 Replies to “Dilemma foot orthoses”

  1. Hi Mrssone.
    If i were in this position i would too, feel stuck between a rock and hard place. i think finding a solution would begin with perhaps getting deeper into his issues with regard to wearing the orthosis. Is it uncomfortable due to the way the orthosis makes his feet feel? Or just the mere fact of wearing something to intentionally position his feet in a way it does not know?
    I think another approach would be to educate this boy thoroughly (with use of pictures, videos etc) about his condition and how intern foot orthosis can possibly increase his quality of life. Ive often experienced that when i explain the patients condition, break it down into components and explain how a suggested treatment/exercise/lifestyle change would benefit the patient, he/she becomes more open minded/compliant and motivated.

    I surely hope you reach some sort of solution that would be beneficial for your patient and give your peace of mind 🙂

    Best of luck- Tayla


  2. Hi Mrs Sonne

    I have enjoyed reading your post on orthoses. 🙂

    In this situation, I would have also been confused and not sure how to proceed. I have also worked in Paediatrics before and I understand how difficult it may be for you to make recommendations or to try to explain to them how important certain aspects of Physiotherapy are.

    To me, the most important thing you have to focus on is to try to understand and figure out, from the patient’s point of view, why he does not want to comply. If you understand why the patient is reacting the way he is, it would also simplify your decision-making process. It is always important to consider what the patient wants as suppose to what they might need, from your perspective.

    Educating the child on the importance of wearing orthoses, may be the way forward. I would suggest that you include his parents/guardians in the session where you educate them on the complications that may arise if the child decides not to wear the orthoses and the benefits of the orthoses as well. In the end, the decision lies with the child, whether we may agree with them or not; that is what makes it really difficult.

    It may also help if you show the child other children who have orthoses and have them explain to him how the orthoses have helped them or if they did not help them. This may actually help the child see and hear how the orthoses are of benefit.

    These are merely suggestions, I hope I have helped you in some way!

    All the best and I hope you can make a decision that will benefit your patient.

    Good luck


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