Tight Achilles Tendons
A GAN family sharse their story and information:
While fitting a GAN patient for new AFO’s, orthotist, Matt Westlake, CO, of Lorelei Orthotics & Prosthetic Inc., strongly recommended an orthopedic surgeon who pioneered a simple outpatient procedure to give range back to the foot so the patient can ambulate correctly and can be properly braced. The patient’s arches were completely collapsed and her Achilles tendons were very tight. The procedure is called SELECTIVE PERCUTANEOUS MYOFACIAL LENGTHENING (SPML).
Dr. Roy Nuzzo, MD, an Orthopedic Surgeon in Summit, NJ performed the procedure on, April 1, 2014, in New Jersey. Dr. Nuzzo said the procedure (essentially, punching little holes in the muscle) only takes a few minutes and the patient was away from her parents a little over an hour. The pre-surgical scrubbing and post-procedure casting were the longest part. The patient left the hospital about 2 hours after she awoke, wearing light-weight casts that will stay on for approximately 4 weeks.
A follow up visit with orthotist, Matt Westlake was scheduled 4 weeks post-surgery for the casts to be removed and a mold made for the patient’s new AFOs. In the interim, while the new AFOs are being made, she will wear her old AFOs. It is critical she not walk barefoot, as it will quickly reverse what was done.
The parents were instructed by Mr. Westlake to buy BIG, cheap sneakers and cut the whole toe off with scissors, similar to wearing the cast. This provides the width to fit over the cast and will not cause tripping from a sneaker that is too long. Mr. Westlake also advised NOT to have the patient in flat shoes, ie, Chuck Taylor, Converse or Sketcher. A sneaker with a heel, like New Balance, is preferred which also comes in double wide size.
Mr. Westlake also advised the parents to have the patient walking and weight bear immediately following surgery! He said that parents who coddle too much, post-surgery and don’t have them weight bearing and walking often do not get as good a result from the procedure. This patient was weight bearing a few times the day of the surgery and actually walked in the casts with sneakers on the same night as the surgery. Her Mother said “Oh, your feet are so straight! She replied “and it’s easier to walk”!” Then she said, “I love you so much, Mom. I thought my life was always going to be difficult but now it is easier.” Both parents choked back tears.
It is always a gut wrenching decision for the parents to have any procedure done, this one included. In consult with both Matt Westlake, the orthotist and Dr. Nuzzo, who recommended the procedure (SPML), the parents acknowledged their concerns about putting their child through the surgery. They were fearful her days of ambulation were short and the casts would be too heavy for her to walk in. The orthotist, Matt Westlake, told them to just do it and not to look back. He said, “If they are too heavy, we just cut them off. I can’t properly brace her feet in their current condition, which would surely lead to loss of ambulation faster.”
Mr. Westlake introduced them to the ‘Up N Go.’ It is a walker that has hydraulics to take some body weight off the legs. It keeps them ambulatory longer, when their legs are too weak for their full body weight. This is an option for your children who are still ambulatory. Another option is to use a belt around the patient’s waste to relieve some of the weight while they walk with a basic walker if you are not able to get an Up N Go hydraulic walker.
Matt Westlake and the Christopher Reeve Foundation have made me realize that just because walking gets difficult, you don’t stop doing it. Have them go shorter distances.