独歩のスピード低下を認めた両側アキレス腱延長術後の一症例

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  • A case of bilateral Achilles tendon extension with reduced walking speed
  • 症例報告 独歩のスピード低下を認めた両側アキレス腱延長術後の一症例
  • ショウレイ ホウコク ドッポ ノ スピード テイカ オ ミトメタ リョウガワ アキレスケン エンチョウ ジュツゴ ノ イチ ショウレイ

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<p>We performed physical therapy for a patient after bilateral Achilles tendon extension and left anterior tibial muscle tendon transition for bilateral pes equinovarus. The patient’s walking speed needed to improve for the patient to return to work. The walking speed was reduced because of failure to kick-off on the digitus primus side during the late stance phase. During walking, supination of the right foot increased because of poor anterior tilting of the right lower leg with right knee joint extension and right ankle joint dorsiflexion from the right mid stance phase to the late stance phase. In physical therapy, the right ankle joint plantarflexion was poor. In addition, we observed no increase in the muscle activity of the gastrocnemius with anterior tilting of the right lower leg in the electromyographic evaluation of forward lunge. As described earlier, the anterior tilting of the right lower leg was difficult to stop from the right mid stance phase to the late stance phase because of right ankle joint plantarflexion muscle weakness. Accordingly, the foot varus muscle group, such as the toe flexion muscle group, was thought to be compensating, stopping the anterior tilting of the right lower leg. During treatment, we tried to improve the right ankle joint plantarflexion strength with heel raises. After the treatment, prevention of the anterior tilting of the right lower leg was possible because the strength of the right ankle joint plantarflexion muscle had improved. Furthermore, the anterior tilting of the right lower leg also involved right knee joint extension and right ankle joint dorsiflexion. Thus, by reducing the compensation activity of the foot varus muscle group at the time of anterior tilting of the lower leg, the loads on the forefoot and digitus primus side were improved. As a result, the patient’s walking speed improved until kick-off on the digitus primus side during the right late stance phase, and the patient could return to work 6 months after the operation.</p>

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