This Case Study describes the gait of a patient who suffered from COVID-19 and contracted neuropathy due to the Coronavirus.
Mr. JB is a 54 year old male who contracted the COVID-19 virus during the pandemic. He was hospitalized for COVID-19 treatment and recovered successfully from the disease. A few days after his recovery, he noticed a numbness and tingling sensation in his right calf and foot. He felt off balance while walking on grass in his yard and also noticed that he had no control of where his right foot landed while walking. He was diagnosed with peripheral neuropathy. While the cause of the neuropathy is unknown, it is suspected to be a response from the Coronavirus that he contracted.
RIGHT Foot and Ankle: Active ROM was impaired; passive ROM was within normal limits. Muscle strength was a 1/5 for ankle dorsiflexion and 4/5 for plantarflexion. Impaired sensation was noticed in the Right foot.
RIGHT Knee: For knee extension, muscle strength was 3+/5, while for knee flexion, muscle strength was 4/5. Active and passive ROM was within normal limits.
RIGHT Hip: Muscle strength and ROM were within normal limits.
LEFT Lower Extremity: Muscle strength and ROM were within normal limits at all the joints.
The initial gait assessment indicated that deviations associated with foot drop were significantly affecting the following gait functions:
(i) balance and stability (due to the deviation of Narrow Step Width);
(ii) symmetry (due to deviation of Right Step Length > Left);
(iii) forward progression (deviation of Steppage Gait);
(iv) shock absorption (deviations of Foot Slap and Inadequate Knee Flexion) (v) energy efficiency (Steppage Gait and Forceful Knee Extension).
Hence, it was determined to focus the intervention on all five of B.E.E.P.S functions. A carbon fiber ankle foot orthosis (AFO) with energy return properties was prescribed for the patient. The following video shows the patient’s gait after the orthotic intervention.
In order to determine the effects of the intervention, a Gait Comparison Chart was used to document changes in the patient’s gait pattern. Patient’s gait with the AFO shows improved balance and stability as he is able to walk with increased step width. (NOTE that the patient occasionally demonstrates a narrow step width with the AFO, but the average step width with AFO is greater than the average step width without AFO). He also demonstrates similar right and left step lengths and symmetrical joint movements with the AFO.
His energy consumption is lower, as the steppage gait pattern and forceful knee extension are not observed with the AFO. No changes were noted in his walking speed and the shock absorption mechanisms. The AFO successfully solved the issue of foot drop and deviations associated with foot drop were not observed after the intervention. Since the AFO restricted the dorsiflexion and plantarflexion movements at the ankle, newer deviations were observed at the ankle. The deviations at the knee and the hip did not change because the effect of AFO was limited to the ankle joint.
Overall, the AFO had a moderate improvement in the patient’s gait and it was recommended to continue with the AFO. Additional physical therapy was also recommended to address the deviations at the knee and hip and improve other gait functions.