Question: Thank you for the help you have given me in the past. I’m a 79-year-old male who developed polio at the age of four. I was in an iron lung for several weeks then treated at home with Sister Kenny’s hot baths and massage. My left leg was paralyzed but improved over the years to a point that I could walk with a dropped foot and limp. At around 45 years of age, leg weakness set in and I was diagnosed with post-polio syndrome. I went from a cane to crutches to a walker and now to a mobility scooter. I spend about 98% of the day on the scooter and can walk with the
walker for about ten feet before fatigue sets in. When I walk, I drag both my leg and foot. I have seen neurologists and orthopedic surgeons and was just referred for ankle fusion surgery to alleviate the dropped foot and tendon and ligament damage. That will, of course, require a long recovery period and the possible side effects. Aside from controlled high blood pressure and bullous pemphigoid l am in pretty good health. Based on the above, do you believe that an ankle fusion is a good option for me?
Answer Dr. Maynard: I am sorry to learn that you are still struggling. I would recommend against doing an ankle fusion because it would potentially only solve one of your problems that are making walking so difficult and energy-consuming for you. Additionally, there are other easier and completely safe alternatives to ankle fusion, such as a fairly rigid plastic AFO brace, perhaps with some movement allowed, which would likely do the same thing as a fusion for helping your walking. And, I agree with you that the post-op recovery period may well be long and arduous with additional surgical risks not insignificant. All of these considerations make an ankle fusion rank poor on a risk/benefit ratio evaluation. Your continuation of using a scooter for almost all mobility and doing regular “therapeutic exercise” short-distance walking for general health, and for the continued ability to do essential short distance upright walking occasionally as the need arises may be your better options for good physical and emotional/social health. If the independent “therapeutic walking” option requires you to need a little coaching from a PT and consideration of an AFO, ask your primary physician or your rehab physician for a referral.
Post-Polio Health (Vol. 36, No. 1, Winter 2020)