Prevention of foot pronation and foot drop in hemiplegic patients

In the past, the prevention of clubfoot and foot prolapse was firstly, the patient used the foot board or thick cardboard during the bed rest period to keep the foot joint in dorsiflexion position, and then furthermore, the foot board and elastic bandage were used to take advantage of the opportunity to change the position by 2-3h to fix the elastic bandage. The current methods to prevent foot entropion and foot prolapse: (1) Bed rest period: ① Change the position and maintain the good limb position: 2~3h implementation once, in order to maintain the position to prepare cushions, cushions, bath towels, pillows, etc., the back should be relied on when lying on the side, the hemiplegic side of the knee pad up, in order to maintain the lower limb in the good limb position, to ensure that the hemiplegic side of the lower limb is not externally rotated, adjust the lower limb to maintain a mild flexion position when lying in bed. ②Extremity exercise (passive exercise, active exercise): the joints of the upper and lower extremities of the paralyzed side were subjected to passive flexion and extension exercise, and the foot joints were subjected to dorsiflexion exercise, so that one set of 15 times was done twice a day, one time before and one time after lunch. In order to promote the passive movement of the paralyzed side, the automatic movement of the healthy side is also made to operate in the same way, and if it is not sufficient, the passive movement is also made on the healthy side. (2) Out-of-bed period: ①Wheelchair riding training: After the acute period, with the physician’s permission, start wheelchair riding training, 1 time/day, 1 time for about 5 minutes, if the wheelchair is more stable, you can extend the sitting time and increase the number of wheelchair rides. Both feet must be placed on the pedals when sitting in the wheelchair. Considering the patient’s safety, the torso and wheelchair are fixed together with a seat belt (such as the seat belt used for driving a car division), and patients whose neck cannot be kept stable can use a wheelchair with a bed. (2) Sitting training: Patients who can sit in a wheelchair are trained to do so twice a day, with the soles of their feet on the pedals of the wheelchair and in a good limb position. (3) Walking period: Dorsiflexion training with the soles of the feet on the ground while sitting in a wheelchair or in a sitting position. Place a 5-6 cm thick sponge between the sole of the foot and the ground for dorsiflexion training, 10 times as a set, 2 times a day, divided into the afternoon and afternoon, each time only 1 set. Although the previous methods of preventing plantar foot drop were positive, when the plantar plank and elastic bandage were removed, the patients developed muscle atrophy and contracture, etc., and did not get the expected effect. In addition, due to the use of plantar plank and elastic bandage, skin abnormalities occurred due to compression of the skin, and there were also local circulatory disorders caused by such preventive means without considering the characteristics of patients with cerebrovascular diseases that produce muscle spasm, of which We believe that foot planking is the least applicable. To effectively use the plantar plank in general, the foot joint has to be maintained at 90°, when the lower limb must be in the extended position, and such forced maintenance of excessive limb position induces and enhances muscle spasm, arguably increasing the likelihood of inversion foot drop. From these facts, it is clear that the preventive approach taken in the past has been confined to the morphological aspects of the foot and has not been taken to inhibit or disperse the muscle spasticity produced by cerebrovascular patients. The period from quiet bed rest to bed release is more often the time when inversion of the foot prolapse has occurred. The number of patients with inversion of the foot foot drop has slowly decreased due to early departure from bed. The characteristics of the current prevention method: changing the position during the bedrest period and maintaining the good limb position has the effect of preventing muscle spasm hyperactivity, and then applying the rehabilitation medicine of maintaining the good limb position to inhibit abnormal muscle tension and prevent the idiosyncratic limb position due to spasm. Passive movements of the extremities (foot joint movements) can all prevent foot joint conformation and muscle shortening. Both wheelchair training and sitting training during the out-of-bed period inhibit co-movement and expand the range of motion of the joint. Passive foot joint training during the walking period disengages the foot joint from co-movement and separates the foot joint from muscle tension.