Tone

Hello to all again.

I have finally seen the results of foot mobilizations on some of my patients and they really do stand better, walk better as they have improved foot placement and contact with the ground hence a willingness to weight bear more on the affected side. And they put on their socks and shoes quicker on the affected side.

Problem is, every time they start putting effort or really focus their attention on the task(especially walking), the tone sets in and the ankle goes into plantarflexion, the toes curl up into knobs and the whole foot inverts like crazy. And the whole foot becomes "solidified" and moves in a chunk without any dissociation. Guess we have to look at the whole lower limb when it comes to the increase in tone but then realizing the fact that 10 minutes of foot mobs and SIMMS gives you 3 minutes of standing/walking with proper foot contact and when the tone comes on, it negates the effort of the mobs. The equation doesn't seem right.

So, I'm currently trying ways and means to decrease the tone in the ankle and foot so that the effects of the foot mobs stay as long as it can during the functional activity.

Things I've done so far(some may seem really silly):

• Doing lots of weight bearing on the affected side in standing
• Distracting them by talking about topics they like(including how to make a pizza from scratch)
• Stroking the extensor surface of the foot
• Firm pressure/contact on the lateral border of the foot to encourage eversion and prevent inversion
• Putting on an AFO for that foot so they can equal weight bear on the whole foot instead of focussing it on certain spots such as the ball of the foot which will cause a positive support reaction

They all do help to buy me spare time to do a little bit more walking before the full blast of the extensor tone sets in or sometimes help to continue walking after reducing the tone slightly. Ultimately, the foot tends to end up like a chunk at the end of the session.

If you have any ideas/techniques/tips to help with prolonging the effects of mobs/SIMMS or other alternatives to help decrease tone do add in your two cents worth. Or maybe I have missed out other components.