Question
Any insights on a patient that stands with most of his weight on the heel of his foot and loses balance backwards frequently? Are there adjustments that can be done?
Answer
Yes. The first thing that I would look at is whether or not they changed shoes. Is that forcing them backwards? If not, I would look at contractures. It could be that they have a contracture that is causing this. Next, if the alignment is correct and the patient is not presenting with any range of motion deficits or weaknesses, then I would probably look at the stiffness of the heel and the relative position of the foot to the socket. Do your assessment.
A transfemoral patient who is standing with all of his weight on his heel probably has a hip flexion contracture, and there needs to be some alignment changes. There is always a balance between accommodating a problem that the patient has and letting the patient work it out with the therapist. I usually under-accommodate a knee flexion contracture by a few degrees, because I know that as they walk, they may work through the contracture. Again, this is why therapists and prosthetists want to work closely. If the patient has been rigid for 10 years with a knee flexion contracture, then we are going to fully accommodate it. But the first thing I would look at, to answer your question, is shoe wear, alignment of the prosthesis, and then contractures or limitations in range of motion or muscle weakness.
