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I noticed that my partner’s left foot is turned in, do you have any advice on what this may be and what I should ask the physical therapist?

My partner suffered a hypoxic brain injury. He is currently still in hospital at the moment and sees a physiotherapist each day for a short period.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Senior physical therapist

Answer transcribed from Brightway's interview with Dr. Cristen Gordon (pt.2):


It could be and probably is spasticity. We mentioned spasticity a little bit last week but to go into more detail about it, the way the brain works is that it sends a signal to the muscle to turn on to do whatever activity you're trying to do. Then it also sends the signal to turn off so that for example, if I need to pick up a glass of water, my brain sends the signal to move my hands at a certain degree, move my fingers at a certain degree, put a certain amount of force, and that's all through the muscles so that I can gently pick up the glass of water. When it's time to set it back down, my brain also has to tell my muscles to stop doing that to gradually release the cut back to the table. In this case, if it is spasticity, it's likely to be spasticity of the calf muscles or gastric muscles. What you should look at or with your therapist is to have them check it out. 


There is a test they can do for spasticity called the Ashworth or Modified Ashworth Test. It basically just consists of doing some passive range of motion to that joint or the therapist may probably just look at the entire leg at that point, including all the joints in the leg. The therapist does some passive range of motion at quick speeds to see if they feel that muscle resistance. In other words, the muscle is turning on when it shouldn't be turning on. After that, it's you and the therapist and now your doctor or your neurologist will look at what the next steps of treatment could be. Spasticity ranges from very mild to very severe. It can be so severe that the joint cannot move at all and it's stuck in one position, but it could be so mild that you only feel it if you're trying to do a particular task. In that case, the treatments would vary. It could be just that stretching needs to happen or it could be a medication that needs to happen. There are oral medications as well as injections. You may hear people getting botox injections to relax those muscles, and then even for very severe cases of spasticity, sometimes patients will get what's called a baclofen pump, which is actually where they implant a small pump device into your body that injects the medication directly to the spinal cord to help tell the brain to relax those muscles. That's in a very severe case but sometimes it might just be exercising like certain strengthening exercises to counterbalance the tightness of the muscles.


The first thing I would recommend is going to your therapist or your neurologist and seeing if spasticity has started to come on. Then, the next step would be to manage it. I should put a plug to that particularly with the foot and the hands if you're starting to see some range of motion changes where now, the foot is pointing down and turning in. The same can happen with the hand, so be very careful of watching the skin that's rubbing inside of the shoe, in the heel, and the top of the foot if your foot is pointed down. Also, inward the top part of your foot becomes susceptible to skin breakdown so you want to keep an eye on that as well.