Delorme boot

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1. DELORME BOOT V. VENKATA RAMAIAH MPT-Ortho , M.Sc -Psychology Associate professor VAPMS College Of Physiotherapy

2. DELORME BOOT Delorme boot is a weighted device used for progressive resisted exercise training. It is made of aluminium casting with rods for holding weights. The boot is used for quadriceps strengthening and strengthening of ankle dorsiflexors through progressive resistance exercise.

3. PARTS OF BOOT It has an aluminum cast base for ankle support . The boot consist of a collor and a rod to hold weight to give progressive graded exercise. The boot has two straps to secure the foot firmly in place.

4. METHOD OF APPLICATION Patient position: sitting position with knee 90* flexed Ask the patient to pull his foot up ( dorsiflex ) and bring down (plantar flex) simultaneously. The weights are added according to the repetition maximum of the patient. Repetition maximum indicates the heaviest weight a person can lift with maximum effort in a single repetition.

5. Training using delorme boot induces contraction of dorsiflexors . It also increases the size and volume of muscle fiber. When the ankle goes into plantarflexion , the weight of the boot along with the pull of gravity causes lengthening of dorsiflexors giving an effect of stretching. For strengtehing of quadrieps , ask the patient to lift his leg up and down with knee in full extension.

6. USES OF BOOT For giving progressive graded resistance exercise Strengthening of dorsi flexors Lengthening of plantar flexors Strengthening of quadriceps To reduce tightness of antagonistic muscle Hypertrophy(increase in size) of muscle caused by increase in myofibrillar volume.

7. Indications of Delorme boot Common indications of Delorme boot are: Common peroneal nerve injury Leprosy Post polio syndrome Acute ankle sprain and chronic instability Tibial stress syndrome(shin splint) Pronation distorsion syndrome Extensor hallucis longus Sprint runners Fracture Stroke

8. INDICATIONS OF BOOT COMMON PERONEAL NERVE INJURY The nerve supplies the anterior and lateral aspect of leg and dorsum of foot. Injury to common peroneal nerve causes weakness of dorsiflexors resulting in foot drop. Delorme boot can be used to give strengthening exercise to the dorsiflexors thus recovering normal gait pattern

9. LEPROSY Leprosy, also called Hansen's disease, is a chronic infectious disease that primarily affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract, and the eyes. Leprosy can lead to progressive permanent damage of these structures, and the resulting devastating disfigurement and disability . When the disease affects the lateral popliteal nerve,the person will have weakness of dorsiflexors . Delorme boot can be used in strengthening of dorsiflexors .

10. Transfering of tibialis posterior tendon to the dorsum of the foot can restore dorsi flexion and prevent chances of ulcers. The insertion of tibialis posterior tendon into naviculum is detatched and is attached to tibialis anterior tendon. Delorme boot can be used to strengten tibialis anterior and lengethen the tibialis posterior muscles. It can be also used in training new action.

11. POST POLIO SYNDROME Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Post-polio syndrome is mainly characterized by new weakening in muscles that were previously affected by the polio infection and in muscles that seemingly were unaffected. Ankle dorsiflexors are commonly affected in post polio syndrome . High intensity resistance training has proved to be effective in restoring muscle strength. Delorme boot can be used to give strengthening exercise to ankle muscles.

12. ACUTE ANKLE SPRAIN OR CHRONIC INSTABILITY Ankle sprain and ankle instability are common conditions of ankle complex. First line of rehabilitation focuses on cryotherapy and resting of ankle. Strength training is given in the later stages of rehabilitation. Strength training via delorme boot improves strength and stability of ankle. Increased stability also results improvements in gait and joint position sense.

13. TIBIAL STRESS SYNDROME(SHIN SPLINT) Shin splints is a common term for pain or inflammation in the front or inside section of the tibia. The patient will complain of tightness or tenderness and sometimes throbbing pain along the border of the tibia. Anterior tibial stress is often experienced by new runners or walkers when pain occurs in the anterior muscles of the shin during exercise. Posterior shin splints (medial tibial pain) is a more chronic condition occurring along the inside edge of the tibia. It generally occurs with overuse during sports.

14. Initial treatment includes ice therapy and resting of the muscles. Later phase of rehabilitation includes stretching of the tight muscles and strengthening. Delorme boot can be used for stretching the plantar flexors in medial tibial syndrome. In lateral tibial syndrome, delorme boot can be used for strengthening the dorsi flexors. Inclusion of delorme boot as a strengthening measure in the fitness regimen of athelets can reduce the risk of developing shin splints.

15. PRONATION DISTORSION SYNDROME Pronation distortion syndrome is characterized by excessive foot pronation (flat feet) with concomitant knee internal rotation and adduction (“knock-kneed”). Functionally tightened muscles that have been associated with pronation distortion syndrome include the peroneals , gastrocnemius , soleus , IT-band, hamstring, adductor complex, and tensor fascia latae (TFL). Functionally weakened or inhibited areas include the posterior tibialis , anterior tibialis , gluteus medius and gluteus maximus.

16. First, inhibit the muscles that may be tight/overactive via self- myofascial release. The next step is to lengthen the tight muscles via static stretching. Key muscles to stretch include the gastrocnemius / soleus , TFL, bicep femoris and adductor complex. Once the overactive muscles have been addressed, activate the underactive muscles. Key areas to target with isolated strengthening are the anterior tibialis via resisted dorsiflexion , posterior tibialis via a single-leg calf raise, gluteus medius via wall slides and gluteus maximus via floor bridges. Delorme boot can be used in lengthening of tibialis posterior and strengthening of tibialis anterior.

17. EXTENSOR HALLUCIS LONGUS Weakness of extensor hallucis longus occurs in peroneal nerve injury or palsy. During normal locomotion, an individual contacts the ground with the heel of the foot first. The ground reaction force applies a plantarflexion moment to the whole foot, which is resisted by all of the dorsiflexors . Weakness of the EHL diminishes an individual’s ability to control the descent of the medial portion of the foot, particularly the great toe. Patients with weakness of the extensor hallucis longus also report that the toe tends to fold under the foot when they are pulling on socks or shoes and can cause tripping. Delorme boot improves strength of EHL

18. Tightness of the EHL pulls the metatarso phalangeal joint of the great toe into extension, which, as in the fingers and thumb, tends to produce flexion at the interphalangeal joint as the flexor hallucis longus is stretched, and a claw toe deformity emerges. Hyperextension of the great toe pulls the plantar plate distally, exposing the metatarsal head to excessive loads and producing pain. Delorme boot can be used in lengthening and stretching of EHL .

19. SPRINT RUNNERS In sprint runners, the muscle group to be aware of in the lower extremity is tibialis anterior. Tibialis anterior is a dorsiflexor of the ankle meaning it pulls your toes towards your knees (along with the extensor group). Increased speed and force of dorsiflexion will shorten the lever arm of the recovering leg during sprinting. This means that the quicker the ankle can go into dorsiflexion , the quicker the leg can get through into the next stride. This will obviously increase stride frequency. Delorme boot can be an effective in fitness training to strengthen the dorsi flexors.

20. FRACTURE Fractures around ankle joint results in immobilization of the ankle joint. inhibition of movement due to pain and decreased use of extremities can lead to weakness of muscles. Initial rehabilitation phase includes isometrics of ankle muscles. In later phase of rehabilitation, progressive resisted exercise can be given using delorme boot.

21. STROKE The gait pattern of stroke patients is characterized by a slow gait cycle and velocity, a difference in stride lengths between the affected and unaffected sides, and short stance and relatively long swing phases on the affected side. In particular, when the stiffening of the flexor on the bottom of the ankle joint is severe, it hinders the advance of the lower limbs during gait, resulting in problems such as asymmetric postures and balance disorders

22. Improvement in the ability of the ankle joint had a major effect on gait velocity and stride length. Undesirable gait exhibited by stroke patients is the result of weakening of the ankle muscles and the lack of their activation Exercises that can increase the ROM of the ankle joint and strengthen the flexor in the back of the ankle joint are necessary which can be given using delorme boot.