Acute anterior poliomyelitis (AAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which generally affects the lower limbs, in an asymmetric and disproportionate form. It is characterized as a lower motor neuron disease with several functional implications, depending on the affected muscles. After a massive vaccination campaign, mainly in the 1950s, the cases of AAP were mainly eradicated from the world, being restricted to a few countries [1],[2].

Currently, there are numerous reports of post-poliomyelitis syndrome, which can be defined by a set of signs and symptoms that generally occur after 30 to 50 years, at least 15 years after the acute poliomyelitis infection. It is mainly characterized by three main symptoms: new muscle weakness, fatigue, pain; associated with other clinical manifestations [3],[4]. Post-polio syndrome occurs in approximately 25–50% of people who survive a poliomyelitis infection. On average, it occurs 30–35 years afterwards; however, delays of between 8 and 71 years have been recorded [1],[3],[4].

The aim of this article is to narrate the case of a patient victimized by post-polio syndrome (PPS), in addition to contextualizing images and historical reports. Countless patients and famous people represented, through figures and pictures, the suffering and/or difficulties caused by the compromise of the osteomyoarticular system [5],[6].

We report a case of a 58-year-old female, who reported that she presented AAP at 18 months of age. Obviously, being very young, most accounts during this time were narrated by her mother. She claimed that even after immunization he developed the disease. The neuro-psychomotor development milestones became delayed and he had always been considered a “different” child in terms of walking, obviously due to the severe sequelae caused in the right lower limb (plegia) when compared to the contralateral side (paresis). During childhood, two surgical procedures for tendon transposition were performed. Bone lengthening of the femur was also part of the process. Upon inspection, the patient uses, on the right lower limb, a tutor for walking (Figure 1), in addition to shoes with high soles, due to the disproportion of size between the limbs (Figure 2). Scars from surgical procedures and bone atrophy in the right foot were observed (Figure 3). Neurological examination showed flaccid paraparesis with abolition of deep reflexes. The patient underwent normal laboratory tests, including vitamin deficiencies, electrolyte panel, inflammatory markers, and/or suggestive of immune-mediated diseases. Electroneuromyography had been characterized by a chronic preganglionic lesion of the anterior horn of the spinal cord. Magnetic resonance imaging of the spinal column revealed numerous disc protrusions, some indenting the dural sac without touching the spinal cord. The clinical diagnosis of PPS was confirmed after the presence of new muscle weakness, central and peripheral fatigue, myo-articular pain, depression, and cold intolerance. When asked about the pain in the lower limbs, the answer called our attention: “My feet seem to cry doctor.” She suffered for about 53 years suffering from chronic pain with an outbreak of an acute condition, months before the diagnosis of PPS.

The patient was medicated and instructed to perform specific exercises to avoid “overuse.” Other diseases of the anterior end of the spinal cord were excluded before the diagnosis of PPS, such as: amyotrophic lateral sclerosis, spinal muscular atrophies, myopathies or myositis, in addition to peripheral nerve injuries. Biopsy was not performed because other hypotheses were discarded in the clinical, electrophysiological, and imaging exams.

There is no diagnostic test for PPS. Diagnosis is based on a medical history and physical exam, and exclusion of other conditions that could cause the signs and symptoms [3],[4].

The pain and suffering caused by the sequelae of acute anterior polio (AAP) are expressed in different ways, some patients through art, such as, the Mexican painter Frida Kahlo (FK). FK had been infected with AAP at age six. She remained bedridden for nine months. A striking feature was the presence of intense pain in the right leg. Although she carried out specific rehabilitation programs and became a swimming champion, the amyotrophy in the right mid-distal crural third was notorious—the painter started to use a shoe with a higher heel on the right foot; probably as a result of polio (Figure 4). After being called by school friends “Frida wooden leg,” she became introverted and determined to express herself through painting [7].

Franklin Delano Roosevelt also suffered from AAP in 1921, at 39 years of age. That date could have been the end of the political career of the thirty-second US president. However, a great ability to overcome the physical and emotional impediment, making him the winner of four consecutive presidential elections, all a record, never equaled. Roosevelt uses lower limb tutors for ambulation and, occasionally, a unilateral (axillary) orthosis to perform basic activities and instruments of daily living (Figure 5) [8].

The presence of pain and depression is frequent complaint in patients victimized by AAP and PPS, being often disabling. An adequate treatment, as in the present case, is necessary. The use of specific medications, psychotherapy, and functional physical activities are crucial for clinical management. Unfortunately, many health professionals are still unaware of the pathophysiology of PPS and, consequently, are unable to set objective treatment goals [9],[10]. The patient in the present case had been instructed to use anti-depressants and medications to modulate pain. In addition, we encourage her to undertake psychotherapy.

Historically, the use of splints for walking or performing functional activities dates back to 1953, in Proceedings of the Royal Society of Medicine [11]. There was an extreme evolution in the models of orthotics, such as weight, size, adequacy—all associated with the analysis of ambulation patterns; some with specific laboratories. The patient presented in the article still uses old equipment, when compared to the latest generation. Although advances in clinical treatment and rehabilitation have emerged, only a minority of patients are able to fund the amounts.

Motor dysfunction is a hallmark feature of the condition, but generalized fatigue, sleep disturbance, decreased endurance, neuropsychological deficits, sensory symptoms, and chronic pain are also often reported and have considerable quality of life implications in PPS.