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Gait plates with blake inverted foot orthoses

Discussion in 'Pediatrics' started by Liz C, Mar 6, 2011.

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  1. Liz C

    Liz C Member


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    Recently a 5yo boy was referred to my clinic from the Gp, with diagnoses of
    'club foot, worse in the left' (according to the GP)

    In the past two months this child has developed significant tripping problem, with wearing out of the dorsal areas of the toe box of shoes.

    Examined, walking and running, shod and unshod there is dragging of the dorsal digits along the ground in swing, significant calc eversion from strike to heel off and some intoeing, left worst than right.

    As a trial, i placed the child in a blake inverted device, which produced immediate relief of all toe dragging, and tripping. I have spoken to a more experienced collegue who has recomended gait plates, but am thinking i would rather see the child in a blake inverted device.

    What say you? (Without seeing the patient) Are the two devices compatable or should it be one or the other?

    PS i am 99.9% sure the GP diagnoses was off track!

    Ta!
     
  2. Re: Gait plates with blake inverted

    Hi Liz

    If the inverted device worked really well - if its not broken dont fix it comes to mind.

    If it worked well and your happy with the result stay with it.

    I dont work with peads but there is quite the discussion if gait plates are of any real advantage.

    Hope that helps
     
  3. footfan

    footfan Active Member

    Re: Gait plates with blake inverted

    Yeah Michael has hit the nail on the head, gait plates only really improve the aesthetics of gait .Is the child symptomatic? Always check for hip displasia with asymmetry and ascertain where the intoe is coming from first.

    FF
     
  4. Lab Guy

    Lab Guy Well-Known Member

    Re: Gait plates with blake inverted

    Examined, walking and running, shod and unshod there is dragging of the dorsal digits along the ground in swing, significant calc eversion from strike to heel off and some intoeing, left worst than right.

    As your pediatric patient has STJ ROM and is excessively pronating, a Blake inverted orthotic is a wise choice. You can also also incorporate a 4-6 mm Kirby Skive with a high heel cup to transfer the CoP medially and help to decrease the pronation moment from heel contact to midstance.

    You could also modify the device by extending the shell to the 4th and 5th toes to encourage the boy to externally rotate his leg and abduct his foot. I would not choose this option as it would cause an increase pronation moment at the STJ and a higher ORF in the MLA that probably would not be tolerated.

    I agree with footfan and would look at hip dysplasia and do a careful gait analysis. The Knee is the reference point for both in-toeing and out-toeing. If the knee is in the frontal plane...leg and foot. Knee internal or externally rotated...thigh/hip.

    My question is why is the boy dragging his foot in swing prior to his orthotics? Why is he not dorsiflexing his foot in swing? Why did he plantarflexed ankle improve with orthotics? What caused this lack of foot dorsiflexion? Did you do a complete neuromusclar work-up?

    Pediatric Orthopedics always interesting.

    Steven
     
  5. footfan

    footfan Active Member

    Re: Gait plates with blake inverted

    Also dont forget genicular rotation/bias http://www.latrobe.edu.au/podiatry/documents/podbiopdfs/Extrinsic factors 2007.pdf page 5 onwards.

    FF =D
     
  6. James Welch

    James Welch Active Member

    Re: Gait plates with blake inverted

    Hi Liz,

    What was the birth history of the child?

    If undertaken, what was found from any neurological assessment?

    James
     
  7. Admin2

    Admin2 Administrator Staff Member

  8. joejared

    joejared Active Member

    Just an opinion, of which, you and your patient's opinion probably matters a good deal more.


    For my customers, from a software perspective, it's a simple matter of applying both designs, blake# and gaitplate. From a design perspective, you're already achieving the desired result and personally, I don't think the two design types will work well together, unless there's also a hallux limitus condition or other reason you want to resist motion in the forefoot. Typically, a Blake inverted device the arch peak is moved proximal about 10~15% to encourage eversion and supination and is more commonly used in athletic devices.

    [​IMG]
     
  9. Bug

    Bug Well-Known Member

    Hi Liz,

    It helps if you present the issue in this sort of format:
    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=22144

    With kids, including a birth history and neuro work up also really helps.

    It is hard to comment without that, I get you say you are 99.9% sure, how can we make 100%. If club foot was mentioned have you done a Pirani score on him to ensure that it really isn't. Again, Club foot = double check the hips.

    I think these are very important questions:
    I'm not a huge gait plate fan, what are you trying to achieve with it's addition?
     
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