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Post bimalleolar fractures and foot orthotics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Ann PT, Oct 5, 2012.

  1. Ann PT

    Ann PT Active Member


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    Does anyone have any particular thoughts on orthotic design for a patient who had a bimalleolar fracture (conservatively managed) with apparent deltoid ligament injury? His talus displaces medially in weightbearing. Would you use a medial flange or a medial skive? Or something else?

    Thanks for any thoughts!

    Ann
     
  2. davidh

    davidh Podiatry Arena Veteran

    Re: bimalleolar fractures and orthotics

    Hi Ann,

    Are you looking for stability, or to treat an underlying biomech problem, or a bit of both?

    Just generalising, a UCBL would provide stability.........
     
  3. Ann PT

    Ann PT Active Member

    Re: bimalleolar fractures and orthotics

    Hi David,

    My patient doesn't have any problems yet but I'm trying to prevent them in the future. I'm trying to control the plantarflexion/adduction of the talus to decrease the load on the medial ankle tissues. With a posterior tib problem I would generally use a medial skive. I was just wondering if anyone did anything different for a deltoid ligament injury with a healed bimalleolar fracture. (Fracture was sustained June 30 and treated nonoperatively.)

    Thanks!
     
  4. davidh

    davidh Podiatry Arena Veteran

    Re: bimalleolar fractures and orthotics

    Hi,

    Ok, I would use a UCBL for stability. And a 1/8th inch heel-lift for comfort.

    Can't be more specific without seeing the case I'm afraid.
     
  5. efuller

    efuller MVP

    Re: bimalleolar fractures and orthotics

    The concern with an ankle fracture is degenerative changes of the ankle joint. If the fracture was non displaced, then it should be fine and you can treat what is wrong with the foot. How is the active and passive range of motion?

    Something doesn't sound right. I'm having a hard time thinking of a mechanism of injury that would cause a bimaleolar fracture that did not involve displacement. At that point surgical fixation is usually done. Do you know the reason that he did not have surgery?

    Eric
     
  6. Ann PT

    Ann PT Active Member

    Thank you for responding Eric.

    I was also surprised when I got this patient. I couldn't remember when I had seen a bimalleolar fracture managed nonoperatively in the past (not that memory is my strong point!) I don't have access to this patient's records but plan to try to get more info about the specifics of his injury from the orthopedist. Stay tuned...

    His story is interesting. He injured his ankle hiking the Presidential traverse in the White Mountains of New Hampshire. The hike is over 20 miles over several peaks so he was wearing a light hiking shoe that did not go above the ankle. He broke the ankle and coincidently there was an athletic trainer in another hiking group who came along and taped it so he could get to the next hut which was about a mile away. He was on Mt. Washington at the time. He stayed over night in the hut then hiked another mile and a half to the top of Mt. Washington the next day and took the cog railway down. Then he made it to a hospital!

    His ROM both active and passive is quite good. He lacks a few degrees of DF as measured by a weightbearing lunge test. He wants to return to hiking (hopefully in higher cut boots this time!) and I'm trying to protect him as much as I can from future injury due to his current mechanical problem. I made the assumption from my exam, the appearance of his foot and ankle, and the incidence of deltoid ligament injuries with this type of fracture that he tore his deltoid ligament. I don't have any objective info on that from the orthopedist.

    Again thank you for your input and I'll hopefully have more information this week.

    Ann
     
  7. Ian Linane

    Ian Linane Well-Known Member

    Hi Ann

    Having read this last bit I wonder if your best bet is for him to wear footwear that stabilises the ankle, even in everyday walking, rather than go an orthosis root alone. It might not be his preferred choice but if you are looking long term preservation of the ankle it might be a very reasonable option, not least if you could have a more general orthosis in there to address his mechanics a little.
     
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