9 year old with navicular heads sitting on the ground

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Treated a patient the other day who is 9. He is so hyperpronated that the navicular heads rest on the ground in static stance. He has no pain , no instability , plays heaps of soccer and basically is symptom free.... His parents insisted that he have a set of prescription orthoses made to correct the morphology . I treated a man some years ago aged 49 with the same clinical appearence who never had symptoms and was a long distance cyclist .. Treat or not treat....My view is , in the absence of symptoms, dont treat.
I would appreciate some feedback and opinions on this issue

Looking forward to a reply

FDCB

 

Personally I will always treat a child who is maximally pronated at their subtalar joint in static/dynamic stance, even in the absence of symptoms.

 

Ditto...

 

Agreed.

We've all seen mature prodigious pronators who have no symptoms and good function. Halle Gabrialesssesesese for one. But measured against them, how many of that type of feet have you seen who DO have problems? And knowing what we know about things like the windlass, a weight bearing navicular is probably not a good thing.

Additionally, from an ethical point of view, consider this. There is no real evidence or basis for thinking that insoles can do harm. There is an intuitive belief that insoles should be used for flat feet (rightly or wrongly). What would you rather defend in court? I gave insoles which turned out to be not neccessary? Or this child I told was fine and ended up broken would have done so even if I HAD given them insoles.

I'd rather defend a reasonable but unneccesary treatment than the lack of a treatment. Especially if being judged on the Bolam principle.

Cheers
Robert

 

Agreed. Succinctly put Rob.

 

I'm gonna lie awake worrying about that one now!

 

-I always treat when at end range pronation, even if nonot symptomatic. Question is, how far from end range do they have to be before one doesn't treat, in the absence of symptoms? How accurate are kinetic tests on children? I find it difficult to get a good idea of kinetic test results but when they can do the tests I find them to be good for justifying intervention.

Just my2p worth

 

Whatever 2 p is buddy ...sounds like you need to empty your bladder...lol...


but thank you for your kind and educated comments...

FDCB

 

Hey Robert....where can I buy a hat like that.......???????????????? You look like bloody Brad Pitt old mate......very sexy ....


Lol....Kind regards and also .. I appreciate your humour , brain and your clinical expertise.....thanks for helping me to learn more......Kind regards


FDCB ... :drinks

 

Found it in a bin. While looking for some fag butts with some tobacco still in them.

http://www.youtube.com/watch?v=QACSo5xk3dE

In a world filled with the dank smelly bits of ignorance and dogmatic biomechanical beliefs loosely based on simplimflifications of rootian theory, spinning wildly through an empty void of assumptions and profit driven misinterpretations , who is left to fight for goodness, decency, scientific process, including vectors in force diagrams and getting smashed on good Portugeuse wine?? Yes, its the surprising further adventures of him, sir digby chicken caesar and his trusty sidekick ginger...

When I'm bored I'll write the full sketch.

 

i would probably treat, but be very careful to manage patient's and parents' expectation. they are likely to think that x amount of weeks in insoles will result in "straight feet" so i would be very careful to explain about improving foot function rather than instant straightening.

 

The poster must mean the head of the talus I was not aware that there was a "head of the navicula" none the less I get the picture. I have seen this in the past in cases of tarsal coalition when there is a complete osseous coalition. I would agree if non pain ful do not tx or at least give tx options. If a rigid deformity and symptomatic with coalition try to use flat posted orthoses to limit motion across STJ.

 

I would at least assess why they are in that position. Tarsal coalition would be my 1st thought. Then you can give the parents full information and expectations.

 

Blokes like me prove you dont need a long neck and feathers to be a goose. :bash: I should have written "Medial aspect of navicular sitting on the ground"

Thanks for the quote and help ..