Hi all, this is the first time posting so sorry if its not well formated.
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I have a question regarding a patient I saw earlier this week, he came to my clinic complaining of very severe right ankle pain.
Previous history was vague and revealed he had had surgery to his right knee, due to severe trauma. The surgeon requiring a tendon and ligament for the knee reconstruction removed the flexor hallucis tendon.
On examination it was apparent that the patient was unable to dorsiflex the AJ using TA muscle as it seems paralysed, his only means of dorsiflexion comes via the extensors and what seems to be a prominant perineous tertius (which is extreamly tight, and so holding the foot in a pronated position).
This is as you can imagine causing abduction of the foot.
On standing the STJ almost looked subluxed as both feet are excessively pronated. RCSP are both everted approx 11 degrees.
Pain is experienced in the region of the sinus tarsi especially on palpation, most likely due to the excesively pronated foot.
Pain is also experienced on any form of adduction of the foot or supination of the MTJ.
slight relief is provided on forced inversion of the calcaneous, although the fore foot stays abducted, andslight dorsiflexed
My question is this; should i refer this patient to a podiatric surgeon for a release of the extensor tendon, or due to this being the only means of dorsiflexion would this be pointless?
I've rescheduled this patient for a casting for custom orthoses but would like some advice on the kind of orthotic i should prescribe him. Is there something that can exert the kind of inversion on the calcaneous that gained relief while facillitaing the forefoot in its current state?
thank you for taking the time to read this long posting.
steve
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