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Bowing legs & orthoses

Discussion in 'Biomechanics, Sports and Foot orthoses' started by lucycool, Mar 4, 2011.

  1. lucycool

    lucycool Active Member


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    Hi,
    I have a pt who came in complaining of numbness in FF when running. He has a LLD of 1cm and requires 4degrees RF posting. My question is.. Do I treat the RF as I normally since his legs bow quite a lot.. I don't want to put him more out of kilter?

    Sorry if this sounds ridiculous, I'm just paranoid of not treating him correctly!! The joys of going straight from uni into PP..

    Thanks in advance!!

    Lucy
     
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Whoa! Slow down Lucy.

    You say there is a chief complaint of numbness (neuropathy). Somehow we now jump to a 'requirement' for 4 deg of posting on an orthotic.

    Firstly, let's try and establish a diagnosis.

    Neuropathy of the forefoot can be one of a long list of differential diagnoses. This may or may not be related to a mechanical, metabolic, toxic, hereditary, drug related, or other systemic condition.

    In all liklihood there is a relationship to running, which you mention. So a mechanical compression neuropathy is most likely. The leg length difference may be part of this. The compression could be a referred nerve root compression at L4/L5/S1 - or it could be common peroneal entrapment, or even superficial or deep peroneal entrapment.

    Work through you physical examination and history findings. Establish the dermatone. Is there a positive Tinel's sign?

    Your answer may be as simple as changing the lacing on the shoe, or putting in a small heel lift. It may be as complex as surgical excision of a spinal cord tumour and chemotherapy.

    As you enter into practice, take the time to establish a diagnosis. Don't assume anything, and certainly don't dish out orthotics before you know what you are treating.

    If you can supply any further specific history and examination findings in a SOAP format, I am sure you will get some of the collective wisdom of our group.

    LL
     
  3. lucycool

    lucycool Active Member

    Thank you!! I don't have my full notes here..but...
    Young guy - mid 20s. Very fit. He gets numbness after 4k of running, (normally runs 5-10k) The numbness usually starts on dorsal lateral aspect, but then continues to plantar surface.
    FF seems fine, no abnormalities. No history of trauma. Always had bowed legs (since childhood) Changed his trainers reasonably recently, but not too worn and not too new to be the cause. I checked his laces too..

    Are you suggesting that I should just treat the LLD? I thought this would be the cause, but thought I should treat the RF req as well anyway..???

    Thanks for any help possible!!

    Lucy
     
    Last edited: Mar 4, 2011
  4. Lucy:

    First thing I would think of is chronic exertional compartment syndrome. Here is a little article I wrote about CECS about a decade ago.

    http://www.podiatrynetwork.com/document_disorders.cfm?id=159
     
  5. lucycool

    lucycool Active Member

    Thank you very much Kevin! ( Or should I call you Mr Kirby as per my quotes in my essays at uni?!)

    Should I treat the LLD and the RF?

    Thanks again,

    Lucy
     
  6. Lucy:

    I would first try to get a firm diagnosis in your mind before treating him. Isolating the distribution and timing of the numbness during running will give you more clues on how to treat him. I have recently been seeing lots of new running injuries from runners that are naturally heel-strikers now trying to run forefoot first. Find out what has changed in his running habits to cause this sudden onset of neurological symptoms.

    Here is a paper I wrote over a quarter-century ago that might still be helpful (Kirby KA, Valmassy RL: The runner-patient history: What to ask and why. JAPA, 73: 39-43, 1983).
     

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