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May I please get some help and advice with the following case study:
I had a 55+ year old 80-90kg Female Patient present to the clinic for an orthotic review.
It was over 10 years since her last biomechanical assessment, during which time she had ankle surgery to her left ankle.
Being a new clinician to the practice, I advised that we review her biomechanical examination, as her new orthotics were being repressed from casts that were from the same initial biomechanical examination over 10 years ago.
My findings were:
Non-weight-bearing examination - ranges of motions - Ankle/STJ/MTJ/MTPJs were all WNL; Both feet are pes cavoid flexible, Both feet plantarflexed first ray; muscle strength tests showed some weakness to the left foot ankle dorsiflexors compared to the right foot.
Weight-bearing - Both feet RCSP: pes cavus with rearfoot inversion, there was a positive Hubscher test identifying a functional hallux limitus and excess lateral/5th Met weight-bearing;
A Lunge test for the left foot was 0cm and the right foot approximately 5cm;
Gait: supinated with lateral weight-bearing and mild-moderate midstance pronation
Management:-
A referral to physiotherapy for L/foot ankle dorsiflexors rehabilitation
I decided on the following orthotics script for both feet:
- Polyprop device
- Rearfoot eversion of 6 deg
- A low MLA profile
- Reverse Mortons
The Patient returned with the following issues of both feet:
- Retrocalcaneal blister formation
- Discomfort to digits 1/2/3
I would value explanations to the issues of the Patient.
Thank You:)
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