Medial Heel skives

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Is there a type of foot pronation problem that a medial heel skive is usually not helpful for? ie hypermobility or pronation primary due to forefoot problems.

 

Yes, There are two kinds of pronators. The first, people with medially deviated STJ axes do very well with medial heel skives. The second, often have laterally deviated STJ axes and the ground will try to supinate them and in response they use there muscles to pronate the STJ. This second group often exhibit late stance phase pronation of the STJ. How do you tell the difference. Look at the location of the STJ axis.

Eric

 

When the forces of pronation are higher (ie supination resistance is higher), more force is neded from the orthotic to counter it (ie the medial heel skive is one of the ways to increase the force)

 

When medial plantar heel pain is a symptom, a medial heel skive will increase pressure and can worsen symptoms.

Rebecca

 

Does anyone know of reference where someone has said that? I know that this is commonly assumed, but I would like to know of a refernce that I can use to cite. We are about to start data collecting to quantify the pressures.

 

Don't know Craig. I remember being told about the indications / contraindications by my orthotic lab when they started using the skive. But that's it.

Rebecca

PS: Any chance that the Bootcamp will be held this year?

 

Craig:

When I wrote the original paper over 15 years ago, I mentioned within the article that plantar-medial calcaneal pain may be a contraindication to the medial heel skive since I had only been using it for about two years when I wrote the article in 1991. However, in the 15 years since, other podiatrists have told me that they use the technique on patients with plantar heel pain without a problem. In the 1,000+ patients I have used the technique on, I probably have had only 5-10 patients develop plantar-medial heel pain because of the medial heel skive. And these will invariably get better just by grinding the plantar aspect of the medial rearfoot post in the orthosis.

Hope this helps.

 

ok big problem with the above line of thought.

Pressure is not the cause of pain with medial plantar heel pain. If it were, then high pressure would be prevalent and obvious to those of us who use in-shoe pressure on a regular basis.

Prolonged pronation in the form of delayed calcaneal unweighting or a stoppage of 1st mpj extension is what causes an increase in the tension of the plantar fascia at the medial heel insertion.

This is rarely if ever a pressure issue.

That said, medial skives can increase the pressure under the medial heel and help to keep the CoF progression more midline as the foot moves into midstance and active propulsion.

Medial skives help to delay the need for a muscular supinatory response to the increased pronatory moments on the lateral aspect of the foot as it enters fully into midstance.

Once the heel is off the ground in late midstance, the skive will no longer have an effect.

The skive will potentially cause pain in midstance if the AJ does not have enough free range of motion. If the AJ does not have enough free range of motion then either the heel will lift off the ground quickly, or slowly. If there is also enough free range of extension ROM at the 1st MPJ, the heel will lift quickly. If not enough, the heel will attempt to lift, but may not, and this can then cause increase in pressure as the heel continues to "pronate" into the medial heel skive.

Those of you having issues with medial heel skive pain should first check for LLD and accomodate the short side. Second, you should start manipulation of AJ's. These two techniques will free 90% or more of your patients from their heel pain very quickly when utilized with your already incredibly well casted orthoses!

Sincerey;
Bruce Williams, D.P.M.

Sincerely;
Bruce Williams

 

Hi Bruce,
Do you compensate for the full LLD difference with hard density materials or do you combine hard and soft (ie. poron.) matrials to deal with timing issues
Thanks,
Mariusz

 

I try to read this post but I don't understand all

if someone has a picture of this type of orthosis, it will be a great help for me

thank's for all

fred

 

Hi Mariusz!
Long time no see!

Good question and I will use what is needed, hard or soft. Usually we will start out accomodating the LLD w/ an EVA from 3mm-6mm. Then we may add 1.5mm of ppt or poron if needed if the accelerations continue to move to fast on the short side.

Sometimes the long side will accelerate after addition of a lift on the short side adn in those instances I'll add ppt or poron on the long side to equalize the accelerations.

So combinations of hard and soft as needed for LLD issues, but sometimes on different feet!

take care!
Bruce

 

Bruce,
Thanks for the reply. Hope to catch up with you at PFOLA.
Have a great summer,
Mariusz