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I have a patient who has unilateral ankle joint complex O/A. She has limited inversion and eversion.
During gait the patient hits laterally with the heel, however fails to pronate (on the right foot) from heel strike to push off. She seems (by observation) to remain mainly on the lateral aspect of her heel. The foot is therefore abducted during gait.
My questiuon is therefore, is there any way an orthosis can assist in reducing this abduction and assisting in maintaining a plantargrade foot?

Any suggestions please?

Regards

Rob

 

Rob,

Not a lot to go on. Low range of motion think STJ coalition. You also need to put your fingers under the foot when the patient is standing. Can you get the fingers under the lateral forefoot? Is there very high pressure. What about the medial side? Is there low pressure there? With this little info it sounds like an uncompensated varus with little load on the medial forefoot until the foot is abducted to roll off the medial side late in stance phase. It could be a lot of other things though.

Regards,

Eric

 

Rob:

I don't know if I totally understand your description....inverted heel and abducted???

The bottom line is that you can perform the maximum pronation test on the patient to see if the patient has the available range of motion to bring the foot plantigrade. If they can't get into a plantigrade position while maximally pronated, then no orthosis will be able to exert enough pronation moment to evert the foot to a more normal alignment with the ground. The ankle osteoarthritis probably has restricted the eversion range motion. Did you measure STJ eversion/inversion bilaterally? Did you measure RCSP bilaterally? Did you do the maximum pronation test bilaterally? If you had done these tests, then you would have already probably had your questions answered.

 

Thanks for these responses.

I think I may need to investigate this further. However, based on Kevin's last email, I doubt an orthoses will be of any use due to the restriction of STJ eversion motion. Appologies - as I am still quite new to this field! Nevertheless, it is great to have feedback from you more experienced guys.

Thanks

Rob.

 

Rob

"I doubt an orthoses will be of any use due to the restriction of STJ eversion motion"


Don't be too hasty.
Come back with a little more info, even a picture if possible, then people might be able to make more detailed advice.

Questions to answer include:
Is there is any pain? Where is it? As others have said, try the above test
What are you wanting to achieve.? e.g. may not have much eversion but you may want to use an orthosis to resist excessive amount of lateral loading.

More info would be useful

Ian

 

Thanks - I will come back with more info.

Rob