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Foot Orthotic treatment in scoliotic patients.

Discussion in 'Biomechanics, Sports and Foot orthoses' started by fabio.alberzoni, Jan 18, 2013.

  1. fabio.alberzoni

    fabio.alberzoni Active Member


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    I'm gonna examine a female patient who is more or less 25 y.o. The osteopath who sends me her told me she gots a painful pronation in only one foot.

    QUESTION: which is YOUR standard clinical examination in these cases? How much to correct this pronation?

    I think that I'll take a look at the pelvis level, to the innominates (foreward-backward torsion), RXs, Risser's graduation, Cobb's angle and some muscolar test....BUT....in the end I'll try with a progressive treatment checking the patient's compliance. I feel like miss something...

    QUESTION2:Hip and spine biomechanics in relationship with the foot biomechanic?

    Thanks,
    Fabio:deadhorse:
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. David Wedemeyer

    David Wedemeyer Well-Known Member

    Fabio,

    Can you supply us any further information, is this an idopathic scoliosis, functional? Is there an LLI? Does she have complaints related to the spinal curvatures? Cobb angle? What do you see in gait?

    Best regards,
     
  4. Dananberg

    Dananberg Active Member

    Fabio,

    Scoliosis is one of the most difficult to assess conditions in podiatric biomechanics. A study by Burwell published in Acta Belgica in 1982 shed the best light on this condition. He described a neurological defect in which the scoliotic subjects were unable to detect subtle variations between L and R sided movement patterns. In other words, each limb functions quite separately from the other, and the subject does not have the neurological system which is capable of sensing and adjusting for this asymmetry.

    For this reason, I have found the in-shoe pressure analysis is the ONLY way to assess these subjects. By using serially posted test orthotics, gait can be measured and changed until symmetry has been reached. How this could be done by eye or even slow motion video eludes my understanding.

    Hope that this helps. My prior work in this area is very rewarding, but the key is very careful assessment via in-shoe pressure analysis.

    Howard
     
  5. Stanley

    Stanley Well-Known Member

    Hi Fabio,

    I find that using a few tests will help you understand how to proceed with this patient.
    I agree that in-shoe pressure analysis is the best way to go. If you don't have access to this then do the following.
    First watch the patient walk. Watch the height of the head at midstance for each foot. The head will be at the highest at midstance of the long functional leg.
    Remember that a scoliosis can be primary in the back or secondary to a lower extremity shortage (functional or structural).
    In cases where the scoliosis is primary (in the back), the concave side will be lifting the hip on that side causing a functional shortage, so the functionally short side will be on the high hip side (In cases where the assymetry is from the lower extremity, the low hip side will be the functionally short side [the opposite from the spinal asymmetry]).
    The second thing to evaluate is how your orthoses are going to affect the asmmetry.
    Evaluate the ASIS to the ground and PSIS to the ground in both neutral calcaneal stance position and relaxed calcaneal stance position.
    If there is no change, then there is nothing to worry about.
    If there is a change, then just remember if there is asymmetry in the pelvis then you may want to maintain it, or even exaggerate it if there is head asymmetry.
    This is just a quick but incomplete way to start looking at this. For instance equinus is a factor that needs to be addressed, and then there is the effect of manipulation and exercises on your orthosis.

    Regards,

    Stanley
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    Fabio most of all if you decide to use a lift think twice about placing the lift on the side of the lumbar concavity please.
     
  7. fabio.alberzoni

    fabio.alberzoni Active Member

    @ David Wedemeyer: I still have to examine her....I'll give you all more information...
     
  8. HansMassage

    HansMassage Active Member

    If the scoliosis is still functional [spine is not rigid] test for response to a lift under the foot on the short side and see if the mastoids below the ear lob move toward level. This is the posturologist mehtod of finding the amount of lift that is tolerated.
     
  9. fabio.alberzoni

    fabio.alberzoni Active Member

    Could you explain better this test?

    thanks,fabio
     
  10. HansMassage

    HansMassage Active Member

    Posturology test for acceptance of foot lift for functional and actual leg length difference.

    Requires practitioner have spatial perception to recognize difference in position of index fingers.

    Place an index finger on the inferior-anterior corner of each mastoid. Note the difference of position. One could be more superior and the other inferior; one could be more anterior to the other posterior; one could be tilted outward and the other inward. This will be a reflection of what is happening at the pelvis.

    Have a progressive set of shims to place under one foot. A 10 mm shim will generally produce a rapid change in the position of the mastoid. Try each foot and note which moves toward symmetry. Try different height until best symmetry is obtained. This can be repeated each week of wearing the lift until stability is reached.

    Hope this helps
    Hans Albert Quistorff, LMP
    Antalgic Posture Pain Specialist
     
  11. Stanley

    Stanley Well-Known Member

    Hi Hans,

    Nice test. I will include this in my exam.

    Regards,
    Stanley
     
  12. drsha

    drsha Banned

    :good:

    I concur with the diagnosis and suggest that you place a lift under the short side that will fixate the pelvis on an angle that will most properly support the spinal curvature reducing the tissue stress on the spine and re-establish a working center of gravoty and symmetry as Dr Dananberg described.

    I would wean away the lifts after a period of time (1 year?) to note whether or not W and D's Laws have improved the deviations ans asymmetries.

    Watch for hip/pelvis lower back sequellae and make sure to balance the feet structurally and muscularly because they will be quite asymmetrical as well witness the very pronated foot.

    I have been very successful with these cases and have no F-scan.

    Dennis
     
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