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Foot orthotics for teenagers with Osgood-Schlatters

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Sam Durnian, Aug 12, 2011.

  1. Sam Durnian

    Sam Durnian Welcome New Poster


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    What is the general consensus when considering orthotics for teenagers diagnosed with oschgood schlatter's and presenting with pronated feet which is contributing to the lower limb alignment?(and suspected exacerbation to patient's symptoms). Should they be referred to a podiatrist?
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Craig Payne

    Craig Payne Moderator

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    I don't think you will find a consensus. I have heard several anecdotal reports of really remarkable results with foot orthoses and also some disasters.

    Foot orthoses should help if there is a problem in the foot that is contributing to it......thats is the challenge determining that.

    What I would suggest that you do what Bill Vicenzino calls a 'treatment direction text' ... for your case, get the child to hop on the painful leg; how many hops until its becomes painful?; add something like some low dye strapping to control foot pronation and get them to hop again; how many hops this time?..... if they can do more hops after strapping, then assume that foot orthotics are probably worth a try. If there is no reduction, then assume that foot orthotics are possibly not worth a try ....

    There are really no evidence or consensus on this, so its a judgement call on your part.
     
  4. CraigT

    CraigT Well-Known Member

    Another one to try is see how they are with a single leg squat- look at their pain and control with and with support under the sustentaculum tali. If the pain is less with support, then you should have a reasonable chance of seeing an improvement with support of the foot.
    Bear in mind that sometimes this needs some rest before you see any improvement with treatment- ie: if you don't find any change in pain with this test, you shouldn't rule orthoses out completely... especially if there is a significant change in control of knee valgus.
    I find this test useful for a lot of chronic type knee probs such as PFJS and patella tendonosis.
     
  5. docbourke

    docbourke Active Member

    Are you guys for real. Please find a good paper to show that orthotics make any more difference than placebo. As a parent of a child who suffered Osgood Schlatters the last thing anyone would need is the inconvenience and expense of something that is goinf to limit footwear. They say that to a man with a hammer everything looks like a nail.
     
  6. many questions for that have been left unanswered here - http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=67942
     
  7. Gerard:

    That is pretty funny. I use the same saying "they say that to a man with a hammer everything looks like a nail" to describe how many orthopedic surgeons are more interested in cutting than in providing state-of-the-art conservative care measures to their patients.

    By the way, Gerard, you still haven't answered my question as what theory best explains the biomechanical effect of Dillwyn Evan's lengthening osteotomy of the calcaneus for the surgical correction of flatfoot deformity. It seems odd to me that orthopedic surgeons would be performing these surgical procedures without good Level 1 evidence of their biomechanical effect on the human locomtor apparatus. Or does the necessity of Level 1 evidence only apply to podiatrists who want to use in-shoe inserts to attempt to modify the abnormal internal forces and moments that are causing mechanically-based pathologies of the foot and lower extremity?

    I am waiting patiently for your reply.
     
  8. CraigT

    CraigT Well-Known Member

    Hi Gerard
    I am interested in your management in this problem- it sounds like you had first hand experience- if you don't mind sharing...

    My experience is that foot orthoses CAN help, but certainly not with every case. This is one instance where clinical tests and reasoning (such as taping) are very valuable and can often ensure that there is no unnecessary expense and 'wasted time'. Certainly I don't think anyone here would suggest it is a stand alone panacea...

    ps- I am somewhat intrigued by your 'footwear limitation' comment- Osgood Schlatter's is closely linked to sporting activity. If an athlete is wearing a shoe which cannot easily fit a foot orthosis, then you might have just found one part of the problem...
     
  9. Which tissues have increased stress / strain in Osgood-Schlatters? How might you design a foot orthosis which could reduce stress on these tissues?
     
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