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Good morning. My Saturday morning head scratcher. Had a patient in with genu valgum and a R/lateral meniscal tear - awaiting surgery - has had surgery 9 years prior for the same issue however only repeated recently. She has been referred to a private clinic by her Orthopedic surgeon with a view to decreasing physical stress to the lateral compartment over the longer term.

On weightbearing she has genu valgum and 'flat feet'. Seemed like a simple fix to help her while she awaits surgery however she seemed to have a lateral deviation of STJ when tested for. This was evident with a very low supination resistance rate whereby I could supinate with relative ease and her 1st MPJ was very mobile and jacks test externally rotated her tib with very little force. I asked her whether she had h/o lateral ankle sprains and she believed she did when she was younger.

So, is it possible to have no arch at all in a laterally deviated STJ or am I observing STJ joint laxity due to the pressure over the long term. Also how would one approach Orthotics long term for this lady. I have put her in a vasyli medially supported insole which subjectively improved her valgum angle and I theorised would reduce compression in lateral knee compartment. Advised to use upto and following surgery whereby we could consider her long term options.

Are there any papers/resources anyone can recommend specifically around orthotic management of valgum/varum knee postures. At risk of sounding slow, preferably with pictures :) as I find K.Kirbys illustrations has helped the penny drop for me on a number of occasions.

Cheers, appreciate any help or insights.
Dan.