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Good morning/evening wherever you reside.
Had a gent this morning with acute MTSS a slight genu varum and 'flat feet'. Post tib musculature was tender on palpation.
His foot function was pretty poor in that his supination resistance was very high and Windlass needed +++ force to hallux to establish with hubscher test. When walking on treadmill he did seem to struggle through propulsion with early hip flexion.
I prescribed a 6 degree medial interpod for the simple reason it decreased supination resistance and he had observable external tib rotation with a hubscher test in weightbearing. He walked on the treadmill a few minutes without issue and I sent him away to continue rehab with the insoles to reduce demand on the deep post compartment musculature. I have given advice to discontinue or look to reduce prescription in the future when MTSS settles.
Obviously, I am still learning and my concern is towards medial compartment knee problems. Is this a risky prescription over the short to medium term or is the fact that he has a varum knee posture not necessarily indicative of medial knee compression even with the insoles.
I am struggling, presently, with providing reasoned biomechanical interventions without inadvertently causing other issues. I am only a year into studying biomechanics properly so any practical advice/additional reading would be gratefully received.
Thanks

 

Symptoms you are describing are typical of the PreClinical Clubfoot Deformity. If present, I suggest using Proprioceptive Insoles as your choice of intervention.

 

You did the right thing. Increased tibial bending moments from the genu varum is probably one of the main risk factors for MTSS, so reducing that is important. You could also look at 'gait retraining' to user a wider base of gait as that also reduces tibial bending moments .... but that hard in a a lot of cases.
Yes, what you (and all of us do) is that the medial wedging will increase the knee adduction moments and yes that does increase the risk for medial knee OA ... BUT, do not be concerned about that unless he has the other risk factors for OA (obesity being the main one) .... unfortunately orthotic prescription is always on of compromises.

 

Treating symptoms will almost invariably lead to disappointments. One must determine the aetiology of the MTSS before contemplating an intervention. Using a forefoot 1-5 medial post will increase the symptoms in a patient with a PCFD.

 

Awesome, cheers Craig.