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Genu varum, knee condropathy, pronation

Discussion in 'Biomechanics, Sports and Foot orthoses' started by fabio.alberzoni, Sep 29, 2014.

  1. fabio.alberzoni

    fabio.alberzoni Active Member


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    I have a patient with condropathy of medial condyle at both knees and a previuos surgery of both medial menisci.

    He got plantar fascitis.

    ankle with -2° of rom bilateral (muscolar equinus)
    anke with knee extended >10° bil

    lateral metatarsalgia bil

    extrarotated patellas in ccc cause of tibial intenal rotation(angle of gait 0° bilateral)

    distal phalanx of both dig toes valgus(FHL)

    FF/RF 0°(INVERTED)/3°(INVERTED)

    SUBTALAR ANGLE 0°/0°

    FOREFOOT ABDUCTION BIL

    RCSP 4°EVERSION/4° EVERSION

    NCSP 1° INVERSION/0°

    TIBIAL STANCE ANGLE: 8°(MORE OR LESS)

    MAXIMUM PRONATION TEST: POSITIVE BILATERAL
    _____________________________________________________________
    HEEL CONCTACT IN EVERSION

    MS: PRONATION

    HELL OFF VERY EARLY


    I put a temporary medial skive of 10mm of semicompressed felt under his feet to see if it works good for the knee too. He felt really better for two day and later he took off those felts.


    My questionS: how the internal rotation and pronation act on the knees?

    using supination moments on STJ the tibia is gonna extrarotate. Is this positive for knee medial condyle condropathy?

    Using supination moments on STJ I increase medial forces on the knee...why he felt better?

    What happen in the knee with intra and extrarotation forces? I can't understand the biomechanics of condyles...

    why with such a pronation foot he got problems only on the medial part of the knee?

    which treatment?does he need a treatment?

    thank you all..fabio

    :deadhorse::deadhorse::deadhorse:
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Tricky one; its going to have to be compromise somewhere. Lateral heel wedging may help the knee (see this thread) and then may make the plantar fasciitis worse.
    What is needed for the plantar fasciitis may increase the joint moments at the knee and aggravate that!
     
  3. Tricky indeed. I would try mild medial support, while not increasing the varus moment at the knee. Lift both heels to help with ankle dorsiflexion and early pronation in the midtarsals. I would add valgus wedging also to off load the medial knees. I've tried this with success in cases like this. May need an extra depth shoe. Also, consider using subortholene with medium density or low density eva as support underneath. The subortholene will give a little under his weight and stay there, as opposed to polypro which will always spring back into it's original shape. This should help keep the varus moment to a minimum and also provide shock absorption he needs...
     
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