Yesterday I was thinking about how to treat a patient with 7° of tibial stance in varum, supinated forefoot of 6° bilateral, tibial angle of 0°, RCSP 0°, NCSP of 5-6° inverted.
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the ankle was a muscular equinus with 0° of ankle dorsiflexion.
In last time I start to introduce in my examination two new ideas:
1. BOOK TEST: I call it in this way cause I often use to put under the heels a book to lift them.
I usaully use the first book of kevin kirby...I think is 2 cm thick. Some times I use thiner or thicker if is an important or not equinus.
When the heels are over the book I measure the RCSP again.
In the end I compare the measurement with and without the book to understand how many degrees of pronation are caused by the equinus.
I usually avoid important rearfoot posting or skive or inverted cast when I see that eversion decrease a lot...may be 2/3 degrees.
If the patient wears an enough heeled shoe I make an orthosis with less antipronation function.
2. COMPARISON BLAKE INVERTED TECHNIQUE AND KIRBY'S SKIVE:
Kirby initially described his medial skive like a development of Blake's Inverted Orthosis for children with rounded heel.
I use this picture to compare.
I think that both modifications have maximum moment nearby the edge of the medial part of the shell.
Considering this modifications I think that if the the most medial part of the rearfoot post were of the same thickness the anti-pronation force would be really similar.
I'm beginning to think that Medial skive is usefull not in rounded heel and orthosis in which I want a low arch.
BIO, for me, is usefull to change the geometry of the orthosis resulting in a more rigid and higher arch.
I'M THINKING IN A RIGHT WAY?
I try through this thinking to make my therapy more reasonable.
I need your opinions.
thanks,fabio
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