Case Study advice - What has gone wrong?

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Hello All

May I please get some help and advice with the following case study:

I had a 55+ year old 80-90kg Female Patient present to the clinic for an orthotic review.
It was over 10 years since her last biomechanical assessment, during which time she had ankle surgery to her left ankle.
Being a new clinician to the practice, I advised that we review her biomechanical examination, as her new orthotics were being repressed from casts that were from the same initial biomechanical examination over 10 years ago.

My findings were:
Non-weight-bearing examination - ranges of motions - Ankle/STJ/MTJ/MTPJs were all WNL; Both feet are pes cavoid flexible, Both feet plantarflexed first ray; muscle strength tests showed some weakness to the left foot ankle dorsiflexors compared to the right foot.

Weight-bearing - Both feet RCSP: pes cavus with rearfoot inversion, there was a positive Hubscher test identifying a functional hallux limitus and excess lateral/5th Met weight-bearing;
A Lunge test for the left foot was 0cm and the right foot approximately 5cm;
Gait: supinated with lateral weight-bearing and mild-moderate midstance pronation

Management:-
A referral to physiotherapy for L/foot ankle dorsiflexors rehabilitation

I decided on the following orthotics script for both feet:
- Polyprop device
- Rearfoot eversion of 6 deg
- A low MLA profile
- Reverse Mortons

The Patient returned with the following issues of both feet:
- Retrocalcaneal blister formation
- Discomfort to digits 1/2/3

I would value explanations to the issues of the Patient.

Thank You

 

That easy. Raise or lower the height of the heel on the orthotic to move heel away from irritating part of the shoe.

What is the actual "diagnosis"? what is the pain? eg neuroma?

 

Thank you for your reply DaVinci.

The effects of the orthotic has been to cause pain/discomfort to digits 1/2/3.

The old orthotic was scripted with only the following:
- pour for the cast with 8-10 deg inversion;
- minimal arch fill

I am afraid that there was little biomechanical information on file to support this prescription, but now it seems that this did not elicit the effects/issues which my prescription appears to have done.
I based my prescription on my clinical findings.

Thank you.