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I've a patient with a lateral instability who has gone to a orthopedic surgeon who told him that to be able to play soccer again needs a surgery.

The lateral ligaments seems to be completly broken (lateral tilt test) and and he has a bilateral forefoot valgus of 3/4°. The knee is varus and the heel too.

Does he need surgery? A good orthotic (latel kirby's skive, denton modification, root orthotic for ff valgus,...) could support enough?

In case of sugery.....what do you all suggest? tendon's transfer? Heel osteotomy with lateralization?

Thanks for attemption

fabio:drinks

 

A good custom AFO might do the trick. Think Richie style or a sport version of the old classic Arizona style brace. Either of these can combine the benefits of a foot orthotic with increased leverage because of the involvement of the lower leg.

 

30 yo with a AFO?He would like to play soccer...
Could you publish a photo of a "Think Richie style or a sport version of the old classic Arizona style brace"

 

Fabio it is quit possible his surgeon is going to do a lateral reconstruction only with capsule tightening and ligament repair. Most of this work may well be simply soft tissue with associated rehabiliation. Have you spoken to his surgeon in question? Maybe he can explain things more thoroughly and you may be able to suggest to him other methods he may not be aware of?

 

Sure, althletes wear AFOs all the time. Here are some pictures for you:

http://www.richiebrace.com/subpage.php?page=standardbrace
http://www.bracemasters.com/products/drafo-dynamic-response-sport.php

I'm suggesting a custom AFO because of his triplanar deformity. He could try an over-the-counter ankle brace, but I doubt that he would find it comfortable.
If he were to try over the counter bracing I would suggest the Active Ankle or ASO.

I happen to have just written a blog on this topic. Here's the link:
http://walkwellstaywell.wordpress.com/2013/09/22/lace-up-ankle-braces/

It's not a technical piece at all - aimed at the general population, but I gives an overview.

Hope this helps,
Angela

 

An interesting question is if your patient can describe the detail of the problem that he is having. It is theoretically possible that anterior posterior shear is part of the instability that he is feeling. That would be a different beast than if it is frequent inversion sprains. The reason that I mention this is that the lack of ligaments doesn't create the inversion motion. The foot would start to supinate before the ligaments if they were intact would limit motion. Increased pronation moment from the ground in the form of a lateral skive or forefoot valgus intrinsic post (Denton mod??) would decrease the liklihood of inversion sprains.

If it were my foot, I'd try some proprioception training and an orthotic with the discussed above before I'd go to surgery. Before proprioception training you need to assess muscle strength. If the peroneals are weak.....That could be your problem right there.

Eric