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Medially Deviated STJ Axis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by ajsgsy, Sep 14, 2015.

  1. ajsgsy

    ajsgsy Welcome New Poster


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    Hi, I'm fairly new and an infrequent visitor to Podiatry Arena, still finding my way around!

    I'm also new-ish to biomechanics. I have a patient who is excessively pronating yet varus wedges in the clinic do little to re-align the valgus heels. I suspect he may have a medially deviated STJ axis. But I'm not clinically experienced yet to determine this and have no colleagues. Could I try a device with a Kirby skive anyway (I've taken a plaster of Paris cast)? His negative cast is 15 degrees everted on the right side side. Would a Kirby skive present a problem if someone had a normal STJ axis?

    Also, what is the rationale for choosing intrinsic posting over extrinsic posting? Or using both? This patient has had right knee problems for a few years, he is middle aged, sporty and active, and appears almost maximally pronated at the STJ ROM on the right side. There is no LLD.

    Many thanks

    Andrew

    Andrew
     
  2. Andrew, which tissue is injured?
     
  3. ajsgsy

    ajsgsy Welcome New Poster

    Simon

    Good question - I cannot specify! I know he had an MRI of his right knee 3 years ago but was not referred for surgery. He has general "nagging pain" around the right hip, and sharp pain around the right knee especially going up and down stairs. Pain can occur when seated. The knee joint "warms up" with a "strange sensation" when cycling at the gym (he's avoiding running.) He has had physio with VMO exercises and strapping, leading to great improvement. Soreness around the knee can be lateral or medial.

    Andrew
     
  4. Medial, anterior, posterior or lateral knee pain might be a start then...
     
  5. efuller

    efuller MVP

    Have you read Kevin Kirby's paper on palpation of the location of the STJ axis? He gives a very thourough explanation of how to perform the test. Let me know if you have any questions after reading the paper.

    Simon's point was a good one. When using the tissue stress approach to biomechanics you should identify the injured structure and model it. Then design the orthotic to reduce stress in the injured structure.

    A device with a medial heel skive will tend to shift the center of pressure under the foot more medially. This will be good for reducing the pronation moment from ground reaction force at the STJ. It will also be good for increasing the knee adduction moment from ground reaction force. This would be bad for the knee with a lot of genu varum and already has medial compartment degenerative changes.

    Design the device for the pathology.


    Eric
     
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