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Orthotic suggestions?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Moose, Sep 26, 2009.

  1. Moose

    Moose Active Member


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    Hi All. I have a patient with very dodgy feet and I have some thoughts on what I would do - but I wonder if there are better ideas out there?
    She is a 30 yr old female, largely sedentary. Approximately 5" tall and therefore ....likes to wear high heels but is negotiable. The stands supinated and remains supinated through the step until heel raise where the weight dist (on a pressure plate) flees medially perpendicular to angle of progression - ie very fast eversionary slump. her 1st met is short and the plate similarly shows very low amt of pressure on the 1st met head. she suffers from p.fasc in high shoes, peroneal pain in low shoes and ITB, SIJt and subscapular pain regardless of shoes. Those of you with strong opinions will be pleased to know the pressure plate is for making pretty pictures and explaining stuff. I don't let its internal hamster design my orthotics. Thanks in advance for your ideas....
     
  2. Sounds like her STJ axis is laterally deviated. Check this next time you see her. If you find this you need to get her out of the heels. Start some physical training for the peroneals.

    Then I would suggest that you cast and issue a lateral skrive device to medially deviate the axis. There is threads on this if you search lateral skrive. There was one in the spainish section with Kevin attached his paper that he wrote on his invention the lateral skrive definently read that.

    You also mentioned pains in the peroneal brevis or longus and where is the pain? If its plantar to the cuboid the PL maybe subluxing from the cuboid grove and if its posterior to the lateral malleolar look at a peroneal subluxation something to consider if pain persists.

    Its most likely that the lateral deviated axis is reducing the lever arm of the pronatory muscle which is leading to overuse, so again look at the position of the STJ axis.
     
  3. Dananberg

    Dananberg Active Member

    This is a classic fibula related ankle equinus with an arthrogenic inhibition of the peroneal group.

    The peroneals can become inhibited when the fibula's translation is restricted. This results in a supinated appearing (actually inverted) foot position. Peroneal inhibition is also related to the lack of sub 1 pressure described in the patient history. It also relates to the late phase pronation, as the foot pronates in the angle the body is progressing over it.

    The treatment is to manipulate the ankle joint. (Description is available on www.vasylimedical.com in an article I have authored). When properly performed, it works like a charm.

    Howard
     
  4. efuller

    efuller MVP

    I'd agree with the assesment of a laterally positioned STJ axis. The late stance phase pronation (medial shift in center of pressure) and peroneal pain are consistant with a laterally unstable foot that needs high peroneal activity to prevent inversion. These feet will often show high pressure on the 1st met and or hallux after the medial shift of the center of pressure.

    Try a maximum eversion height test (ask the patient to evert in stance without moving knee in frontal plane) and observe how much distance there is between lateral forefoot and the ground. If there is very little eversion available then try a valgus heel wedge. If there is eversion available add a full length valgus wedge not higher than the eversion height.

    Regards,

    Eric
     
  5. Kevinl

    Kevinl Member

    Those of you with strong opinions will be pleased to know the pressure plate is for making pretty pictures and explaining stuff. I don't let its internal hamster design my orthotics. Thanks in advance for your ideas....


    THATS THE FUNNEST THING I HEARD ALL WEEK!, THANKS FOR THE LAUGH.
     
  6. Peter Towers

    Peter Towers Welcome New Poster

    Nice Pressure plate,

    Cant you see it in gait or callous build up. A 2 dimesional picture (pedograph is much cheaper although why make an 3D orthotic of one)
     
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