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Chief Complaint (CC)
Left ankle pain - lateral, worse on exercise / impact.
Patient suffers from blisters at heel on left foot (as if foot is twisting when walking/running).
History of Present Illness (HPI)
Ongoing pain in left ankle for a number of years. Worse with use.
Past Medical History (PMH)
Twisted left ankle on several occasions.
Nil further.
Physical Exam (PE)
Left foot pronation > right foot pronation.
Laxity of lateral ligaments of left ankle.
Left achilles tendon is bowed medially.
True left leg length discrepancy (left leg shorter by 1-2cm).
Left calf greater by 2cm circumference than right (no worry of DVT).
Diagnostic Tests
Nil.

Patient continues to have discomfort using arch supporting insoles and left heel raise.
Patient complains that left foot “slides off” insoles and unable to wear insoles (tried mid length and full length insoles).

Any further advice?

Cannot post photo links as new member.

 

Hi James,
What is the discomfort from insoles? arch pain? or just slipping? Are they generic ?
If the client is sliding laterally look at
- lateral flange
- lateral heel post
- modify topcover (use lunasoft for grip)

 

Arch support insoles is the issue if I can guess the design features.

If someone is laterally unstable and you add a supination type of device inshoe things can go wrong fast.

Don't worry about the pronation worry about the lateral ligaments instability.

You need to increase the orthotic reaction force lateral to the STJ axis. Or more push on the outside

You can do this through design features such as lateral skive, cuboid notch, increased height of the lateral side of the device or all 3

The patient is sliding off the device because there is reduced resistance to the supination moment.