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Orthoses for partially flexible F/foot varus and pes cavus foot type

Discussion in 'Biomechanics, Sports and Foot orthoses' started by TeKsTeR, Jul 5, 2007.

  1. TeKsTeR

    TeKsTeR Member


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    hi everyone!
    I am new at this but I have a patient who was diagnosed with a painful L heel spur. Examination of his feet showed: rigid pes cavus foot-type, STJROM 1:1 restricted, MTJROM reduced, and 1MPJROM < 65. the patient also have a partially flexible forefoot varus app. 6 degrees. AJROM < 10 (ankle equinus) and reduced hamstring flexibilities. His gait is unremarakble except for being very stiff due to lack of shock absorption.

    Sorry for my ignorance but I just recently graduated: can anyone out there help me with the most appropriate orthotic prescription?
     
  2. Donna

    Donna Active Member

    Hi Tekster,

    Some information that would be more useful (instead of all those numbers)would be: history of the injury/symptoms, what makes it worse?, what makes it better?, previous treatment and/or investigations (if any), footwear, occupation info, activities (sports/gym/etc)...

    What is your diagnosis? :confused: It sounds as if the patient has come to you previously diagnosed with "spur"...

    What other info can you give us? ;)

    Regards

    Donna :)
     
  3. DaVinci

    DaVinci Well-Known Member

    I think you may beed to go back and re-evaluate this patient:
    How can you get a forefoot varus with a cavus foot type? If forefoot varus was present, then the arch would be flat during WB and non-WB
    How can the forefoot varus be flexible, when the foot structures are rigid?
     
  4. Donna

    Donna Active Member

    I was waiting for CP to say something about the almost mythical creature that is FF varus... :eek:
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I have been lurking ... I am actually on leave today looking after the Arena'ette's ...amazing how little time one has ;)
     
  6. Donna

    Donna Active Member

    Especially since when I've seen FF VR discussed previously it wasn't simply a quick question & answer... :eek: Makes me weary just remembering it... :p

    Regards

    Donna
     
  7. TeKsTeR

    TeKsTeR Member

    thank you for all the respond guys. I am greatly appreciated.
    As I mentioned earlier, even though the patient has a rigid foot- type, I can see he has a forefoot varus when you placed the foot in neutral, and its partially flexible not totaly flexible.
     
  8. TeKsTeR

    TeKsTeR Member

    This patient was previously diagnosed with heel spur from his x-ray film.
     
  9. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I'm with Davinci - It is not possible to get a forefoot varus in a cavus foot type! Was the patient prone or supine when you made that determination?
    Not relevant. See this.
     
  10. Lawrence Bevan

    Lawrence Bevan Active Member

    Why cant a cavus foot have an inverted forefoot?

    "Cavus" relates to the pitch of the tarso-metatarso joints in the sagittal plane and thus the height of the arch non-weightbearing. Sometimes this is called forefoot equinus.

    Not all high-arched "cavoid" feet have the classic rigid forefoot valgus and some, albeit not many, high-arched "cavoid" feet can have an everted heel and therefore develop a supinatus.
     
  11. Donna

    Donna Active Member

    Tekster...

    What is the first ray range and quality of motion like? Are you sure you're not seeing the influence of first ray position/motion on the forefoot's appearance? :confused:

    Have you taped this patient to gauge their response first? How do you know an orthotic is going to help this patient with their "spur"? The A Pod A Orthotic Guidelines, although a few years old, state minimum requirements for each step in the orthotic prescription process. :eek:

    Just a couple of things to have a think about that's all...

    Regards

    Donna :)
     
  12. All you need to do to find a "forefoot varus" deformity in any foot, is to draw the heel bisection line everted and/or hold the subtalar joint supinated from the neutral position. In this fashion, you can make any foot have as much "forefoot varus" as you want!!!
     
  13. TeKsTeR

    TeKsTeR Member

    thanks again for all your responses, it was very interesting. After hearing all your advices, I actually went back and had a second observation of the patient's feet. I check the feet in supine with STJ in neutral and I think the patient have a f/foot supinatus as the 1st ray was clearly plantarflexing when a downward pressure was applied to the 1st ray.

    I will keep you guys up o date ..on the outcome of this patient. thanks again for your help. This is a great learning outlet for me who is still very new to the profession.
     
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