have recently graduated and biomechanics is not my strong point!
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I recently saw a gentlemen in my clinic who presented with pain in his right leg. one of his main hobbies was judo however he stopped this over 4 years ago as he was suffering from lower back pain. to keep his activity levels up he started running and has completed three marathons over the last three years. However not long after he started running he developed anterior knee pain. He went to a local podiatrist who advised him that he over pronated probably due to the fact he has flat feet. the podiatrist then gave him insoles (valgus dome with a 4degree medial hell wedge) These insoles did help with knee problem and he went on to enjoy two years of pain free running.
However when i saw this gentleman he was complaining of pain in the dorsal aspect of his right foot (he has no knee pain) The pain radiates from around the styloid process dorsaly across the cuboid to his lateral maleoli. He describes the pain as a dull ache which gets worse after activity and lessens after rest
He recently had an xray which showed multiple fractures to his right 1st metatrsal (the result of years of judo) the xray also showed arthritic changes in the 1st mpj which has left him with a severe hallux rigidus.
apart from this range of motion in the ankle joint and stjt is good. the patient does over pronate and appears to have a functional rearfoot varus and suffers from very tight calf muscles.
what can I do. could he be rolling over his insoles? should i encorperate a forefoot wedge into his insoles. Any advice would be gratefully recieved
sorry for the poor patient history
thanx ross
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