I have a 53 y.o. female patient who weighs 155 lbs and has foot drop after a laminectomy x 2 with complications 20 years ago. She has a strong EHL but very little ant. tib. and does not wear an AFO. I think she is reconsidering the AFO after meeting with me but still wants orthotics for her heel, arch, met head pain. Her arch is chronically swollen, "boggy," and thick to palpation. I don't have the MRI with me now, but I remember it showed no tear of her plantar fascia according to the DPM's note. With overuse of her EHL she clearly is pulling on the medial band of her fascia which I'm sure is part of the arch irritation. Her subtalar joint does not supinate much however with the Hubscher Maneuver, and she has significant navic. drop coming into midstance. She obviously also has a short gastroc which I assume contributes to her pronation.
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My concern is controlling her pronation without irritating her arch due to the overuse of her EHL. I'm concerned about asking the lab to make a plantar fascia accommodation due to the difficulty in getting proper placement. Normally I would pour the cast inverted, use a skive, etc. but I don't want the arch height to be a problem. I planned on using a small lift given the short gastroc which I assume will help with control somewhat, but does anyone have any thoughts on controlling her pronation without irritating her arch given how much she uses her EHL without an AFO?
Thank you!
Ann
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