Orthotic prescription help needed!

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Hi everyone,

I hope you all had a wonderful Christmas / NY break!

I am hoping for some help with an orthotic prescription.

70 year old male came to see me wanting a new pair of orthotics. This man has a largest talo/nav/cuneif bulge on the left side I have ever seen. Right side is quite normal. He explained to me (sort of anyway) that the deformity was caused by a series of football injuries (many many years ago) and by CS injections that followed. He didn't think there had been any significant tendon/lig damage. He was very vague about the details so I am not entirely sure of the accuracy of the history. Other than a THR on the right side in 09 he is very healthy (no meds).

His current orthotics are modfoot (rightside - assympomatic limb), and a DC wedge (Id say 15 deg, maybe a little more) on the left. He couldn't really remember specifically why he was prescribed the orthotics, just that there was some ankle and foot pain. He commented that they are very comfortable and he wears them virtually all the time. He is completely assymptomatic, unless you consider the aesthetics, which is why he wants a new pair. He doesnt "like the way the ankle and foot looks". There is still a significant of midfoot bulge when standing on the orthotic (calc bisection is pretty straight).
Bio results for the left limb are below.
-RCSP 9 deg ev
-NCSP 2 deg inv
-Drop Drift 1:1, both are well over 1cm
-SRT: hard
-Medially deviated stj axis
-Very mild restriction through STJ/MTJ (I was surprised that there wasn't more restriction)
-Equinus (gasc and soleal) ** He saw an acupuncturist for achilles pain in Dec 10, all okay now
- Weak gastroc, peroneals and post tib
- No inversion of calc when rising to tip toes
- Supinatus

Obviously there are some musc issues going on here, not overly surprising considering the history. Ill will try and deal with these.
What I am really hoping for is some advice. DC wedge is not giving him the control he wants, am I going to get anything better from an Inverted device. Or is this a case for a UCBL? He wears only 3 types of shoes. Runners, laceup workboots and lace up dress shoes (these the most).

Ahhh .... save me from this :bang:

 

Personally I wouldn't issue this guy new orthoses at all. He wears his current pair all the time, he finds them very comfortable, and he is completely asymptomatic. So why change them??

Can you guarantee him you will be able to elicit an "improved visual appearance" (whatever that is) with your new devices? (And without changing their comfort or eliciting any new symptoms?)

If you cannot answer that with anything other than a definitive yes (and I couldn't) then steer clear of issuing him a new set of devices. You don't need that grief in your life.

Ian