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Orthotics and the elderly patient

Discussion in 'Biomechanics, Sports and Foot orthoses' started by LindaG, Jan 29, 2015.

  1. LindaG

    LindaG Member

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    Hi everyone,

    I have an elderly lady who has one very flat foot and the other low arch but certainly not as low as the other. She has callosities over plantar met head area and generalized metatarsalgia. Both feet are quite rigid with all ROM in the foot and ankle joints below average. I would like to give her a cushioning insole to help with shock absorption but am not looking to correct the arch profile or give her something too aggressive as I think at this stage it would only worsen her pain. Do any of you have similar experience? And if so how did you manage this?


  2. efuller

    efuller MVP

    Are you familiar with posterior tibial tendon dysfunction and the relevance of STJ axis location in the cause of unilateral flat foot.

    If there is rupture of the PT tendon, a high arched orthotic can be really painful. However, a low medial arch with a medial heel skive can improve symptoms. Ankle foot orthoses and gauntlet's are other things that can help depending on what hurts. So, what hurts? Does the PT tendon produce any motion?

  3. Jeff Root

    Jeff Root Well-Known Member

    Like Eric, my first thought was posterior tibial tendon dysfunction/adult acquired flatfoot. If metatarsalgia is her chief complaint, does she have other symptoms? You said she has rigid feet and that the ROM in her foot and ankle joints is below average. Her metatarsalgia and callouses could be related to ankle joint equinus and possibly to a limited ROM in her MTJ. Does her heel function everted? What is her age? Elderly is relative. For example she could be 70 or 98 years old, which is a 28 year range. How is her general health and how active is she? Does she appear to have atrophy of the plantar fat pad, especially in the ball of the foot?

    If she has adult acquired flatfoot it is important to provide medial arch support and pronation resistance (pronation control) with your device. You should not assume that she needs a cushioning device simply because she is "elderly". Many elderly people need and do very well with a more supportive, semi-rigid device. In some cases they may need a little cushioning on the top surface of the device, especially if there is atrophy of the plantar fat pad, but they may need a semi-rigid shell to resist their pathological forces. If you are using a prefabricated device, select one that will provide good medial arch support. That doesn't mean it needs a high arch since her arch is so low, but she will probably benefit from some arch support. If you use a custom orthosis, your cast will replicate her low arch so in order to support it, you may want to use minimal medial arch fill on the positive cast with the possibility of a medial heel skive and inverting the heel a few degrees, depending on the ROM and functional position of her rearfoot (heel/heel bisection). Edit: also may want to consider a heel lift for ankle joint equinus.


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