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Orthotics for Pes Cavus Foot Type

Discussion in 'Biomechanics, Sports and Foot orthoses' started by kemplr, May 29, 2013.

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  1. kemplr

    kemplr Member


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    Hello,

    I have a 74 year old gentleman who presented complaining of a painful callosity over the left 5th MP head. He received orthotics from a private practitioner about 10 years ago - although he wasn't experiencing any foot pain then.

    O/E: Idiopathic Pes cavus feet since childhood, flexible (no restriction in any joints), slight forefoot valgus, no tibial varum, laterally deviated STJ axis L>R. His wife states that his left foot (left side was affected by a stroke in January) appears to be more supinated than was previously before the stroke.
    Gait - obviously heavy heel striker, overloading lateral column, some mid-foot pronation, toe off normal.

    His orthotics appear to be a standard poly device - high arch, min fill, no rear foot post.

    I was thinking of a poly device, with 0 degree reafoot post, min fill, full length spenco cover with a Poron 2-5 reverse morton's, possibly a lateral/cuboid skive?

    I also read that a heel lift may be beneficial. Does this sound like I'm on the right track?

    He is also complaining of bilateral abductor hallucis pain (more towards origin at heel). I'm stumped to why this may be causing pain? Would it be the orthotics in some way?

    Forgive me for my lack of biomech knowledge - I work in a hospital with high risk patients and don't tend to do a lot of biomechanics.

    Thanks again, Lauren
     
  2. davidh

    davidh Podiatry Arena Veteran

    Hi Lauren,

    You are on the right lines.

    A fairly safe prescription for a caves-type foot is a small (1/8th inch) heel lift on a neutral heel, with a lateral FF post. Add cushioning on the orthotic or orthotic/forefoot to suit.
    If you are using a preform ensure it has some stiffness to it, and don't allow the arch to rub.

    With a CVA patient, remember that the contralateral limb (to the affected one) will probably be carrying a higher workload - and there may have been a limb length discrepancy prior to the CVA It will be worth experimenting with a small heellift if you find that one leg is a little shorter than the other.

    In my experience the patient should find this instantly more comfortable than no correction. Unfortunately it's impossible to be more specific (with any degree of accuracy) without seeing the patient.

    Let us know how you get on.
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. Jo BB

    Jo BB Active Member

    I am just going to divert for one moment and share an experience of mine.I had a new patient, very angry with a painful HD, L PMA5.I was podiatrist number 17. He had all manner of orthoses over this period.We had 3 sessions over 3 months. I just had to put my head down and give him relief! It was at his third consultation he was complaining of the pain in his calf from the altered gait [especially walking up "cardiac hill"] that I suggested he may have symptoms of I.C. I didn't see him again for 12 months when he returned with his wife.He did have a blockage, had a stent and the corn went. I am not suggesting that your patient has anything but a biomechanical problem but vascular issues and smoking can be part of the mix.
    Kind regards,
    Jo BB
     
  5. kemplr

    kemplr Member

    Thanks for the replies...

    DavidH - I added a 2-5 reverse Morton's in PPT and a full length valgus wedge to his current orthotics. Pt phoned me to say it was working very well - Am seeing him this week and will add some small heel raises. Thanks for the advice.

    Jo BB - I completely agree with your post. It is interesting to note that this patient was an ex smoker (quit approx six months ago when he had the stroke). I have done ABI's and TBI's on this gent as I thought this may have been a factor but the results came up pretty normal. Will revisit this next time he is in. I had another patient in a few months ago with intractable plantar keratoses - heavy heavy smoker. She refused to stop smoking though..... so she was eventually discharged - never knew what happened to her IPK's - probably still there!

    Thanks, Lauren
     
  6. efuller

    efuller MVP


    There are two things that cause high lateral load and they need to be treated differently. There is the foot that supinates very easily (laterally deviated STJ axis) and the foot that does not have any eversion range of motion available (rearfoot varus). You can have both at the same time. The reverse Morton's would help the laterally deviated STJ axis foot by shifting the center of pressure more laterally, increasing the pronation moment from the ground. Other things that could help the laterally deviated STJ axis foot are a forefoot valgus post and a lateral heel skive. The forefoot valgus post doesn't help the rearfoot varus foot.

    Eric
     
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