Hi guys,
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I'm prescribing orthotics for this lady who has chronic sore ball of feet. She's had bad experience with wearing orthotics before (unfortunately she threw them out so I'm not sure about previous prescription), she is also having trouble with L anterior knee pain, and L hip pain + clicking, core instability, and lower back pain.
Her main issue is pain under 2-4 metatarsal heads after prolonged use of feet. She's a keen tramper but always get sore from midpoint of the tramp and find it frustrating.
She has had met dome put on shoe insole but it actually hurt the ball of feet more, and toe prop made for her rigid mallet lesser toes that actually made the pain worse as well.
I'm prescribing new orthotics for her and given she's a bit of complex case, I came here to get some confirmation/help.
Below is my clinical findings:
Non WB:
- short 1st ray, slight hypermobile
- collapsed metatarsal arch (callous under 2nd-4th met heads)
- moderate bunion defomity on L. neutral on R
- Callous plantar-medial L hallux IPJ (none on the R)
- slight plantarflexed forefoot to rearfoot
- whole body hypermobile
- normal subtalar joint axis
- weaker L leg overall.
- tight gastroc-soleus complex on both, L slightly tighter
WB:
- flexible cavus foot (high medial and lateral arches that collapsed a little upon weight bearing)
- mild genu valgum, L more
- large Q angle
- easy supination resistance test on both
- normal easy windlass
- arch height did not change at all during small knee bend
Gait:
- abductory twist on both
- R more abducted angle of gait
- late stance pronation
Proposed Orthotics prescription:
- low density polypropylene with reinforcement
- metatarsal dome/pad/cookie (or whatever you want to call it).
- neutral rearfoot post/stabilizer
- plantar cover with 2nd-4th cut-out
- slight heel lift
- medial and lateral arch pad
- morton's extension
My concern is:
- given she's had trouble with met dome before, is she likely to tolerate this time?
- should I try to correct late stance pronation with morton's pad or forefoot varus pad at all? or correct it much early on using rearfoot varus posting.
Any help or advice or guidance are much appreciated.
Mike
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Forefoot angle determines duration and amplitude of pronation during walking
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Reasons to Not Do Gait Retraining (i.e. Chi, Pose or Evolution Running)
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Forefoot angle determines duration and amplitude of pronation during walking
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Reasons to Not Do Gait Retraining (i.e. Chi, Pose or Evolution Running)
>
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