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Ultrasound results reveal Tendosynovitis of the post tib. Pt has multifaceted contributing factors:

1. Moderate overpronation
2. Functional LLD due to pelvic torsion
3. Exaggerated internal tibial rotation with an abducted foot
4. Pes planus
5. Plantar fasciitis


Should an AFO (Richie Brace type) be prescribed before transitioning into orthotics to allow the tendon to calm down? Weightbearing foot x-ray is normal. AP xray of the foot and MRI tbd.

I have put the pt in orthotics which are worn for 1/2 hour two to three times per day. Pt has bi lateral bruising on the medial side of the knees from the orthotics. They are posted minimally.

 

If supination resistance is high and deformity is progressing and PTTD has got to stage 2, then yes something like a Richie brace probably needed to stop the progress.
If sup res lower, deformity is not progressing and still early stage, then foot orthotic (probably aggressive Blake type device) is all that is probably needed.

Sadly, PTTD does need aggressive orthotics or it will keep progressing. If knee or other symptoms develop, then a way need to be found to deal with that in the short term.