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Perroneus brevis tendonitis + pes planus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by phil, Nov 7, 2011.

  1. phil

    phil Active Member


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    Hi everyone,

    I've got a case of two biomechanical-foot-function-theory worlds colliding here and its causing me much angst.

    Patient presents with bilateral chronic perroneus brevis pain. It is worse on the right foot, which is also significantly more abducted.

    Treatment, as i understand it, should involve reducing the work done by these tendons. My choice was to add forefoot valgus felt padding to the insole/ sock liner and give it a couple of weeks.

    So far, so good?

    Problem is, she's got pes planus. And I know this FF VL padding is going to pronate the STJ furthur. Mind you, she doesn't have any of the common injuries that can present with pes planus. Actually, the only problem is this perroneal pain.

    I checked the maximum eversion height, so i know she's got the ROM to accomodate the FFVL padding.

    So, what im asking for is permission to pronate. Can I pronate the foot please?
     
    Last edited: Nov 7, 2011
  2. efuller

    efuller MVP

    Go ahead. It took me a few years to unlearn supination good pronation bad. One of the keys to making you feel better about this is palpation of the location of the STJ axis. There are some rare feet that are really flat and flexible that have laterally positioned STJ axes. These should still be pronated.

    Eric
     
  3. phil

    phil Active Member

    Thanks eric! This kind of feels like confession. A podiatrist wantonly pronating feet? Blasphemy!

    I'm yet to review this patient, and it will be a couple of weeks until I do. I'm a bit nervous.

    It's funny; when I saw her really flat feet it's almost instinctive to want to un-pronate them, if you know what I mean? Even though the presenting complaint seems to be indicating the need for the complete opposite.

    RE: STJ axis location- my poorly practiced technique seemed to show a fairly medially deviated STJ axis, and supination resistance was high. However, as i mentioned before, there's enough extra eversion to accomodate the FF VL padding.

    So, some extra question for my pod arena collegues- If my FF VL padding is an absolute failure and makes it way worse, what could be the potential explinations for this? Could a flexible pronated and abducted foot cause perroneus brevis overuse? What would be the mechanical explination for this? Any clinical anecdotes for perroneal tendonitis with flat feet?
     
  4. Was peroneus brevis in spasm ? Would explain excessive pronated high supination resistance and overused muscle.

    As Eric often asks where is the moment coming from. Medial deviated STJ axis you would assume ground reaction force in this case maybe PB
     
  5. Timm

    Timm Active Member

    Hi Phil,

    I have come across the odd patient with peroneal symptoms despite significantly medially deviated subtalar joint axes. I find these patients respond really well when sagittal plane mechanics are addressed.

    How was the patients Jacks test / Windlass force? Lunge?

    I have found forefoot 2-5 / Reverse Morton's pads to be effective for some of these patients. Others required an orthotic device with skive, heel raise etc. Will be interesting to see how your patient responds at the review

    Tim
     
  6. phil

    phil Active Member

    mike, perronius brevis wasn't spasming when standing. the high supination resistance was just old fashioned medially deviated STJ position. though i will check it again!

    timm, as my biomechanical assesment skills are in the process of being dusted off and thoroughly exercised, I neglected to check the sagital plane stuff very closely e.g. jacks test, lunge test. the lateral forefoot felt padding I applied should approximate the reverse mortons you suggested.

    thanks for your input everyone!
     
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