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I am uncertain what to prescribe a patient of mine. 60 year old lady with some mild arthritis in her feet and ankles. She has had flat feet all her life and is for the last few years getting pain in them. SHe ios getting pain in the met area and around the ankles (medial & lateral), some Tib Post pain also.

She has had vasyli insoles in the past but couldnt cope with these.

I have casted her today and I am just at the point of writing the prescription adn wondered if anyone had any thoughts.

Biomechanically
- medially deviated STJ axis
- RCSP 4 degrees everted both and NCSP 5 degrees inverted.
- SHe has slight ankle equinous (+5degrees)

Both of her feet collapse mainly I feel due to the medially deviated STJ axis although the heel isnt massively everting.

She wears Padders / hotter shoes.

SO far I am thinking yes kirby skive, yes medial flange and probably full length device, but I am unsure of the material to be used, do I go CAD CAM plastics or EVA?

Thanks for any thoughts.

MR_ Wal

 

Most likely this is due to Navicular drop and drift - have you checked those ? The medial deviated Stj axis and Pronation of the STJ will help to enable more Navicular motion.

Probably worth getting a better diagnostic picture - re met area could be one on 30 -40 different things and the ankle pain diagnosis, will also be important.

The tib post pain is good and I agree with the Medial skive and medial flange for that.

it really does not matter what material you use from the device up to the metatarsal heads the stiffness of the device is important, being 80 I would generally go with something of less stiffness 3 mm poly or the same stiffness of EVA the forefoot material and prescription will depend on the diagnosis ( ie what tissue is stressed and how the device will reduce mechanical stress on the stressed tissue). But before you decide the stiffness what is the supination resistance the higher the resistance the more skive and stiffer device required.

Hope that helps

 

Im just wondering , If she did not tolerate a Vasyli insole,

What did you mean "did not tolerate?" As in , would not wear them ?

Other factors ,

Is she overweight?

What is her activity level?


I had a patient very similar last year . A satisfactory result was reached by wearing a good quality pair of athletic shoes for walking and nothing more. No orthotic treatment . Not , No Clothing .

Patient re ed seemed to be the best

It is a hard call .


FDC

 

A Squodgie