I have a friend who has diabolical biomechanics and experiences chronic symptoms that I believe can be controlled by the use of appropriate orthotic therapy. As I am recently qualified I would appreciate advice regading my diagnosis and whether my choice of orthotic design would be appropriate.
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The person in question has broad feet that bilateral grade 2 HAV The feet are very flexible and the medial column is hypermobile. In the NCSP the feet are more or less vertical, however in the RCSP the fall into a position that is in excess of 10 degrees everted. The person experiences continuous knee pain, posteriomedial shin pain and pain radiating behind and below the medial maleolus, all of which I suspect are the result of the excessive pronation. As a result of the continuous pronation the foot has developed into a supinatus position and, if I am correct then according to Davis's law eventually the soft tissue structures within the foot will eventuallt tighten and shorten and the foot will assume a more rigid forefoot varus position. Therefore, as the repetetive inversion of the forefoot will eventually cause the foot to rigidly assume that position, if I am right, it would not be appropriate to use medial inverted forefoot posting to control the forefoot.
Here is the point that I have been building up to. Even though the pronation is not the result of excessive motion at the STJ, the fact that the medial column offers no stability caused the STJ to pronate anyway. Therefore, is it appropriate to post the rearfoot into inversion and post the forefoot with 2-5 wedging to slightly evert these metatarsals and use a 1st ray cutout to try to encourage the 1st ray to plantar flex and hopefully over time become more competent as a weight bearing area of the foot. Advice would be really appreciated. Cheers.
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