Achondroplasia

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Hi everyone im hoping to get some inspiration, this 30 year gent has achondroplasia (short limb dwarfism) they always nearlly present with high tibial varum angles which has caused his foot position. he is complaing of peroneal brevis tendonpathy which is obvious given the fact he walks massively supinated through the whole if gait and also the callus formation.

His STJ ROM is pretty good and the coleman block test shows that his heel can move into a valgus position. i worked around the lateral deviated stj axis to produce an orthotic with both a lateral / varus rearfoot and forefoot post- the only thing is that this patient was seen in the NHS and our internal lab technician cannot correct +ve cast to create lateral skive.

Anyhow used a large lateral RF and FF post but dyamically it did nothing, infact the patient supinated over the orthotic - even used high lateral flange. What i cant get my head round is that there is good movement at the STJ so what am i doing wrong? do i need to create a larger pronation moment? if so how? Will an orthotic achieve and reasonable goals in this patient? he already wears a shoe with mild flare. Is surgery an option? from what i can gather he saw an orthopod who said he didnt want to touch him?

Any ideas?

See Pic below!!! i even have a video clip of his walking to appreciate the fullness of his inversion but dont know how to attach it? i could send it via e-mail?

 

It looks to me the the axis is so far lateral deviated that you may have to look at knee braces in combination with orthotics.

If the axis is so far deviated then the device will have no effect as it must begin its" push" from a more lateral position in this case.

If the device "push" is medial of the axis you will be adding to the supination moment.

Maybe if a better position of the knees could be found then the result would be a less lateral deviated Stj axis and the orthotic may have more effect.

thats my 2 cents worth, not sure its possible good luck

Michael Weber

 

i initially saw this gentleman with the orthotist who made him an AFO, this stabilised the ankle and STJ but absolutely shot his knee mechanics, the stability which was provided caused an increase valgus moment - internal rotation force so much at the knee- i thought his patella was going to pop out medially! the problem with such a high tibial varum is that his patella fem (Knee) joint is in an externally rotated position. It couldnt handle the effects of the AFO which was cut to below the fibula - as i read in some articles that AFO in Achondroplasia patients can get peroneal nerve irritation.