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When one is conducting a biomechanical examination and finds out that the patient has an elevated first ray, and a plantarflexed 5th ray... should one implement a modification to the orthotics provided? Furthermore... if one has LLD and requires a Kirby skive on the shortest foot what do you suggest as a treatment? can both be applied? How would one know whether to use a varus bar or the normal bar?

 

I am not exactly sure of your questions - why don't you either give us more information or put it up as a patient case study?

Are you referring to a an observation of the forefoot being inverted in the frontal plane relative to the rearfoot?

Are you asking if it is ok to incorporate a medial heel skive and a heel raise on a device?

Not sure what you mean here at all. Terminology cab vary greatly between countries etc - you need to be more specific.

 

I've used normal bars for years. Never had any problems besides hangovers.

 

Is the first ray elevated because the person was born that way or is it elevated because of high amounts of ground reaction force under the first ray for long periods of time. The answer would be different for one over the other. Although, I might change my answer if I new what hurt. I usually try to design my orthosis to relieve stress on a painful anatomical structure.

Welcome to the arena,
Eric

 

Both can be applied, but remember the skive itself will act as a heel lift so you may want to lower the height of the heel lift slightly.

 

I will discuss only part of the question. When examining a foot, and finding an elevated first and plantarflexed fifth, you must watch the patient walk. Are they functioning normally for this forefoot varus type foot and collapsing the medial arch and heel or not? The reason it could be "or not" is that other factors may be over-riding like a tibial varum with intoed gait, producing more of a supinating force around the subtalar joint. So, step back from your measurements and first watch the patient walk. What forces do you see? Is this a pronator that I need to support that forefoot varus and met primus elevatus, or is it a supinator, or a normal arched patient. Based on the study of gait, you will be able to answer your questions better. Rich Blake