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Questions re Skive technique

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Jun 1, 2009.


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    Hi Ive got 2 questions.

    1. When using that Lateral Skrive tech, Ive started to notice the more distal the skrive finishes the better the lateral stibility. Ive a pat with a Cavoid foot, Peroneal Brevis partial tear and lateral deviated STJ axis, which Im considering bring the skrive distal to the cuboid to give the greatest mechancial advantage to the PB, PL. Is this ok or am I missing problems that can occur from this.

    2. Medial Skrive question. Ive just had a patient with a perfect foot for a 6mm medial Skrive, but she has had 5 left hip replacements in the last 6 years and 6 weeks ago had vertibrae L2 - S1 fused. Her Q angle is WNL but has a slight circumduction gait on the left side, the right leg is 3/4 longer, very flexiable joints, medially deviated STJ axis the rest of assessment WNL. Apart from the lateral heel being well supported with a high heel cup anything else that is important or would the medial skrive place to much stress on the repaired hip and fused vertebrae ?

    Thanks

    Michael Weber
     
  2. Griff

    Griff Moderator

    This makes sense - the more distal you go, the longer the STJ supination moment lever arm

    Why not use lateral/valgus FF posting or extensions? The lever arm and consequent STJ supination moment is far greater here than it is just distal to the cuboid
     
  3. Indeed, try removing plaster along the 5th distal shaft and MTPJ . Evert the cast etc.

    Why not use the wedge I described in the windlass thread placed beneath the digits; even bigger lever arm.;) Yet completely untested :D
    http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=92814&postcount=25
     
  4. The lateral heel skive (Kirby KA: Foot and Lower Extremity Biomechanics III: Precision Intricast Newsletters, 2002-2008, Precision Intricast, Inc., Payson, AZ, 2009, pp. 161-162) may be extended distally on the positive cast to increase the subtalar joint (STJ) pronation moment but normally the lateral heel skive will end proximal to the calcaneocuboid joint. In patients that I am considering using a lateral heel skive, I may also use the following modifications to further increase the STJ pronation moment and decrease the STJ supination moment from the orthoses along with the lateral heel skive:

    1) Balance the positive cast everted to increase the intrinsic forefoot valgus correction and decrease the medial longitudinal arch (MLA) height.

    2) Use extra thick medial expansion plaster on positive cast to decrease the MLA.

    3) Dorsiflex the medial column of the foot during negative casting to decrease the MLA.

    4) Add filler material plantar to the lateral longitudinal arch (LLA) of the orthosis to increase the stiffness of the LLA of the orthosis and increase the orthosis reaction force (ORF) plantar to the lateral forefoot.

    5) Add a valgus forefoot extension to increase STJ pronation moment at the metatarsal head level.

    6) Use a flat rearfoot post, with no motion, to increase the ORF on the lateral plantar calcaneus.

    I would tend to not use a 6 mm medial heel skive (Kirby KA: The medial heel skive technique: improving pronation control in foot orthoses. JAPMA, 82: 177-188, 1992) in such a patient due to her surgical history. In such a patient, it is better to start with a lower amount of medial heel skive (i.e. 2-3 mm) and then add further varus correction with time once the patient has adapted to the lower correction, if you still feel she needs it. The medial heel skive is a very powerful orthosis modification.....a little goes a long way in most instances.

    Hope this helps.
     
  5. thanks guys, Im seeing the lateral skrive guy now so will try some casting mods to reduced the MLA and then go from there.

    Michael Weber
     
  6. efuller

    efuller MVP

    I agree with the concept, but you need to switch you supinations for pronations. The farther distal the lateral heel skive the greater the pronation moment from the ground will be applied to the foot. I've made the same mistake. For us older guys it's hard to get out of the supination good, pronation bad thought process.

    Regards,

    Eric
     
  7. Griff

    Griff Moderator

    Sorry Eric - was a mistake - you are right - I meant pronation moment lever arm

    My bad
     
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