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Rapid onset fixed hyperpronated STJ

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Asher, Jul 24, 2007.

  1. Asher

    Asher Well-Known Member

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    I've got a 52 year old male patient who within three weeks has developed a rigid hyperpronated left foot. This was noticed by his chiropractor (seeing for shoulder pain). He had appointments 3 weeks apart. In this time, he had been on holiday with his son involving trekking through the Kimberley (West Aus)for one week. Although he found it tiring to keep up with his son, he managed to keep up. Ordinarily, he drives machinery most of the day.

    Symptoms: There is mild pain around the lateral sinus tarsi area and anterior ankle with walking.

    Left Foot
    - no STJ motion
    - fixed in excessively pronated position
    - no change to arch contour, moderately planus
    Right foot no change.

    Previous to this, he had adequate and symmetrical STJ range. He has had foot orthoses for many years for pronatory symptoms which have been successful in eliminating symptoms (I last saw him 2004).

    Family history: Father has similar foot structure unilateral

    There was no injury within that 3 weeks or before. No diabetes. No arthritic disorder, no other joint pain.

    Xrays show no abnormailty.

    I see quite a number of people with similar unilateral or bilateral deformity but there has either been an injury or I have assumed that it has progressed slowly from a relatively planus / hyperpronated foot type that has not been supported with orthoses over the long term.

    Any ideas on the cause of this rapid onset rigid excessively pronated foot would be appreciated.


  2. CraigT

    CraigT Well-Known Member

    Are the peroneals in spasm???
    My initial thought would be whether he has had a rupture of his plantar fascia or perhaps tib post. Is the windlass mechanism working at all?
    I know it would seem strange, but I have seen patients who have these features who cannot recall any trauma. It may be a degenerative creep occurring that has reach a sudden end stage...
    Just some quick ideas off the top of my head
  3. Asher

    Asher Well-Known Member

    Thanks Craig T.

    I didn't check peroneal spasm, that may well be it as we are at end range of pronation.

    I can't be sure of tibialis posterior rupture as I can't do any muscle testing with no STJ motion available. Could coexist with peroneal spasm though.

    And will check plantarfascia and windlass mechanism.

    Many thanks

  4. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    It could be common peroneal nerve entrapment secondary to excesive prox tib/fib jt movement and/or soft tissue swelling from the rocky terrain.
    In a past life I was a tuna fisherman and we all suffered from forearm parasthesia through to full spasmic contraction after 3-4 weeks fishing.
    A little rest and a needling of the forearm muscles relieved markedly.
    Just palpate the peroneals and if you need to peel him off the roof voila!
  5. Asher

    Asher Well-Known Member

    The peroneals were not tender to palpation nor did I get any jump or twitch sign, however, dry needling to peroneus brevis and peroneus tertius (not longus) provided the result. I'm not sure if its possible but p. tertius could have been the sole culprit if one went by the pain distribution on its own. But its such a small and what I have thought a largely irrelevant muscle - I think I was wrong.

    Mind you, after dry needling, I couldn't passively supinate the STJ myself, each time I did, the muscles would resist and hold the STJ maximally pronated. The patient had to concentrate in making the the foot invert and adduct and allowing the spasming muscles relax. It took about one minute. Once he did, I could throw the foot around and get full passive motion ... it was like there was never a thing wrong with the foot. It was quite remarkable. :)

    So thanks to CraigT and Mahtay for your advice!

    I do have a question that I know I should know so sorry in advance for being dumb ... while the STJ was locked in maximal pronation, there was no windlass establishment, that is, the 1st metatarsal could not plantarflex. Once full STJ range was available, the windlass kicked in. Why?


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