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Hello! Any comments and advice willingly accepted.... I have a 55 year old patient who had an right AJ athrodesis 35 years ago following a road accident. This has left her with no AJ dorsiflexion, and A LLD of about 2.5cm L > R. She is in good health. She has never worn orthotics or any custom footwear. Her presenting problem is pain in the digits/dorsum of Right foot (Mid tarsal joint area). The casted prescription orthotic is flexible polypropylene with a heel raise. All ok so far. What type of rocker bottom sole? Just for right foot? I hope any improvement is good, but any advice will be welcomed.

 

A rocker sole modification can be done to one shoe but we tend to do both to give some appearance of the shoes been a pair if you know what l mean.

Do we assume there is also no plantarflextion at the AJ also? if so the rocker will have to be both heel and toe rocker features.

Talk to your local Pedorthist if you can he/she will be of help with this modification

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I tend to find that the fused side "functions longer". So whatever you measure the LLD to be it can help not to raise the short side as much as you would have if both AJ's were normal. I would be thinking rocker heel and rocker toe, kind of like MBT, but if proprioception is not good this can lead to instability and a feeling of insecurity. Adequate proprioceptive retraining is often not done after trauma of this kind.
regards Phill Carter

 

Metabolic cost and mechanical work during walking after tibiotalar arthrodesis and the influence of footwear.
van Engelen SJ, Wajer QE, van der Plaat LW, Doets HC, van Dijk CN, Houdijk H.
Clin Biomech (Bristol, Avon). 2010 Jun 21. [Epub ahead of print]