Good Evening! Have been browsing all day and haven't really found what I'm looking for which is possible foot orthotic treatment for anterior tibial tendinitis / tendinopathy.
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Patient is Female, 43 y.o., 120 lb. active walker, yoga, outdoors etc.
Pain is focused on the dorsal-medial aspect of right foot only along the area of the navicular / medial cuneiform.
Pain is elicited when she everts / abducts the foot not wt bearing. Resisted eversion / inversion does not make it worse. Resisted dorsi - plantar flexion does not elicit pain.
One particular yoga pose causes it to flare: imagine starting with your back to the wall feet shoulder width apart. now slide down the wall until you are basically in a baseball catchers crouch but flat footed (not on the toes). It's supposed to be done free standing but she can't balance without the wall behind her.
This position, every time, causes it to flare up.
MRI results showed some signal alteration around the anterior tib. tend. adjacent to the navicular and medial cun. but an intact tendon.
Some signal alteration around the peroneals but saggital sequence did not confirm.
Some signal alteration within the pasterior tibiofibular and deltoid lig.'s.
all others normal.
Impressions were tendinopathy / tenosynovitis distal anterior tibial tend.
possible tear in one of the peroneals
possible grade 1 strain of ptf and delt ligs.
I put her into a device with a medial heel skive, medial flange and a first ray accomodation (she looked to have a plantarflexed 1st MTH).
I'm wondering if I went a wrong direction with the insert and am looking for some additional guidance as she is not worse but is no better either.
Any thoughts would be welcome and if I can provide any further information please let me know.
Thanks!!
Stephen
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