3/28/2012 4:10 PM
A young patient presented with:
severely pronated feet, 12+ degrees calcaneal eversion with further collapse through the midtarsal and the tarsometatarsal joints, and a pretty rigidly abducted forefoot on the rearfoot. The patient has a history of a tarsal coalition that was resected bilaterally which took this otherwise rigid hindfoot, and loosened it up which allowed the patient to pronate even more. This resulted in calcaneal fibular impingement and pretty severe pain. Another doctor had constructed a custom orthotic for her and, unfortunately, the patient was pronating so aggressively that she tipped her very wide poly shell orthotics (with a small 1st ray cut out) right off of the ground when viewing from behind and watching the rearfoot post. The entire orthotic was valgus!
I decided to make the patient a new pair of orthotics with the following prescription:
The problem with inverting the patient beyond this was that the 1st ray was lifting off of the ground, and I did not want to leave the patient with lateral column pain or lesser met pains. We will see how this works for the patient - the initial report was positive, "I love these!" They controlled the hindfoot and actually rotated this forefoot abducted foot remarkably well into a straighter position.
- poly shell, wide device for as much surface area contact as possible
- extra deep heel cup to control the hindfoot additionally
- no first ray cut out
- the poly rearfoot post was NON beveled on both sides in an attempt to stop her from lifting it off the ground in stance
- inverted 6 degrees and medial skive 4mm bilateral