10/22/2014 9:16 AM
I had the opportunity to attend and lecture at the Colorado State podiatry meeting a couple weekends ago. It was an excellent assortment of talks with numerous “take home and apply in the office” tools. But my two favorite talks were both presented by Dr Kevin Kirby. The first was “Successful Treatment of Peroneal Muscle / Tendon Disorders and the second a discussion of “Barefoot vs Shod.”
The barefoot talks are always pretty interesting, since we live in an environment where shoes are worn. I have a very small patient population who confess to me that they do any portion of their training barefoot, but many more that are/were part of the “minimalist” shoe fad. Unfortunately many of those patients became patients of mine due to stress fractures or other overtraining types of injuries. More importantly, once these folks were treated and healed, many of these folks had biomechanical findings that are nicely addressed with functional foot orthotics (cavus or planus feet with secondary tendonopathies. ) One example, is peroneal tendonitis, which Dr Kirby addressed in its own lecture.
Things to consider for an orthotic prescription in the case of a peroneal tendonitis diagnosis:
- Remember to examine these patients standing which is important on every patient examination! Evaluate the resting calcaneal stance position. What does the heel bisection look like? Is it inverted? Is this a cavus foot? Does the patient report lateral ankle instability or a history of inversion ankle sprains?
- Consider a wide semi-rigid polypropylene shell with a deep heel cup. This will allow better control of the foot because of the larger surface area.
- Consider standard arch fill … this allows room for the foot to pronate versus minimal fill that could hold the foot inverted and laterally unstable.
- Request that your lab not bevel the lateral side of the otherwise flat 0/0 rearfoot post. This offers a pronatory torque on the hindfoot.
- Finally, if additional pronatory torque is needed, consider adding a top cover and applying a forefoot valgus wedge beneath the metatarsal heads (korex or EVA) to stabilize that laterally unstable foot. This will decrease peroneal tendonopathy pains.