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Nov 21

Written by: Larry Huppin, DPM
11/21/2009 11:51 AM

A patient presented to my office yesterday complaining of lateral foot pain left only. He had a history of clubfoot at birth that was only partially corrected surgically. He now has a left foot that has:
• Inverted heel in stance. Heel sits about 10 degrees inverted. Coleman block test is negative in that I could not reduce the inverted position by supporting the lateral forefoot.
• Equinus. Unless the knee is placed into recurvatum, the heel is about 1 cm off of the ground.
• Extremely high arch and plantarflexed first ray.
• Planatar prominence of the 5th metatarsal base

Overall, pretty classic findings for a clubfoot.

His only complaint is pain under the styloid process. He has never had orthotics, nor have they been recommended.

Our treatment goal is to reduce pressure on the plantar 5th metatarsal base. This is what was prescribed for the left foot:

• Vacuum formed poly 4mm on the left side and 5mm on the right. Because the left has a dramatically higher arch, the greater curvature on that side will lead to a more rigid orthosis. Thus, we can use a thinner material on that side.
• Minimum cast fill. A minimum fill will better transfer force off of the lateral column onto the medial column.
• Sweet spot for the 5th met base
• Wide orthosis to transfer as much force medial as possible
• Deep heel cup
• Polypropylene post. He has so much force coming down laterally, that an EVA post will likely compress quickly
• Diabetic topcover. I want a cover that provides extra cushion for the lateral column. Also, I asked that the cover be glued “heel only” so that I can easily modify the area of the orthosis where he is likely to have the most problem – the 5th met base.

For the right foot, I prescribed a simple poly orthosis with a standard heel cup, standard width, standard cast fill, rearfoot post and the same cover as the left.

I’ll try to take some pictures and video of the patient with his orthotics when they arrive. You can use the search function to look for “clubfoot” to check if there are any further entries on this patient.

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