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Oct 6

Written by: Cherri Choate, DPM
10/6/2010

The incidence of ankle sprains within the general population is alarmingly high.  If you were to  poll a group of people, it is likely that at least 50% have had an ankle sprain sometime during their life.  Even more alarming, a larger number have had multiple ankle sprains. For this "recurrent" sprain population, RICE, bracing, and orthotics may not be enough.

A number of years ago I attended a lecture, presented by Doug Richie, at a PFOLA seminar.  It was the first time I had really focused on the value of evaluating postural control.  As I listened to his lecture I started to make a list of common podiatric problems which may involve postural issues.  My list of issues included:  chronic pain, post-op, post-fracture, post-casting, etc.  All of these issues seemed likely to lead to decreased postural control and eventually to a change in the gait pattern.  How many of our patients would benefit from a physical therapy evaluation?  How many would benefit from core strengthening and gait awareness?  The complex interaction between proprioceptors, sensory nerves, motor nerves and central nervous system should be respected.  I have observed the gait pattern change dramatically after a patient has been in a weightbearing cast for 8 weeks.   In a similar manner, nearly every patient who has had a hip/knee replacement exhibit a gait pattern that is confused and inconsistent.  

All of these patients would likely benefit from a "team" approach for their whole body response. The value of improvement in postural control by use of orthotics, strengthing, stretching, or bracing is difficult to argue.  By offering a whole body approach, we are certainly recognizing the significance of a neuromuscular system that is connected on all levels.

Interested in more?  See today's EJournal Summary:  Richie, DH, Effects of Foot Orthoses on Patients with Chronic Ankle Instability.

 

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