Male, 10 years of age, 70 lbs.
Pain in the arches of both feet, sore legs. The parents complain that the child walks funny and he looks like he has flat feet.
The child wore Dennis-Brown bars at 8 months of age for about 6 months in an attempt to correct a toe-in position.
The patient walks with an abducted gait. Heel strike is around neutral position, which for him is mild inversion. However, his feet immediately move into a maximally pronated position and remain that way throughout stance phase of gait.
Bilateral compensated subtalar varus complicated by internal femoral torsion.
This patient has a small amount of subtalar varus. Of greater important, though, is the internal femoral torsion, which causes severe pronatory stress on the foot. It is not unusual to find pronatory compensation occurring at the subtalar joint and midstarsal joint following Dennis-Brown bar therapy for rotational leg conditions. When dealing with torsional conditions of bone, Dennis-Brown bars are ineffective. The appearance of straightened gait is due to the abduction of the forefoot which results from the compensatory pronation.
It is more important to retain the integrity of foot function than to straighten the gait.
Usually, there is an improvement in the gait angle as the child grows.
- Explain to the parents the necessity of preserving foot function as opposed to correcting the gait angle.
- Cast for and dispense a pair of properly posted orthotics with a deep heel cup to control the compensation. The child may in-toe more when wearing the orthotics but this is desirable (this too should be explained to the parents) since it indicates that compensatory pronation has been controlled and normal foot function has been established.