Foot Orthoses For Chronic Ankle Instability
In light of an increasing body of research on the
Patient
Male, 29 years old, volleyball player, 267 lbs.
Complaint
Increasing pain and swelling in both knees over a six year period. Pain and stiffness in lower back and morning stiffness in feet and ankles.
History
He has had multiple and often conflicting diagnoses and treatment, all directed at his knees. Arthtoscopic surgery on the right knee produced no definitive diagnosis or change in symptoms. He has had a succession of soft “orthotics” that were basically arch supports.
Clinical Observations
Static Stance Position shows a high degree of tibial varum with subtalar compensation. The head of the talus and navicular hypertrophy create a large prominence on the medial aspect of each foot.
Biomechanical Evaluation
Subtalar varus with forefoot valgus. Hip rotation in both flexed and extended position was more internal than external indicating bilateral femoral torsion and anteversion. All other joint ranges of motion were within normal limits.
Gait Analysis
Patient had a pronounced “bounce” in his gait with complete collapse of the medial longitudinal arch. There is a marked medial rotation of both knees as the forefoot contacts the ground.
Diagnosis
Rearfoot varus, forefoot valgus with compensated equinus gait.
Discussion
This is another case of years of treatment aimed at the symptoms while the biomechanics are ignored. In addition to the primary structural problems, lack of proper stretching has led to a severe posterior muscle group imbalance, causing changes in the postural complex and further knee stress and damage.
Treatment
Semi-rigid sport orthotics posted with 5 deg rearfoot varus posts bilaterally, 3 deg forefoot valgus posts bilaterally, and a 1/8″ poron forefoot extension to the sulcus. Stretching exercises were prescribed for the posterior muscle groups.
You might also enjoy
Can Foot Orthoses Have An Impact For Knee Osteoarthritis?
Dr. Kevin Kirby, DPM Given the common nature of knee
Effect of Different Orthotic Material on Plantar Pressures
James M. Gerrard, Daniel R. Bonanno, Glen A. Whittaker, Karl
