Jan 4

Written by: Larry Huppin, DPM
1/4/2010 4:14 PM

A patient presented today with bilateral pain on the plantar lateral foot with activity. His exam was significant for:

• Cavus feet
• Inverted RCSP with a positive Coleman Block test (by supporting the lateral forefoot the heel came to perpendicular)
• Humongous styloids – plantar and lateral.
• Pain to palpation on plantar styloids – no pain lateral.

He had a pair of orthoses that were not helping much. These devices were gapping extensively from his medial arch and although they had some accommodation plantarly for the styloids, it wasn’t nearly enough.

Our treatment goal is to reduce pressure under the styloid processes.

Here is the orthotic I prescribed:

• Vacuum formed polypropylene, semi-rigid
• Deep heel cup
• Lateral heel skive. This acts to shift the center of force lateral to the STJA and limit inversion force on the heel.
• Wide width in order to put as much force on the medial arch as possible in order to reduce force laterally
• Minimum cast fill so that the orthosis hugs the medial arch tightly in order to transfer force from lateral to medial
• A large sweet spot 3mm. Putting a sweet spot laterally can be a problem as the plantar prominence of the orthosis can cause it to rock on the sweet spot. To stop this we’ll use a……..
• Heel lift 3mm. By lifting the heel, the lateral column elevates a bit to prevent the orthosis from rocking on the big lateral sweet spot
• Rearfoot post
• EVA cover to toes, glued heel only (so the sweet spot can be adjusted if necessary)
• Valgus forefoot extension.  Supports the lateral forefoot and reduces heel inversion. 
• 1.5mm Poron glued to bottom of cover. This extra cushion will also reduce force on the styloid plantarly.

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