Jan 14

Written by: Larry Huppin, DPM
1/14/2010 6:34 PM

I had a patient present several months ago with diffuse midfoot osteoarthritis bilateral. Pain was present with most weightbearing activities and increased with exercise. Regardless of the joints involved in the midfoot, our goal with treatment is to limit the motion that causes pain.

Our first line of treatment was a custom foot orthosis with the following prescription:

• Semi-rigid polypropylene
• Deep heel cup
• Wide width
• Minimum cast fill
• 0/0 rearfoot post

When trying to limit midfoot motion, be sure that your orthosis conforms very closely to the arch of foot and also acts to limit subtalar joint pronation.

These orthoses provided about 30% improvement of her symptoms, but she was still experiencing significant pain.

Our next line of treatment was the use of rigid rocker soled shoes. Rocker soles, particularly when the apex of the rocker is just anterior to the calcaneus, do a very good job of limiting midfoot motion. The combination of foot orthosis and rocker soled shoes provided our patient with about 70% pain relief.

We still had one more conservative option – the use of an AFO to limit internal rotation of the tibia. Since the STJ pronates and MTJ unlocks with internal tibial rotation, by limiting internal tibial rotation, we can further limit midfoot motion. She was casted for a gauntlet AFO. The gauntlet was dispensed four weeks ago and she returned for follow-up yesterday reporting over 90% relief of her symptoms. She now uses the gauntlet when she is most active and the foot orthoses the rest of the time and finds that she can participate in most activities that she enjoys.
 
Check out our casting video for gauntlet AFOs

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