5/20/2011 6:26 PM
I never thought I would place a full-length valgus wedge on a patient's orthotics.
I see a lot of workers comp cases and presently see a roofer. After about 2-3 hours on the roof he feels pain. In a stance exam of this patient, he is bow legged b/l with pronounced tibial varum and his RCSP is nearly perpendicular to the ground. Initially, he presented with typical plantar fasciitis symptoms and we tried a 0/0 motion rearfoot posted functional foot orthotic, neutral device with no inversion. This seemed to help the arch, but the patient slowly developed peroneal pain. In my initial attempt to relieve this, I added a reverse Morton's extension of cork to the devices that the patient enjoyed; then he increased time on the roof and this was proving to not help. So, I used a piece of 1/4" thick felt as a valgus wedge on the lateral aspect of the orthotic. The patient liked this; he said it offered him "more support." I warned him about sinus tarsi pain if I over everted him (and to carefully peel off the felt if this was happening), but this didn't seem to be an issue. We started over with the orthotics and I have ordered a full-length 1/4" thick valgus cork wedge beveled down medially on both devices.
I will update the blog after the patient trials them.