Sep
3
Written by:
Larry Huppin, DPM
9/3/2009 2:33 PM
I had a 9 yo soccer player in my office today with a complaint of medial ankle pain with activity. She was brought in by her mother who was frustrated with the treatment that had been provided so far. The patient, we’ll call her Cindy Lou, has been active in sports since age 4 and has never been one to complain of pain except for this problem. Now she has been having medial ankle pain for over 4 months. They have seen the pediatrician several times and he has recommended Tylenol and ice. They purchased more stable soccer shoes and some Superfeet arch supports – which helped a little. When they presented again to the pediatrician he told them to it was “growing pains”, don’t worry about it and to stop activity if it continued.
Frustrated, they were referred to us by the mother of one of Cindy Lou’s soccer teammates. Her pain was medial ankle behind the malleolas and posterior-medial leg. There is pain to palpation along the course of the posterior tibial tendon.
Not surprisingly, her biomechanical examination was significant for a pes planus foot with RCSP of about 10 degrees everted. So Cindy Lou is suffering from posterior tibial tendonitis / medial tibial stress syndrome secondary to pediatric flatfoot. Given that she has already tried good quality prefabricated orthoses without adequate improvement, we discussed the use of custom orthoses designed to decrease tension on the posterior tibialis.
The ProLab Pediatric Flatfoot Pathology Specific Orthosis should be the perfect prescription for Cindy Lou. It incorporates a deep heel cup, medial flange, minimum cast fill, medial heel skive and a rearfoot post. Details on the design of this orthosis and a list of references is available here.
We also taught Cindy Lou’s mother how to apply a modified low-Dye taping in order to provide relief while waiting for the orthoses.
I haven’t met this pediatrician yet. I’ll send a letter on the patient to the pediatrician and follow-up with a phone call. By doing this regularly we have developed a referral base of over 15 local pediatricians who regularly send patients.
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