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Dec 19

Written by: Larry Huppin, DPM
12/19/2011 7:22 AM

These pictures show the feet, shoe and orthoses of a longtime patient of mine. He is 77-year-old who has severe cavus feet bilateral, and on the right suffered a tibia and fibula fracture many years ago which left him with a severely inverted right rearfoot. This led to multiple recurrent sprains of the right ankle.
When I first saw him a couple of years ago, we discussed a number of treatment options including the use of an AFO. He had already tried an AFO and found that they were uncomfortable because of the prominence of his lateral malleolus. It was very difficult to find one that would support him and would not irritate the malleolus.

Instead, we decided to try orthotic devices and shoe modifications. We made him a pair of orthoses and on the right one added a valgus heel wedge and a valgus forefoot extension. You can see that in the picture. Once he tried the orthotics for a couple weeks, we increased the thickness of both forefoot and rearfoot valgus wedging. We found that the orthoses certainly made him feel much more stable, but he was continuing to be laterally unstable. We then sent him to have a lateral buttress and flare applied to his right shoe. You 
can see this modification on the shoe in this picture.

The combination of the orthotic and shoe modifications eliminated his problem. He has not sprained his ankle in over two years since receiving the orthoses and shoes.

He came back in today because he is starting to feel a little less stable. The orthotic devices appears to have held up well, but the shoe is starting to wear laterally. As the shoe wears laterally, it is going to cause him to more likely roll laterally. Today we simply replaced the valgus wedges on his orthotics and then sent him for new shoes with the same medial buttress and flare added to the shoe.

ProLab takes a scientific approach with our orthoses by integrating evidence-based medicine into orthotic therapy. Our team of Medical Consultants

regularly evaluates the medical literature pertaining to orthotic therapy and 

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