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Mar 31

Written by: Larry Huppin, DPM
3/31/2014 5:53 AM

 A ProLab client contacted us today with a question regarding how to best prescribe an orthosis to treat an 11-year-old child with bilateral apophysitis affecting the base of the fifth metatarsal.

In general, this is fairly straight forward problem in that we have a primary goal of decreasing tension on the peroneal brevis in order to decrease tension on the apophysis at the styloid process. Since the peroneus brevis is an everter, we will use a somewhat everted orthosis in order to decrease tension on the peroneus brevis. We also at the same time are going to attempt to transfer pressure from the lateral column to the medial arch of the foot.

I recommended an orthosis that would conform closely to the arch of the foot medially in order to transfer pressure from medial to lateral but not so tight to the arch that it starts to supinate the foot excessively. A minimum cast should accomplish this. If, however, it does appear that the device causes excessive supination, it can be thinned in the arch to increase the flexibility in order to reduce the supinatory torque that is applying to the foot.

We also recommended a device that is as wide as the foot in order to transfer pressure as much as possible from lateral to medial.

Two modifications were recommended to evert the orthosis and thus evert the foot. Those were a forefoot valgus extension and a valgus wedge added to the rear-post of the orthosis. Once the symptoms have resolved, those modification can be removed.

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