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Aug 24

Written by: Larry Huppin, DPM
8/24/2009 1:26 PM

A client called today with a question about a patient with OA of the left ankle joint. His biomechanical examination was significant for a 10 degree everted RCSP. Xrays show a valgus angulation of the ankle joint with increased moment through the lateral ankle and decreased moment medially.

Our goal with the orthosis to reduce the RCSP and bring the heel as close as possible to perpendicular in order to equalize force across the ankle joint. Thus, this will be an aggressive orthotic prescription. In fact, I would recommend warning the patient that the orthosis may have to be adjusted if the patient experiences uncomfortable pressure on the foot. The patient would not likely tolerate an orthosis that applied enough force to bring the heel all the way to perpendicular, but our prescription will act to bring it as close as possible to perpendicular.

Here is what we recommended:

  • Direct milled polypropylene, semi-rigid
  • 22mm heel cup (deep heel cup aids in preventing heel eversion)
  • Wide width (Wider width stablizes midtarsal jont to help prevent excessive STJ pronation and subsequent heel eversion)
  • Minimum fill left. Standard fill right  (Minimum fill to stabilize midtarsal joint)
  • 2 degrees inversion left. No inversion right. (Inversion increases arch height and stablizes midtarsal joint)
  • 6mm medial skive left. 2mm medial skive right (Reduces pronatory torque on STJ
  • 0/0 polypropylene post (stabilizes orthosis in shoe)
If you have any questions or comments regarding this prescription, please leave a comment. 

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