I consulted with a ProLab client recently regarding a patient with pain at the calcaneal cuboid joint. He apparently has a fairly stable foot with mild eversion of the heel in stance. Pain is achy with activity and there is a little pain to palpation dorsolaterally. Radiographs were negative.
He does not have an exact diagnosis, but if nothing else, he is certainly having some calcaneal cuboid arthralgia. In a way, it doesn’t really matter what the exact diagnosis is. For patients with chronic pain in the area of the calcaneal cuboid joint we have a fairly straightforward goal of treatment, regardless of the underlying etiology. Our goal is to minimize motion of the calcaneal cuboid joint and to transfer pressure from the lateral column to the medial column.
The following is the prescription that we recommended for this patient:
- Milled polypropylene shell
- Standard heel cup
- Wide width
- Minimum cast fill
- 0/0 polypropylene rearfoot post
- Topcover to toes, glued heel only
Potential Complication: A potential complication with this orthosis, particularly if you prescribed a very minimum fill, is that the orthosis will grab the medial arch so closely that it will apply a supinatory force to the foot causing increased pressure on the lateral column. This is an easy problem to take care of. In this situation, simply grind the medial arch of the orthosis from the bottom to increase the flex. This will allow the orthosis to flex, allowing the patient to pronate and decrease force on the lateral column.
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 biomechanics. ProLab clients are encouraged to contact a Medical Consultant whenever they have questions about an orthotic prescription.