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Saturday, January 22, 2011

Posterior Tibial Tendinitis/Dysfunction Improved with Inverted Orthotic Technique

The posterior tibial tendon is one of the main supporters of the arch. For many unfortunate patients, the tendon tears leading to significant arch collapse. I will have many posts on this very disabling injury. I am very happy to use the Inverted Orthotic Technique (aka Blake Inverted Orthotic) for this injury. The pronation is so severe that a corrective orthotic device is necessary, and sometimes medial shoe wedging and/or ankle bracing. Many of these patients do need surgery, but some can avoid surgery with the Inverted Technique. This is a brief introduction.

     Let's start by watching this great video on a posterior tibial dysfunction patient on both sides.

So how can this patient be helped. Let us focus on the right foot. I measure the heel position from vertical (heel straight) with a goniometer. Here the ruler is only being used to show how much this 10 everted (valgus) is off from that vertical heel position.

Impression Casts are taken of the feet. In this case, the casts show the valgus heel and can be measured. The goal is to correct the heels back to vertical.

From the measurment of heel valgus standing, the Inverted Technique uses a 5 to 1 ratio to set the cast in an overcorrected position with the goal to straighten the heel back to vertical. If the heel is measuring 5 degrees of valgus, the positive cast would be set at 25 degrees inverted. I never go above 35 degrees initially due to the radical change that the patient will need to make. I will talk later about how you increase the correction based on the patient's response.

In the positive cast above set at 35 degrees of inversion see the amount of space under the medial heel area. It is this part of the cast which will attempt to control the pronation by placing supination forces into the medial heel and midfoot.

In the above example, a 35 degree inverted orthotic device was initially used to correct a 10 degree valgus position. The correction was true to the 5 to 1 rule. The 10 degree valgus position was changed to a better 3 degree valgus heel. If necessary, further simple mold adjustments will be used with Kirby Skive and Medial Column Correction to obtain the remaining 3 degrees.

I hope this is a good introduction.


  1. Hi Doctor Blake

    A lovely demonstration of the benefits in using correctly selected orthoses therapy for patients suffering from mechanical dysfunction and physical injury.

    As an added bonus a post treatment video of walking with and without (shod) would have been great. But we cant have it all....Can we?


    Steven Dowdeswell
    UK Podiatrist

  2. Dear Steven, I will try to get a patient to volunteer soon. Thanks for the suggestion. Rich


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.