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Sunday, May 31, 2020

Pronated Left Foot: New Orthotic Device to be Made (Posterior Tibial Tendon Dysfunction)

This patient presents with a collapsing left arch for several years. I inherited the patient from my retired partner (Dr. Ronald Valmassy) who kept him going on a 20 year old orthotic device. However the patient has noted a change in the last year with a collapsing left arch and more left arch pain. He has no pain in his right side. He tries to walk 3-4 miles daily, but the last 6 months has been limited to very little walking. 

I am going to start with my highest correction of 35 degrees Inversion for the left foot. I am only making a new left for 3 reasons: only has pain on left, the right orthotic device seems excellent, and he has no insurance and is paying for this himself. 
     This is actually a typical stage 3 PTTD patient. The RCSP (resting heel position) was 17 everted or valgus standing on the orthotic device. The highest correction I do is 35 degrees initially which should push the patient into more varus by 7 degrees (5 to 1 plaster inversion to actual foot change). I will go up from there after he is used to it. I am always hoping for more than the 7 degrees change, but sometimes it will be less with the first correction. 3 months after his new left orthotic device is dispensed, I will either push the orthotic correction 3 or 5 degrees more.      

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