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Saturday, February 27, 2021

Assessing Correction with the Inverted Orthotic Technique

This is the right foot of a patient with posterior tibial tendon dysfunction. She is trying to avoid surgery as her foot has begun the damaging process of collapse. As the arch collapses, the heel everts to the ground, and the foot gets more and more dysfunctional ("apropulsive" in the Podiatry world). Even though this foot would look better in the shoe, from the walls of the shoe holding the foot some, this is the image of a pronating right foot through the orthotic device. The right foot is still everting at the heel and sliding laterally at the heel on the orthotic device, collapsing the arch, and abducting the fore foot on the rear foot as the front of the foot moves laterally. 

In this particular patient, the RCSP was 11 degrees everted to start on the collapsing right foot, and 4 degrees everted on the left. The patient was given a 35 degree Inverted Orthotic right (7 degree change with that orthotic technique), but only responded by inverting 4 degrees. Therefore the photo above shows a 35 degree inverted orthotic device that does not have enough power now to invert the heel enough, so the pronation still wins. Therefore the patient's right heel went from 11 everted to 7 everted (a 4 degree positive change) instead of the 7 degree change I desired. Failure? No!! The mold that made this orthotic device is back in the lab for 4 major changes: 3 mm Kirby medial heel skive, slight increase in the proximal medial arch, change in plastic from 5/32 inch to 3/16 inch (this one I should have done initially), and a full length 3 mm or 1/8 inch extrinsic varus wedge. From each of these variables, I should get 1-2 degrees more extrinsic supination moment to help center that heel at vertical (the whole 11 degrees). I think it is easy to at least see by this photo how the medial Kirby will narrow the medial heel area and let the orthotic device grab the foot better. 

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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.