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Hello Alastair.

Don't rule out severs disease. Generally it does present as posterior but if you look at an x ray



The apophysis is plantat posterior. I see no reason why the more plantar part of the apophysis might be inflamed, particularly if the patient has a heavy heel strike on the more lateral side of the heel.

I would certainly be thinking in terms of heel cushions / raises. Otherwise (and its always tricky without the patient in front of you!), I would be thinking in terms of medial rearfoot wedging with a substantial lateral arch and forefoot valgus extension to sulcus. Strengthening exercises for the calves and stretches for the Calves and Hams. Depending on the degree of the met adductus I may also consider reverse last footwear. My objective would be to work on a less lateral and softer heel strike to reduce trauma to the lateral part of the calcaneal apophysis.

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

small, yellow, leech-like, and probably the oddest thing in the universe

Semper in excretum sum sed alta variat

That's a fair point, it could be well worth investigating. I can also see how that prescription could work, would you also include a heel raise in that script? Or could you replace the medial rearfoot post with the heel raise?

It would depend on how much post / skive I'd need to have the desired effect. If possible, I'd put the poron raise on top of the medial post (on top of the insole). If not, I'd use the poron underneath the medial heel skive.

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

small, yellow, leech-like, and probably the oddest thing in the universe

Semper in excretum sum sed alta variat

Appreciate your help, sometimes can't see the wood for the trees!

Alastair