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Hi

Anyone with any experience or suggestions?

21 y.o. gentleman STJ over pronation,with tibia vara - slight (EM<10) but c/o knee pain when running (for football) and some new bony growth at the ankle as a result of the off centre angle.

Also noticed a forefoot varus which makes this gentleman's STJ pronation even more extreme as he tries to get the 1st MPJ plantargrade

I am considering either altering the scan of his foot 'straight up' in neutral with a whole foot medial posting (ie. the eversion angle in Amfit correct and confirm) -- but am wondering if there is perhaps an even more effective method of scanning with the foot at an angle, but the the knee in 'neutral'

This pt has had orthotics before from another practitioner who had not taken account of blouts/T. vara at all and had taken a sponge cast of the foot in neutral and then produced from that with no alteration -- obv he was not able to use these as they were painful

Thanks

Optimotion Camden
London NW1

www.orthotics-london.com
@OrthoticsLondon
facebook.com/optimotion

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Related threads:
Subtalar Arthroereisis and Tibia Vara
Tibial Varum

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My personal experience of Amfit, and any milled device really, is a limited amount of correction. you really can't get up into the upper eschalons of correction. But I'd be interested to see what you end up doing and how it works.

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I will update the thread with how this one goes -- I'm going to see the patient again on thursday and will try a scan in 'final position' as in the OP, and then decide whether to mill from the original scan with eversion angle added, or the new one. Instintively I think the new one will do the job a bit better. Either way will update the thread.

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Optimotion Camden
London NW1

www.orthotics-london.com
@OrthoticsLondon
facebook.com/optimotion

In your first post you mentioned adding a medial posting which does make sense to me. However, in your second post you said eversion angle added. By eversion angle are you talking about an eversion wedge over the AMFIT pins when you scan? This seems as it would be the opposite of what you said the first time.

With high degree of tibial varum there is an increased liklihood that the medial forefoot can't fully weigth bear. Bring the ground up to the foot.

Eric

I wasn't clear enough esp in the second post -- using the word eversion to describe the name of the function in the AMFIT correct & confirm software for adding a medial wedge whole foot..

Its a peculiarity of the programme that the function is named eversion...because the image is being shifted that way I suppose, wasn't using it in the general way we use the term.

Obv intend to bring up the medial side, I added self adhesive felt to the manufacturer's insert in his trainers at the first visit as a temp quick fix, and he reports its doing its job

I'm not completely decided between using this function to add a whole foot medial wedge, or scanning with foot at an angle, (i.e. the EM..) would be really interested if anyone has tried this.. it would not be possible with paster casting but with CAD/CAM it is

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Optimotion Camden
London NW1

www.orthotics-london.com
@OrthoticsLondon
facebook.com/optimotion