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Hi, this is one of my first posts so go easy on me!!
Did anyone else learn in uni that genu recurvatum is a contra-indication for a functional orthotic?
I remember our Biomech lecturer telling us that it is not recommended when t is present......I think he said its because it might push them even further into hyperextension.... I'm trying to visualise what an orthotic would do to a hyper-extended knee.
If someone has hyperextended knees and associated "hypermobility", surely if they are getting pain/symptoms in the feet or elsewhere it would be a good thing to control the foot as much as possible, deep heel cups etc.
I saw a 21 year old patient the other day with plantarfasciitis. She is very "bendy" as she called herself and has hyperextended knees. I spoke to my colleague about it and he agreed that I need to control the feet with a functional orthotic, no reservations about the genu recurvatum.
If anyone has any opinions I'd be mighty grateful.
Thanks
SJ
Hi, this is one of my first posts so go easy on me!!
Did anyone else learn in uni that genu recurvatum is a contra-indication for a functional orthotic?
I remember our Biomech lecturer telling us that it is not recommended when t is present......I think he said its because it might push them even further into hyperextension.... I'm trying to visualise what an orthotic would do to a hyper-extended knee.
If someone has hyperextended knees and associated "hypermobility", surely if they are getting pain/symptoms in the feet or elsewhere it would be a good thing to control the foot as much as possible, deep heel cups etc.
I saw a 21 year old patient the other day with plantarfasciitis. She is very "bendy" as she called herself and has hyperextended knees. I spoke to my colleague about it and he agreed that I need to control the feet with a functional orthotic, no reservations about the genu recurvatum.
If anyone has any opinions I'd be mighty grateful.
Thanks
SJ
Sarah-Jane:
Welcome to Podiatry Arena!
I have been making custom foot orthoses for patients with genu recurvatum for the past 25 years without a problem so your lecturer didn't know what they were talking about.
One concern is that genu recurvatum is often times associated with a gastrocnemius equinus deformity and if the orthosis restricts arch-flattening motion too much, then some believe this will tighten up the gastrocnemius muscle so much that the genu recurvatum deformity will worsen. I've never seen this happen.
If you will simply have the patient wear the orthoses in a shoe with a slightly higher heel-height differential, have them avoid flat heel shoes, or if you put a slight heel lift onto the rearfoot post of the patient's orthoses, then this is all that you will need to have their orthoses not cause a problem in your patients with genu recurvatum deformity.
Good question and please feel free to ask many more. That is how you learn!
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I have heard people say that, but never seen a problem. If there is a problem, then it is as Kevin said, that is is the assumed equirement for those with genu recurvatum to need a greater ROM at the ankle joint.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
However, as a slight digression I have found some folks with knee hyper-extension issues find orthoses quite positive in that they no longer (without orthoses) feel pushed back into extension but have a choice (when wearing their orthoses) to extend or adopt a more suitable knee posture for themselves.
Ian
Last edited by Ian Linane : 16th September 2009 at 12:21 AM.
Reason: added bits
Thanks very much for the replies. I reckon my lecturer had the wrong end of the stick. I will see how it goes with this patient, I might try a small heel lift on the orthoses like you mentioned Kevin.
No doubt I'll have more questions!
Thanks again
SJ
Hello all,
I would like to take this subject to another level, as I am reconising many more patients with joint hypermobility scoring 10 on the Brighton Scale. These bendy patients are also presenting with many other problems such as shoulder dislocation, back, knee and hip pain also IBS, endrometriosis. Often having a member of the family with scoliosis.
I feel these patients are often not being treated holistically and would like to investigate how I can help these patients more effectivley.
I would be greatful if you can direct me to any relivant research papers on Hypermobility Syndrome management.
From: Allan M. Spencer: Practical Podiatric Orthopedic Procedures. Ohio College of Podiatric Medicine 1978
“Rigid Devices
it is paramount to recognise both the indications and contra-indications of the devices.
Contra-indications
Peroneal spastic flatfoot
Rigid foot types commonly seen in arthritics and the elderly
There is a group of conditions which may be considered to be Relative Contraindicated for the use of rigid devices. However, these conditions may respond well to such a device made from a pronated cast:
I feel these patients are often not being treated holistically and would like to investigate how I can help these patients more effectivley.
Jude:
What is your definition of "holistic treatment"? What medical therapeutic approaches are included within "holistic treatment", in your opinion?
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
By holistic I refer to the patient being assessed as whole rather than just individual symptoms being treated and no one relating one symptom with the other.
I would like a better management programme of these patients, can I do more?
For instance:
A young girl of 24 presents with a verruca whilst taking a history of this patient I identify she has had multiple shoulder dislocations. Is at present under investigation for Endometriosis and has constant back pain with a Sway back Posture. On the Brighton scale she scores 9 failing to touch floor with both hands but she states she could do as a child.
My management strategies at present would be:
Treat what she really came for the verruca, although these long term problems may be compromising her immune system. Also postural training with core strengthening a referral to a physiotherapist for long term management and orthotics only if deemed necessary. Ask her to make her Gynaecologist aware she is hypermobile.
By holistic I refer to the patient being assessed as whole rather than just individual symptoms being treated and no one relating one symptom with the other.
I would like a better management programme of these patients, can I do more?
For instance:
A young girl of 24 presents with a verruca whilst taking a history of this patient I identify she has had multiple shoulder dislocations. Is at present under investigation for Endometriosis and has constant back pain with a Sway back Posture. On the Brighton scale she scores 9 failing to touch floor with both hands but she states she could do as a child.
My management strategies at present would be:
Treat what she really came for the verruca, although these long term problems may be compromising her immune system. Also postural training with core strengthening a referral to a physiotherapist for long term management and orthotics only if deemed necessary. Ask her to make her Gynaecologist aware she is hypermobile.
Jude
Jude:
Thanks for that.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
The differential diagnosis of children with joint hypermobility: a review of the literature
Tofts LJ, Elliott EJ, Munns C, Pacey V, Sillence DO
Pediatric Rheumatology 2009, 7:1 (5 January 2009) http://www.ped-rheum.com/content/7/1/1
Do you know any papers relating to Podiatry and Hypermobility Syndrome?
Please accept my apologies for spelling error: Beighton score not Brighton scale must need to visit there again!
The differential diagnosis of children with joint hypermobility: a review of the literature
Tofts LJ, Elliott EJ, Munns C, Pacey V, Sillence DO
Pediatric Rheumatology 2009, 7:1 (5 January 2009) http://www.ped-rheum.com/content/7/1/1
Do you know any papers relating to Podiatry and Hypermobility Syndrome?
Please accept my apologies for spelling error: Beighton score not Brighton scale must need to visit there again!
Jude
Jude:
When we wrote our chapter on "Evaluation and Nonoperative Management of Pes Valgus" about 18 years ago (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992.), I did some research on hypermobility syndrome and discussed it's mechanical significance in pes valgus deformity in children using this reference (Kirk, J.A., Ansell, B.M., and E.G.L. Bywaters: The hypermobility syndrome: musculoskeletal complaints associated with generalized joint hypermobility. Ann. Rheum. Dis. 26:419, 1967.) Here's the chapter for your continued research on the subject.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Thank you Kevin most useful it seems you have been ahead of your time, this is such a vast subject that I feel I have been neglectful of. Now just awaiting some infomation leaflets for chiropodists, physiotherapists and osteopaths ..etc, from: Ehlers-Danlos Support Group UK.
The below also made interesting reading:
Joint hypermobility syndrome in childhood. A not so benign multisystem disorder?
Rheumatology (Oxford). 2005; 44(6):744-50 (ISSN: 1462-0324)
Adib N; Davies K; Grahame R; Woo P; Murray KJ
Arthritis Research Campaign Unit, School of Epidemiology, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK. navid.adib@man.ac.uk http://www.medscape.com/medline/abstract/15728418.
Thank you Kevin most useful it seems you have been ahead of your time, this is such a vast subject that I feel I have been neglectful of. Now just awaiting some infomation leaflets for chiropodists, physiotherapists and osteopaths ..etc, from: Ehlers-Danlos Support Group UK.
The below also made interesting reading:
Joint hypermobility syndrome in childhood. A not so benign multisystem disorder?
Rheumatology (Oxford). 2005; 44(6):744-50 (ISSN: 1462-0324)
Adib N; Davies K; Grahame R; Woo P; Murray KJ
Arthritis Research Campaign Unit, School of Epidemiology, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK. navid.adib@man.ac.uk http://www.medscape.com/medline/abstract/15728418.
Jude
Jude:
"Joint hypermobility syndrome" is something that few podiatrists are educated on during podiatry school. In fact, the whole idea that there is a large range of passive load-deformation characteristics of the joints of the foot and lower extremity from one individual to another or from one age to another, is a poorly researched subject.
The cross-sectional area and elastic modulus of ligaments from one individual to another may vary widely. This leads to large differences in the motion produced at a joint for a given external force applied to the segment in question. When I wrote that section in our chapter, it seemed quite obvious to me that we needed to pay more attention to the load-deformation characteritics of the joints of the juvenile flatfoot if we were to hope to better understand it.
Here is the section from the chapter on Biomechanical Effects of Ligamentous Laxity from my original manuscript that I submitted for publication on the subject for the chapter over 19 years ago. Note the much greater length of what was submitted from what was finally published in our chapter (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992)
Quote:
B. Biomechanical Effects of Ligamentous Laxity
The observation that joints of the child's lower extremity have a greater degree of range of motion than the joints of an adult's lower extremity is clinically obvious to anyone actively involved in the treatment of structural or mechanical problems of the lower extremities. Specifically in the foot, the characterization of a child's foot as being "fat, flat, and floppy" is certainly a good description of the overall clinical picture of "overflexibility" which all children's feet demonstrate off and on weightbearing. (24)
The greater degree of flexibility seen in the joints of the lower extremities of children is well documented in the literature. Engel and Staheli, in 1974, reported that total hip range of motion decreased by 25% from birth to the age of 10.(25) Sgarlato reported that transverse plane rotation motion within the extended knee joint reduces from 15 degrees at birth to zero degrees by six years of age.(26)
There are many authors who also feel that this excessive flexibility, or ligamentous laxity, in the foot may be one of the primary reasons why flat feet are very common in children and less common in adults. Engel and Staheli found that arch height increased relatively rapidly in the first four years of life and then increased gradually until the age of 14. (25) Other authors have noticed a gradual increase in arch height in preschool age children both with and without treatment with corrective shoes and arch supports. (27-29) All of these authors suggest decreasing ligamentous laxity with age as being one of the possible explanations for the gradual increase in arch height with age.
Of course, there are varying degrees of ligamentous laxity and many of the most severe forms of ligamentous laxity may actually be caused by hereditary disorders. Marfan's syndrome, Ehlers-Danlos syndrome and osteogenesis imperfecta are three of the more common and severe of these connective tissue disorders which results in ligamentous laxity and very commonly result in severe flatfoot deformities. In addition, many of the less severe cases of isolated joint hypermobility have been grouped into a set of disorders called generalized familial ligamentous laxity.(30)
Whether it is a physiologically normal stage of early childhood or it is one of the hereditary disorders which may exhibit varying degrees of joint hypermobility, the specific biomechanical effects of the ligamentous laxity on the foot are that the pedal joints allow more motion than normal under the loads of weightbearing activities.
One of the manifestations of ligamentous laxity within the foot is excessive subtalar joint supination and pronation range of motion. If the foot does allow more subtalar joint pronation range of motion, then calcaneal eversion to the tibia will be increased. As a result, any force which acts to pronate the subtalar joint will be able to evert the calcaneus farther than it normally would.
It is the medial longitudinal arch of the foot, however, which is the structure which is most sensitive to the many different inherent degrees of ligamentous laxity which can be present in the child's foot. Since the medial longitudinal arch acts somewhat as a bridge to support the weight of the body as it passes through the head of the talus during weight bearing activities, then the same mechanical concepts which affect the structural integrity and durability of a bridge's structure also affect the structural integrity and durability of the medial longitudinal arch.
The concept of the medial longitudinal arch of the foot acting like a medial supporting bridge for the head of the talus is actually a very useful one. Often, overly complex descriptions of complicated structures of the foot, such as the medial longitudinal arch, do little good in furthering the knowledge of the mechanics of the foot for many otherwise astute clinicians. Of course, there are many mechanical differences between the foot and a bridge, but a description of the mechanical principles inherent in their structural similarities definitely outweighs the problems due to their functional and structural differences.
Therefore, if we can take the liberty to compare the structure and function of the medial longitudinal arch of the foot with a bridge then the following analysis holds true. The medial longitudinal arch of the foot can be modeled as a series of irregularly shaped rigid structures (i.e. the osseous elements) interconnected plantarly by strong, elastic and deformable sheets of fibrous material (i.e. the plantar ligaments) and reinforced at its two ends by a strong, elastic and deformable tie rod (i.e. the plantar fascia). [An excellent and detailed description of these and more concepts of mechanical support of the arch structure of the foot should be explored by the reader in the papers by J. H. Hicks.(31-34)]
Assuming that no muscular contraction occurs, when a vertical force is then exerted in a plantarward direction on the medial longitudinal arch one of two things happen. Either the bones and ligaments of the arch resist collapse or it collapses into a flatter shape. If the arch does resist collapse the reason for the strength of the support in the arch is due to the tightness and resistance to stretching of the supporting plantar ligaments and the plantar fascia. The greater the load on the arch, then the greater the tension force in the plantar ligaments and plantar fascia and the greater the compression force within the bones of the arch.(31)
If the arch collapses to some degree under increasing vertical loads then this is due either to an inherent looseness or to a decreased resistance to stretching in the plantar ligaments and plantar fascia. Independent of the inherent laxity of the ligaments, since ligaments are elastic(36), the greater the load on the arch then the greater the degree of flattening of the arch, assuming no muscular force interferes.
The analogy is quite clear. Ligamentous laxity affects the overall structural integrity of the medial longitudinal arch of the foot. Increased ligamentous laxity, such as that seen normally in young children or abnormally in certain familial connective tissue disorders, causes the medial longitudinal arch of the foot to be much more susceptible to plantarly directed vertical forces acting on it. The result is increased medial longitudinal arch collapse with increased ligamentous laxity.
Any force acting on the foot which tends to evert the calcaneus on the talus (i.e. subtalar joint pronation) will likewise tend to increase the dorsiflexion bending moment of the forefoot on the rearfoot due to the increased GRF on the medial metatarsal heads which results.(22) Therefore, pronation moment generated within the body, such as peroneus brevis contraction, or pronation moment generated outside of the body, such as wearing a shoe with an everted sole, would both tend to cause collapse of the medial longitudinal arch. Again, the greater the ligamentous laxity in the arch, the greater the collapse of the arch.
Of course there are many other factors which affect the medial longitudinal arch height of the foot and its resistance to collapse. Included in these factors would be the strength of the intrinsic muscles of the foot and the extrinsic muscles of the leg, abnormal muscular tightness (i.e. equinus), inherent shape of the bones of the foot, degree of medial deviation of the subtalar joint axis, inherent joint congruity, trauma history, disease history, treatment history, shoegear history and other miscellaneous functional and structural factors affecting the overall function of the foot during gait.
Because of the complexity of biomechanical interrelationships of these factors, simplification of a problem is sometimes necessary to gain more knowledge. Such is the case with the concept of ligamentous laxity in the foot. Ligamentous laxity, by itself, probably rarely causes temporary or permanent flattening of the arches of the feet. However, in combination with less severe deformities or forces, ligamentous laxity can be thought of to be a primary cause of many cases of the flattened medial longitudinal arch which is so commonly seen in pediatric pes valgus deformity.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Ian I wrongly included skin elasticity thank you for your correction.
Kevin your help has been much apreciated, I now need digest all this which I think is only the tip of the iceberg and start putting this knowledge to use. I have conected to a physio now who is to work along side me with some of these cases.
I've found in hypermobile children (who never have any ankle equinus, usually way too much), that funtional orthoses reduce the genu recurvatum by eliminating the degree of internal rotation of the lower limb, thereby giving the pelvis a posterior tilt, closer towards neutral. This then reduces the excessive lordosis and allows normal stacking of vertebrae. If you ask, they will often say the suffer lower back pain. This can be really helpful. patients that move like this often have reduced core stability as this stance is inactive for the postural muscluature. You can have a big impact of them holistically by addressing this - orthoses can be a powerful tool, but not on their own. Just don't leave it at that, I would see them jointly with a physiotherapist, or refer off to one you know will follow them up. They may also need a strengthening program.
Good luck. and great to see pods thinking a bit higher up. Feet are attached to bodies that need to funtion as a whole, not just on their own.
best wishes,
Sally
__________________
Patient (age 6) "Mum, I know you're pregnant, but why is your bum big too?"
The Following User Says Thank You to Sally Smillie For This Useful Post:
Joint hypermobility: the use of a new assessment tool to measure lower limb hypermobility.
Ferrari J, Parslow C, Lim E, Hayward A.
Clin Exp Rheumatol. 2005 May-Jun;23(3):413-20
Regards
David Liddle
The Following User Says Thank You to davidl For This Useful Post:
Actually, Jill's lower limb hypermobility score is a very useful clinical tool I use routinely now. It incorporates 12 points on the lower limb, compared to 1 in a beightons score, so would seem much more senstitive to lower limb hypermobility.
__________________
Patient (age 6) "Mum, I know you're pregnant, but why is your bum big too?"
Last edited by Sally Smillie : 25th September 2009 at 09:38 AM.
Reason: typo
The Following User Says Thank You to Sally Smillie For This Useful Post:
Hello all, thank you for all the input but cannot locate J Ferrari's: The New 'Lower Limb Assessment Score', is there a fomula out there or is it in the full article? (on my wish list) abstract below, also Sally Smillie's lecture looked interesting: The Clumsy Child - Podiatric management of children with Developmental Coordination Disorder (Dyspraxia) Sally Smille: http://www.members.feetforlife.org/d...h-Oct-2008.pdf
Joint hypermobility: the use of a new assessment tool to measure lower limb hypermobility.
J Ferrari, C Parslow, E Lim, A Hayward
Department of Podiatry, School of Health and Bioscience, University of East London, UK. j.ferrari@uel.ac.uk
OBJECTIVES: The aim of the study was to compare the use of a new assessment tool for diagnosis of hypermobility in the lower limb to the Beighton score for generalised hypermobility. METHODS: Three groups of children were compared (n = 225) and included a "normal" population of 116 school children, a "possible hypermobile" group of 88 children attending afoot and gait clinic and a "known hypermobile" group of 21 children referred from a paediatrician or rheumatologist. The Beighton score was used to measure generalised hypermobility. The Lower Limb Assessment Score was used to measure hypermobility in the lower limbs. RESULTS: The Lower Limb Assessment Score was able to distinguish between the three groups of children better than the Beighton score. At a threshold of 5/9 indicating hypermobility, the Beighton score identified hypermobility in 34% of school children; the lower limb score identified hypermobility in 21% of school children after a threshold was identified. There was disagreement between the scores in school children where 26.7% of children appeared to have a positive Beighton score that was not accompanied by a positive lower limb score. In the "known hypermobile" group the Beighton score was positive in only 10% of children when the lower limb score was negative for hypermobility. CONCLUSION: In this group of school children, the Beighton score appeared to over-diagnose hypermobility at the threshold of 5/9. Specific thresholds for diagnosis need to be set dependant on the age and ethnic group of the population being studied. The Lower Limb Assessment Score may be a useful score for health professionals specifically interested in lower limb hypermobility.
the download above is pictorial of the Ferrari, Lower Limb Hypermobility Score, as well as Beightons. There is an error in one of the positions, but I would contact Cheryl regards to this. From a quick going over this, I noticed that the ankle anterior drawer was mid-air, and I recalled it was meant to be with foot on plinth.
__________________
Patient (age 6) "Mum, I know you're pregnant, but why is your bum big too?"
If you contact Robert Isaacs, he treats floppy kids all the time in his NHS job so I would assume he would have plenty of references for you, in the unlikely event he misses this thread of course
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
I recently had a 6 y/o come in to the office with a more mild form of osteogenesis imperfecta. His large bones have responded to treatments but in the last 6 months he has had 3 foot fractures. He has extreme hypermobility in the feet. I can see some of the pros and cons of a rigid device. In the short term my question is are the orthotics going to place too much stress in the foot causing potential problems or prevent them? I am also concerned about the long term potential implications of not having a functional orthotic. What do you think?
I recently had a 6 y/o come in to the office with a more mild form of osteogenesis imperfecta. His large bones have responded to treatments but in the last 6 months he has had 3 foot fractures. He has extreme hypermobility in the feet. I can see some of the pros and cons of a rigid device. In the short term my question is are the orthotics going to place too much stress in the foot causing potential problems or prevent them? I am also concerned about the long term potential implications of not having a functional orthotic. What do you think?
Orthoses shift stress from one location to another. You need to look at the individual bones that are fracturing. For example, an arch support, or pressure in the arch, can move stress from the met heads to a more proximal location. This should reduce the stress on the metatarsals and you would be less likely to have metatarsal fractures. You could analyze the stress for all the bones that have fractured.
I recently had a 6 y/o come in to the office with a more mild form of osteogenesis imperfecta. His large bones have responded to treatments but in the last 6 months he has had 3 foot fractures. He has extreme hypermobility in the feet. I can see some of the pros and cons of a rigid device. In the short term my question is are the orthotics going to place too much stress in the foot causing potential problems or prevent them? I am also concerned about the long term potential implications of not having a functional orthotic. What do you think?
Depends on the orthotic. I'd not use anything too rigid in a case like that. A neutralish cast in hi density EVA with no arch fill and very high medial and lateral flanges in an boot would be my suggestion.
Remember, movement does'nt hurt, force hurts. Its not the amount of movement, its the sudden stop at the end. I want him decellerating slowly, through the elastic deformation of EVA and the boot, not coming to s sudden shuddering stop when he hits the unyeilding shape of a UCBL.
To All,
Just have a 9 year old and her 45 year old father EDS. The 9 year old has the worst cast of HAV I have seen and the youngest. I am organising custom footwear for both people. Any other suggestions?
Can I ask why you have prescribed custom f/w? I'm not sure why you would do this. I'd be more inclined to prescribe appropriate retail F/W. What type EDS? If skin of the foot not affected, high quality retail would be better. I bet you any money the 9yo will never wear them.
See if there is a functional hallux limitus, then in stance correct to more of a stj neutral position and see how much this position improves the hallux movement. If so, prescribe an appropriate orthosis. If they are as mobile as some EDS's can be - but don't assume. I've seen EDS kids less hypermobile than a benign hypermobility syndrome kid. Sometimes I make an ottoform toe spacer to use in conjunction with the orthosis.
__________________
Patient (age 6) "Mum, I know you're pregnant, but why is your bum big too?"
I have been making custom foot orthoses for patients with genu recurvatum for the past 25 years without a problem so your lecturer didn't know what they were talking about.
One concern is that genu recurvatum is often times associated with a gastrocnemius equinus deformity and if the orthosis restricts arch-flattening motion too much, then some believe this will tighten up the gastrocnemius muscle so much that the genu recurvatum deformity will worsen. I've never seen this happen.
If you will simply have the patient wear the orthoses in a shoe with a slightly higher heel-height differential, have them avoid flat heel shoes, or if you put a slight heel lift onto the rearfoot post of the patient's orthoses, then this is all that you will need to have their orthoses not cause a problem in your patients with genu recurvatum deformity.
Good question and please feel free to ask many more. That is how you learn!
'this will tighten up the gastrocnemius muscle so much that the genu recurvatum deformity will worsen'
Hi Kevin,
Whilst i understand a genu recurvatum leading to ankle equinus through gastroc tightness, I dont understand how tightening the gastroc more can lead to recurvatum? Sorry, my biomech.s is rusty. I would have thought tightening the gastroc would flex the knee?
Contra-indication for functional orthotics?
Re: Contra-indication for functional orthotics?
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