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hi everyone!
I am new at this but I have a patient who was diagnosed with a painful L heel spur. Examination of his feet showed: rigid pes cavus foot-type, STJROM 1:1 restricted, MTJROM reduced, and 1MPJROM < 65. the patient also have a partially flexible forefoot varus app. 6 degrees. AJROM < 10 (ankle equinus) and reduced hamstring flexibilities. His gait is unremarakble except for being very stiff due to lack of shock absorption.

Sorry for my ignorance but I just recently graduated: can anyone out there help me with the most appropriate orthotic prescription?

Hi Tekster,

Some information that would be more useful (instead of all those numbers)would be: history of the injury/symptoms, what makes it worse?, what makes it better?, previous treatment and/or investigations (if any), footwear, occupation info, activities (sports/gym/etc)...

What is your diagnosis? It sounds as if the patient has come to you previously diagnosed with "spur"...

What other info can you give us?

Regards

Donna :)

I think you may beed to go back and re-evaluate this patient:
How can you get a forefoot varus with a cavus foot type? If forefoot varus was present, then the arch would be flat during WB and non-WB
How can the forefoot varus be flexible, when the foot structures are rigid?

I was waiting for CP to say something about the almost mythical creature that is FF varus...

I have been lurking ... I am actually on leave today looking after the Arena'ette's ...amazing how little time one has

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Especially since when I've seen FF VR discussed previously it wasn't simply a quick question & answer... Makes me weary just remembering it... :p

Regards

Donna

thank you for all the respond guys. I am greatly appreciated.
As I mentioned earlier, even though the patient has a rigid foot- type, I can see he has a forefoot varus when you placed the foot in neutral, and its partially flexible not totaly flexible.

This patient was previously diagnosed with heel spur from his x-ray film.

I'm with Davinci - It is not possible to get a forefoot varus in a cavus foot type! Was the patient prone or supine when you made that determination? Not relevant. See this.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Why cant a cavus foot have an inverted forefoot?

"Cavus" relates to the pitch of the tarso-metatarso joints in the sagittal plane and thus the height of the arch non-weightbearing. Sometimes this is called forefoot equinus.

Not all high-arched "cavoid" feet have the classic rigid forefoot valgus and some, albeit not many, high-arched "cavoid" feet can have an everted heel and therefore develop a supinatus.

Tekster...

What is the first ray range and quality of motion like? Are you sure you're not seeing the influence of first ray position/motion on the forefoot's appearance?

Have you taped this patient to gauge their response first? How do you know an orthotic is going to help this patient with their "spur"? The A Pod A Orthotic Guidelines, although a few years old, state minimum requirements for each step in the orthotic prescription process.

Just a couple of things to have a think about that's all...

Regards

Donna :)

All you need to do to find a "forefoot varus" deformity in any foot, is to draw the heel bisection line everted and/or hold the subtalar joint supinated from the neutral position. In this fashion, you can make any foot have as much "forefoot varus" as you want!!!

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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thanks again for all your responses, it was very interesting. After hearing all your advices, I actually went back and had a second observation of the patient's feet. I check the feet in supine with STJ in neutral and I think the patient have a f/foot supinatus as the 1st ray was clearly plantarflexing when a downward pressure was applied to the 1st ray.

I will keep you guys up o date ..on the outcome of this patient. thanks again for your help. This is a great learning outlet for me who is still very new to the profession.