Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Recently a 5yo boy was referred to my clinic from the Gp, with diagnoses of
'club foot, worse in the left' (according to the GP)
In the past two months this child has developed significant tripping problem, with wearing out of the dorsal areas of the toe box of shoes.
Examined, walking and running, shod and unshod there is dragging of the dorsal digits along the ground in swing, significant calc eversion from strike to heel off and some intoeing, left worst than right.
As a trial, i placed the child in a blake inverted device, which produced immediate relief of all toe dragging, and tripping. I have spoken to a more experienced collegue who has recomended gait plates, but am thinking i would rather see the child in a blake inverted device.
What say you? (Without seeing the patient) Are the two devices compatable or should it be one or the other?
PS i am 99.9% sure the GP diagnoses was off track!
Yeah Michael has hit the nail on the head, gait plates only really improve the aesthetics of gait .Is the child symptomatic? Always check for hip displasia with asymmetry and ascertain where the intoe is coming from first.
FF
__________________
If you don't enjoy Podiatry , your not doing it right!!!
Examined, walking and running, shod and unshod there is dragging of the dorsal digits along the ground in swing, significant calc eversion from strike to heel off and some intoeing, left worst than right.
As your pediatric patient has STJ ROM and is excessively pronating, a Blake inverted orthotic is a wise choice. You can also also incorporate a 4-6 mm Kirby Skive with a high heel cup to transfer the CoP medially and help to decrease the pronation moment from heel contact to midstance.
You could also modify the device by extending the shell to the 4th and 5th toes to encourage the boy to externally rotate his leg and abduct his foot. I would not choose this option as it would cause an increase pronation moment at the STJ and a higher ORF in the MLA that probably would not be tolerated.
I agree with footfan and would look at hip dysplasia and do a careful gait analysis. The Knee is the reference point for both in-toeing and out-toeing. If the knee is in the frontal plane...leg and foot. Knee internal or externally rotated...thigh/hip.
My question is why is the boy dragging his foot in swing prior to his orthotics? Why is he not dorsiflexing his foot in swing? Why did he plantarflexed ankle improve with orthotics? What caused this lack of foot dorsiflexion? Did you do a complete neuromusclar work-up?
I agree with footfan and would look at hip dysplasia and do a careful gait analysis. The Knee is the reference point for both in-toeing and out-toeing. If the knee is in the frontal plane...leg and foot. Knee internal or externally rotated...thigh/hip.
As a trial, i placed the child in a blake inverted device, which produced immediate relief of all toe dragging, and tripping. I have spoken to a more experienced collegue who has recomended gait plates, but am thinking i would rather see the child in a blake inverted device.
What say you? (Without seeing the patient) Are the two devices compatable or should it be one or the other?
PS i am 99.9% sure the GP diagnoses was off track!
Ta!
Just an opinion, of which, you and your patient's opinion probably matters a good deal more.
For my customers, from a software perspective, it's a simple matter of applying both designs, blake# and gaitplate. From a design perspective, you're already achieving the desired result and personally, I don't think the two design types will work well together, unless there's also a hallux limitus condition or other reason you want to resist motion in the forefoot. Typically, a Blake inverted device the arch peak is moved proximal about 10~15% to encourage eversion and supination and is more commonly used in athletic devices.
With kids, including a birth history and neuro work up also really helps.
It is hard to comment without that, I get you say you are 99.9% sure, how can we make 100%. If club foot was mentioned have you done a Pirani score on him to ensure that it really isn't. Again, Club foot = double check the hips.
I think these are very important questions:
Quote:
My question is why is the boy dragging his foot in swing prior to his orthotics? Why is he not dorsiflexing his foot in swing? Why did he plantarflexed ankle improve with orthotics? What caused this lack of foot dorsiflexion? Did you do a complete neuromusclar work-up?
I'm not a huge gait plate fan, what are you trying to achieve with it's addition?
__________________
Cheers,
Cylie.... in a permanent state of confusion
Gait plates with blake inverted foot orthoses
Linear Mode
