ericparker
New Member
Remember, today is the tomorrow you worried about yesterday
Posts: 24
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Post by ericparker on Jul 1, 2009 14:11:24 GMT
Hi Your thoughts please. Patient very happy with the orthotics I prescribed at 2 degree FF varus for his walking boots. He now wants orthotics for his running shoes. The lab still has the cast. Would you alter the prescription for his new orthotics and if so how.
thanks
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Post by davidsmith on Jul 1, 2009 14:34:13 GMT
Eric
Good question but can you give us some more info?
How does he run? What surface does he run on mostly? How different is it from his walking gait? What was his original complaint? How will the forces change during running compared to walking and in terms of his original problem? Has he tried running in his present orthoses? Are they too wide for his running shoes? Is weight and volume a consideration? Is extra stiffness required? Do you have facilities to analyse his running gait? Do you want to get involved in the problems that can come with prescribing athletic orthoses - like blistering and tearing up the top covers etc? Would OTC's, allegedly designed for running, be a safe option?
All these and probably more need to be considered to answer your question properly.
Cheers Dave
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Post by samrandall on Jul 2, 2009 4:32:05 GMT
Also, I would add: What was the original prescription? What material did you use.
Could definitely use much more info on the patient and previous treatments.
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ericparker
New Member
Remember, today is the tomorrow you worried about yesterday
Posts: 24
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Post by ericparker on Jul 2, 2009 8:28:08 GMT
Hi Chap originally came to me 2 months ago suffering from plantar fasciitis and some occasional form of nebulous knee pain. Both of which seem to have subsided. He is mid 30s and verging towards the tubby. Scored a 7 for both feet on the FPI scale and showed delayed windlass. Full ROM. No sign of FHL but plantar callus going up medial 1st ray. Cast feet and asked for 2 degree FF varus post on a 1/8" polypropylene with vinyl cover. He has tried running in his insoles but "doesn't feel like he has any spring in his step" and are too large for his running shoes. I do not have the necessary to analyse his gait but observationally he seems to only supinate only slightly when running.
hope this helps
Eric
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Post by samrandall on Jul 2, 2009 9:12:53 GMT
Just my tuppence worth:
It is my opinion that with that thickness polyprop it will flex and return to it's original shape when walking, but he will probably push straight through it when running..
I see a lot of guys on National Service here in fortress Singapore, alot of whom are fairly heavy and have high degrees of pes planus.
Personally I tend to go towards a high density EVA for a running/sports orthotic rather than a polyprop. My reasoning for that is that I like Polyprop to flex a little with the patients body weight so you are effectively allowing the foot to pronate, but the poly prop is acting like a break, slowing down the speed with which the foot pronates, but allowing it some movement still, which if you choose the right thickness for the right patient it does.
However, if you put the same force through that thickness Polyprop during running the patient will flatten it right out with each step and it will not provide the same flex and return properties as it did during walking.
I like EVA for running type activities because, although it of course doesn't flex like polyprop it also won't flatten out with each step, it also has some shock absobing properties which may or may not be of benefit. Also If you get a poly prop that is thick enough, it will be too rigid and therefore possibly very uncomfortable.
Hope this is of some use..
Sam
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Post by davidsmith on Jul 2, 2009 11:51:31 GMT
Hi Chap originally came to me 2 months ago suffering from plantar fasciitis and some occasional form of nebulous knee pain. Both of which seem to have subsided. He is mid 30s and verging towards the tubby. Scored a 7 for both feet on the FPI scale and showed delayed windlass. Full ROM. No sign of FHL but plantar callus going up medial 1st ray. Cast feet and asked for 2 degree FF varus post on a 1/8" polypropylene with vinyl cover. He has tried running in his insoles but "doesn't feel like he has any spring in his step" and are too large for his running shoes. I do not have the necessary to analyse his gait but observationally he seems to only supinate only slightly when running. hope this helps Eric There are many biomechanical / anatomical variations that will strain the plantar fascia and will manifest as symptoms of plantar fasciitis. Why did you prescribe 2dg varus f/foot post? Is this just some arbitrary decision or do you have a protocol for applying prescription variables? Is this protocol related to the anatomical and pathological tissue stress or to some foot posture index that you use? By delayed windlass do you mean the foot does not resupinate early enough? Please state the anatomical and biomechanical variations that you noted as significant in this case. Just because the symptoms resolved does not necessarily mean that you gave the optimum prescription. You may have changed the tensional force in the part of the plantar fascia that was symptomatic but did this also result in increased saggital plane perturbation for instance. I.E. since he feels flat footed with no spring in his step then he may well not be progressing thru the saggital plane in the optimal manner and so will be making compensations to reduce saggital plane perturbation. (or saggital plane block for those not up to speed) This may involve trick actions that reduce the elastic action (potential energy) of the achilles tendon and so he cannot store elastic energy very efficiently for the propulsive stage of each running step. Perhaps now, with his orthoses when running he has a heel toe action and flexes his knees as a compensation to accommodate saggital plane pertubation, maybe without orthoses he runs on his toes with a forefoot strike, which will feel very propulsive and springy compared to the gait described above, with orthoses. If he is a forefoot runner and the 2dg forefoot valgud post was the correct prescription perhaps for running he only needs a simple insole with propulsive posting i.e. posting that extends into the MPJ and toe area. This will tend to supinate the foot during the time he is on his forefoot i.e. propulsive, braking and adaptive phases and reduce plantar fascia tension. Did he get symptoms when running originally or were they just left over from walking pathology? E.G. while walking he may have a heel to progression that propogates plantar fascia tension and symptoms of plantar fasciitis, but when running he may go straight to forefoot striker style and never really trouble the plantar fascia. Any of these or none of these may be true but without specific biomechanical data we cannot really guess what might be his problem or how to modify a prescription. A foot posture index of score 7 means nothing to me in terms of internal tissue stress and how to address it in terms of reducing that stress and the associated symptoms. Neither does nebulous (nebulous = 1. unclear: not clear, distinct, or definite encarta dictionary MSN) knee pain mean anything, where was the knee pain and what tissue specifically was giving pain.? Eric, these are good questions and in my opinion many clinicians are not asking the right questions in their assessments. When you can set out your biomechanical assessment and evaluation in terms of tissue stress and how the presenting biomechanical and anatomical variations are affecting the tissue stress then you will become more skillful in your prescriptions. Robert Isaacs has done some nice lectures (in plain easy language) for the clinician who wants to improve in this area, perhaps you should find yourself on one some day. Regards Dave Smith
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