Responses : Wedges for severe flexible flat foot

Responses : Wedges for severe flexible flat foot

Mohammad Reza Mirheydari

4/20/2006

My great thanks to all who responded to my questions .
  below are the original post and responses :
   
   
  Dear list members
  A patient has refered to me with his feet having sever flexible flat foot and also has mild metatarsus adductus .
  he is 15 years old , his medial ankles is bulged , the head of 1st metatarsals enlarged distinctly and the feet seem az kidney while uncorrected in weight bearing situation .
  As I tested , there is no evidence of vertical talus or accessory navicular bone .
  While testing I found that the feet almost return to normal shape if I supinate the hindfoot and pronate forefoot but if I want to reach this aim by applying related wedges ( medial heel wedge and lateral forefoot wedge ) so the thickness of wedges may need to be up to 17 milimeters .
  I,m hesitating that if such thickness of wedges doesn,t harm safety of intersegmental joints of foot ?
  anyone knows the answer ?
  Sincerely
  Mohammad reza Mirheydari
  Orthotist/Prosthetist ( Bsc)
  Orthomir Ind.
   
   
   
   
  I am replying to your posting about a boy with met/abductus flexible. I would definitely go for a submalleoli orthosis or a free motion DAFO. I would extend the footplate wall proximal to the first metatarsal head along with extending the footplate out to beyond the toes. You can also try to tie in a strap around the first toe.
  Good luck! Rick/CPO


  Dear Mohammad, A medial wedge approx 1/8 inch thick in the shoe will work if used in conjuction with a medial arch (scaphoid) pad , also known as an arch cookie. The scaphoid pad is the most critical part and come if many different sizes. Good luck.
  Jeff Reser L.Ped L.O.
   
  You describe a Skewfoot. These are indeed a challenge to treat. I use an UCBL with excellent posterior alignment, a very aggressive Carlson modification to support the sustentaculum tali, the medial wall then extends distal applying a laterally directed force to achieve a neutral forefoot. Leave space on the lateral wall for correction. If the person supinates within the orthosis a velcro strap can help to control it.
  Good Luck,
  Don McGovern, CPO, FAAOP

  
  Try using a UCBL with high medial flanges to control the rearfoot and midfoot. Since the foot is flexible, you can make some of the corrections intrinsically in the UCBL, but I would add posting externally as well so as to have maximum adjustibility. Add about half of the correction that you would first consider as you can always add more. A UCBL will allow a greater level of control than wedges. Rick E. Sevier C. Ped
   
  I have had pretty good success with a full medial wedge for severe flat feet. Since we can't really hold up all the body weight with a small arch support, I often wedge the inside of the shoe with about 5 mm medial wedge to start, then more once they get used to it. I have not done the wedges like you described. Good luck.
Karl Entenmann, CPO
Preferred O and P
Federal Way, WA, USA
   
  I would not suggest such high wedges. It is important to remember that we don't walk around with our foot in a sub talar neutal position all the time. The foot needs to both supinate and pronate to allow for surface level changes and shock absorption amoungst other reasons. I would suggest that you start by casting the foot in a neutral position. Have a firm and supportive medial and lateral arch. If you like add a low (3mm)medial heel wedge and make a metatarsal dome (positioned behind met heads 2-5) Try this and let the patient gradually wear them in and get back to you 4-6 weeks. If necessary you can then increase wedges.
  Jayson Chin Orthotist , Progressive Orthopaedics
  

   


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