Tarsal Coalition Responses

Tarsal Coalition Responses

becky and yitzchak langer

12/9/2014

Hello Listerv.



Thank you very much for responding to my tarsal coalition and to my Gel
Sock questions. I have posted the Tarsal Coalition responses below and
will post the Gel Sock answers in a separate post. I ended evaluating her
and do not know why she didn't' opt for surgery. However, she lacks some
dorsiflexion ROM and both inversion and eversion is painful so I will be
wedging medially with a heel cup, addint a medial forefoot post, and
putting a lift under her heels.



-----Original Message----- From: becky and yitzchak langer Sent: Sunday,
November 16, 2014 12:16 PM To: <Email Address Redacted> Subject: [OANDP-L]
Tarsal Coalition
Hello O&P.

I have a patient in her 30's. When she was a child a tarsal coalition
between her talus and her calcaneus formed. I have not officially
evaluated her yet but believe that the coalition is bilateral. She opted
not to be operated on and the coalition breaks and reforms periodically.
She has been wearing cork FOs from another practitioner which are old and
worn out. She says that she cannot walk without them. She has shown me
that she has rigid varus alignment of her hindfoot. I will be evaluating
and casting her this week and was wondering if anyone has any ideas on
which position to cast/biofoam her since STN does not necessarily represent
her feet during gait. I'm pretty sure that I will simply be accomodating
a rigid hindfoot deformity but if anyone has any helpful suggestions I'd
appreciate them.

Thanks.
Yitzchak Langer, CPO



1) Here is my stand by technique. Bio Foam seated simi weight bering foot
impression, then with your hands on her knee have stand, you will be able
to control inversion and eversion when she stands with your hands then have
her bend her knee to about 20 degrees, then sit down. Fill cast modify in
met pade that extends into mid foot or what ever other mods that u usually
do. I feel that this weight bearing allows for foot elongation and good
halux longes representation that is difficult to establish non weight
bearing. When fitting the orthotic it's much easier to increase mid foot
support than to adjust for the arch and met support being too proximal.
Make sure as always to look at planter flexion contractures with knee
extended R1 should be around 90 degreees and R2 +10, though I doubt that
she has this ROM. Will need to accommodate with additioanl heel lift for
what the shoe dosn't provide.



Good luck



2) Based on your description, I would look at her current FOs and go from
there. She will need a rigid support that accommodates the varus deformity
by wedging the heel and providing a deep heel cup. Have her stand barefoot
and determine how much wedge is needed prior to taking the foam impression.



3) I would have to try to change her to an SMO. Not sure height, weight, or
activity level, but to influence the talus I feel that she is going to need
to go higher than a FO. Just my thoughts.



4) Hi. It would make sense to me to cast in the varus position and
accommodate that position in your foot orthosis.



5) In my opinion as he has to be fitted with rigid custom foot orthotics
leaving his toes free. So that no movement occurs in the tarsal bones.