A Guide To Orthotic Therapy For Adult-Acquired Flatfoot

Start Page: 48
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Author(s): 
Paul R. Scherer, DPM

Orthotic Therapy Recommendations For Stage III AAF

• Semi-weightbearing negative cast on foam with the foot at 90 degrees to the leg or fully dorsiflexed at the ankle. The deep foam board compresses the plaster or STS sock into the arch and snugly around the heel, producing a more accurate and comfortable brace.
• A heel cutout in the polypropylene shell produces a more comfortable design, especially for older patients.
• The brace height should be at least 18 cm from the floor for a 150 cm tall patient and 23 cm for a 180 cm tall patient. One would measure this from the floor to the collar of the brace.
• A fabrication laboratory that requests the circumference of the patient’s leg, midfoot and malleoli to ensure a total contact custom device is provided for your patient.
• A lace closure with two top Velcro straps. This allows ease of entry and exit of the foot, and contributes significantly to patient acceptance.

In Conclusion

The non-surgical treatment of adult-acquired flatfoot requires a firm understanding of the pathomechanics of this disorder. It is not simply a function of tibialis posterior dysfunction. Successful treatment is dependent on accurate staging of the disorder, utilizing all tests, observations and examinations. The effective treatment intervention is different for each stage and utilization of inappropriate treatment for a particular stage is doomed to failure.

   The appropriate staging and bracing application for stages I, II and III of adult-acquired flatfoot can restore mobility, dramatically reduce symptoms and slow the progression of a severely disabling disorder.

   Dr. Scherer is a Clinical Professor within the College of Podiatric Medicine at the Western University of Health Sciences in Pomona, Calif. He is also the CEO of ProLab Orthotics/USA. Dr. Scherer is the author of the book “Recent Advances In Orthotic Therapy.”

References

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2. Hirano T, McCullough MB, Kitaoka HB, et al. Effects of foot orthoses on the work of friction of the posterior tibial tendon. Clin Biomech. 2009; 24(9):776-780.
3. Richie DH. A new approach to adult-acquired flatfoot. Podiatry Today. 2004; 17(5):32-46.
4. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthoped Rel Res. 1989; 239:196-206.
5. Kettelkamp DB. Spontaneous rupture of the posterior tibial tendon. J Bone Joint Surg. 1969; 51A(4):759-764.
6. Myerson MS. Adult acquired flatfoot deformity. J Bone Joint Surg. 1996; 78A:780-792.
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10. Baumhauer JF, Wervey R, McWilliams J, et al. A comparison study of plantar foot pressure in a standardized shoe, total contact cast and prefabricated pneumatic walking brace. Foot Ankle Int. 1997; 18(1):26-33.
11. Kirby KA. The medial heel skive technique: improving pronation control in foot orthoses. J Am Podiatr Med Assoc. 1992; 82(4):177-188.
12. Imhauser CW, Abidi NA, Frankel DZ, Gavin K, Siegler S. Biomechanical evaluation of the efficacy of external stabilizers in the conservative treatment of acquired flatfoot deformity. Foot Ankle Int. 2002; 23(8):727-737.
13. Augustin JF, Lin SS, Berberian WS, Johnson JE. Nonoperative treatment of adult acquired flatfoot with the Arizona brace. Foot Ankle Clin North Am. 2003; 8(3):491-502.

   Editor’s note: This article is adapted with permission from the book “Recent Advances in Orthotic Therapy” by Dr. Scherer and published by Lower Extremity Review.

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