Pertinent Roundtable Pearls On Orthotic Management

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   Dr. Harris says that tibialis posterior dysfunction, as one would see in adult orthopedic medicine, implies inflammatory change in the tibialis posterior tendon. This change leads to varying degrees of degeneration and rupture, resulting in painful rigid or flexible acquired flatfoot. However, as a pediatric specialist, Dr. Harris say this pattern “is so seldom seen in the child that it may not even exist, except in children with seronegative or seropositive arthritis.” Some adolescents have pain from unstable accessory naviculars and Dr. Harris says one can best manage them by excising the accessory navicular alone if indicated or in combination with other flatfoot reconstruction procedures.

   However, if such a clinical pattern corresponding to adult tibialis posterior dysfunction should develop in the child, Dr. Harris says management requires control of the foot and ankle in all three planes, which one can only accomplish through the use of a solid ankle AFO.

Dr. Dananberg is in private practice in Bedford, N.H.

Dr. Harris is a Clinical Associate Professor in the Department of Orthopaedics and Rehabilitation at the Loyola Medical Center in Maywood, Ill. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Spencer is an Associate Professor of Orthopedics/Biomechanics at the Ohio College of Podiatric Medicine. He is also a Diplomate of the American Board of Orthopedics and Primary Podiatric Medicine.

Dr. Jay is a Fellow of the American College of Foot and Ankle Surgeons. He is a Professor of Foot and Ankle Orthopedics at the Temple University School of Podiatric Medicine and is board-certified in foot and ankle surgery. Dr. Jay is in private practice at Cumberland Orthopedics in Vineland, N.J. He is the author of “Pediatric Foot and Ankle Surgery,” which is published by Saunders/Elsevier.

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1. Dananberg HJ, Shearstone J, Guiliano M. Manipulation method for the treatment of ankle equinus. JAPMA 2000; 90(8):385-89.

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