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when do patients need orthotics
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when do patients need orthotics - March 20, 2008 2:08:18 AM
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Kaden
Posts: 263
Joined: June 17, 2007
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Scenario: 45 yo patient training for a marathon (his first) and presents with ITB friction syndrome on the left. He is up to 12 mile runs currently, until pain stopped him. Tends to have slightly pronated feet bilaterally in standing and this increases with ambulation.
This presentation got me thinking. When does one decide orthotics would be appropriate or is a trial of more conservative treatment needed before jumping into orthotics.
Obviously we can't go around throwing all "pronated" pts into orthotics but what criteria do we use to select patients who will benefit most from orthotics. Kind of an expensive intervention if don't respond.
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RE: when do patients need orthotics - March 20, 2008 5:51:30 AM
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JSPT
Posts: 271
Joined: April 19, 2005
From: Michigan
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I make orthotics, and here is how I decide:
1. Does the patient have a fairly flexibile foot deformity?
2. Are the patient's symptoms distal or proximal? It is my contention that the effect orthotics have are dissipated as you travel proximal. I don't think that someone's back or neck pain can be improved with orthotics. So, foot, ankle, or knee pain is more likely to be alleviated with orthotics.
3. How does the patient respond to taping? I use McConnell tape to suppor the subtalar joint and have the patient walk around for a few days with it on. If they feel better, I'm more likely to try custom semi-rigid orthotics. If the patient weighs over 200# or has a more rigid foot, I may try a rigid orthotic.
It is worth noting that I tell every patient that orthotics are 1/3 of the solution. The other two components are stretching what is tight and strengthening what is weak, and activity modification (not walking around without shoes on, etc.)
For your patient, I'd look at the hip abductors and external rotators, as well as the hip and low back extensors. I'd also have them do the ITB roller stretch. It took me awhile to figure out that in people with ITB symptoms, unless I address the entire kinetic chain, won't get better.
Hope that helps.
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RE: when do patients need orthotics - March 20, 2008 6:55:52 AM
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rwillcott
Posts: 352
Joined: March 20, 2006
From: Canada
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I wouldn't rush into orthotics with this person. Sounds like there are some muscle imbalances that need to be addressed. With runner's I always take a look at their shoes. Often times they are either wearing the wrong shoe for their foot or the shoe needs to be replaced. Someone like this with a mild pronation should try a stability shoe. I'll usually explain to them that with the right shoe they don't need an orthotic.
Even the right shoe can be too much! I mean heck look at those waffle trainer's Steve Prefontaine broke records with! I use the example of the 1960 Olympic Marathon that was won barefoot.
Rob
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