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Orthotic Case Study
Flat Feet

Patient Symptoms
Severe stabbing pain in left foot, 1st interphalangeal joint when walking and during passive movement
Severe pain in right foot, lateral side of sub talar joint when walking
Occasional burning pain right foot, 3rd interspace when walking, particularly noticeable when walking barefoot

Clinical Observations Left Foot - Medial View Patient Standing Flat medial longitudinal arch, alternatively called pes planus, flat foot, fallen arch or foot rolling in. Internally rotated hallux Left Foot - Dorsal View Patient Standing Internally rotated hallux Developing Hallux Valgus Previously partial nail avulsion medial side of hallux nail - the internal rotation of the hallux encouraged the medial side of the nail to rub against the shoe at propulsion 2nd toe - starting to contract Right Foot - Medial View Patient Standing Right Foot - Dorsal View Patient Standing Posterior View Patient standing on toes Shows heel inversion suggesting the tibialis posterior muscle is functioning. The heel inverts as the tibialis posterior contracts because it is the main invertor of the foot. Ankle Joint Dorsiflexion Adequate for normal walking Treatment Orthotics (functional insoles to wear inside shoes) provided to change walking and standing, deflect pressure and support the foot. Custom orthotics provided to help pain

Biomechanical Examination and Gaitscan To help determine treatment and orthotic prescription Bisection Lines marked on heel and calf Patient standing in Relaxed Calcaneal Stance Position (RCSP) i.e. normal standing position Prominent left and right medial malleoli RCSP 5 deg valgus left and right Gaitscan Static Measurement Shows high pressure areas in red Gaitscan Dynamic 2D photo Gaitscan - 3D. left foot Gaitscan - 3D. right foot Gaitscan - Report and Measurements Follow Up Pain free at 2 month follow up