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Modifying Shoes And Orthoses For Severe Lateral Ankle Instability

These pictures show the feet, shoe and orthoses of a longtime patient of mine. He is a 77-year-old who has severe bilateral cavus feet. The patient suffered a tibia and fibula fracture many years ago, which left him with a severely inverted right rearfoot. This led to multiple recurrent sprains of the right ankle.

When I first saw him a couple of years ago, we discussed a number of treatment options including the use of an ankle foot orthosis (AFO). He had already tried an AFO and found it was uncomfortable because of the prominence of his lateral malleolus. It was very difficult to find one that would support him and would not irritate the malleolus.

Instead, we decided to try orthotic devices and shoe modifications. We made him a pair of orthoses and on the right one added a valgus heel wedge and a valgus forefoot extension (see right photo). Once he tried the orthotics for a couple weeks, we increased the thickness of both forefoot and rearfoot valgus wedging. We found that the orthoses certainly made him feel much more stable but he was continuing to be laterally unstable. We then sent him for application of a lateral buttress and flare to his right shoe (see bottom left photo).

The combination of the orthotic and shoe modifications eliminated his problem. He had not sprained his ankle in the two years since receiving his orthotics and shoes.

He came back in later because he was starting to feel a little less stable. The orthotic devices appeared to have held up well but the shoe was starting to wear laterally. As the shoe wears laterally, it is more likely going to cause him to roll laterally. We simply replaced the valgus wedges on his orthotics and then sent him for new shoes with the same medial buttress and flare added to the shoe.

Editor’s note: This blog was originally published at https://www.prolaborthotics.com/Blog/tabid/90/EntryID/341/Default.aspx  and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com .

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