Dear Don
Since your client finds dorsiflexion painful, how about getting her a shoe with a
higher heel? That way the anterior part of the talar head won’t be articulating with
the ankle mortice. However, this is a more unstable position for the ankle joint and
may be undesirable because it shifts too much weight onto her metatarsal heads.
Pat McKee, M.Sc., O.T.(C),
Assistant Professor,
Department of Occupational Therapy,
University of Toronto
416-978-1817
On Sun, 15 Nov 1998 21:02:41 -0500 Don McGovern wrote:
> From: Don McGovern
> Date: Sun, 15 Nov 1998 21:02:41 -0500
> Subject: How can one remove pressure on the talus?
> To: [email protected]
>
> Dear List,
>
> I am working with E.S. E. S. is a fifty year old, Caucasian woman with
> lupus. She presents walking with care and the right L. E. in ext. rot. due
> to pain. Her hx includes a fall on the ice one year ago sustaining fractures
> of the tib-fib. and talus. The recent MRI reveals several nonattached
> fragments on the ant. medial aspect of the talus. The area corresponds to a
> clinically observable localized swollen, warm area on her ankle. She has
> cavus feet. Plantarflexion and eversion are painfree. Dorsiflexion and
> inversion are limited and painful. She does not tie her shoes all the way up
> since any compression on the proximal dorsum is intolerable. E. S. reports
> she wears high top shoes to bed to immobilize the foot and ankles. At present
> she is limited to short distances of ambulation.
>
> It is my assumption her pain is from the talus accepting an increasing load in
> stance as DF proceeds. She is limited to neutral. Therefore, I have
> recommended an orthosis to stop DF at the point of pain, or earlier. I
> discussed a lt. wt, carbon graphite type of low profile AFO with free PF and
> DF stop. The biomechanics of the pain and of the orthotic intervention has
> been explained and understood by E. S.
>
> Understandably, E. S. was not prepared for intervention of this extent. She
> had expected a small little “whatever.” She has tried ankle wraps but her
> dorsum is too painful.
>
> The only other type of intervention I thought may help and be minimal was
> rocker bottom soles.
>
> My question is there something other than my ideas to satisfy the persons
> requirements.
>
> Thank you for your time and effort.
>
> Don McGovern CPO
