Current Pedorthics January-February 2017 | Vol.49, Issue 1 - Page 46

Equinus Management for Better Orthotic Outcome
rigid functional orthoses is a major reason for unsuccessful orthotic treatment .”— This statement is accurate , and I agree with it .
“ Equinus patients who receive orthoses as their sole treatment may not be capable of accepting orthotic control .”— This statement is accurate , and I agree with it .
“ A rigid orthotic will prevent the foot from pronating . The result is arch irritation from excess friction against orthoses .”— This statement is inaccurate , and I disagree with it . I will provide a sound evidence-based argument on why this statement is incorrect .
Thoradson et al . examined which structures stabilized the arch and deformed the arch by applying increasing loads to various extrinsic foot tendons and the plantar fascia . 4 The Achilles tendon was found to have the most significant deforming force on the medial arch in both the sagittal and transverse planes . 4 The authors noted 3.3 ° and 3.7 ° of medial arch decrease at 350N and 750N respectively in the sagittal plane . 4 Additionally , there was significant abduction in the transverse plane for both load amounts . 4
The exact location where the arch flattens was answered by Johnson and Christensen in part five of their series of articles on the medial

" Equinus patients who receive orthoses as their sole treatment may not be capable of accepting orthotic control ."

DEFORMITY EVALUATION TECHNIQUE
Figure 1 — Correct sagittal plane positioning of the foot in supination to evaluate ankle joint dorsiflexion locking the midtarsal joints and neutralizing the hindfoot position
Figure 2 — Correct frontal plane positioning of the foot in supination to evaluate ankle joint dorsiflexion locking the midtarsal joints and neutralizing the hindfoot position
Photos : Courtsey of Dr . DeHeer
44 Pedorthic Footcare Association www . pedorthics . org