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From: Anthony Achilles
Sent: Tue 09/11/2004 09:21
To: A group for the academic discussion of current issues in podiatry
Subject: RE: Intoe gait in childres and transverse plane motion of the tallus
Clive,
Not sure if I can necessarily see the connection between the the STjt pronation creating an internal rotation of the leg, which subsequently produces an intoe. The foot is far more likely to abduct and evert, and in fact when "correcting " the excessive pronation, the primary cause of the problem becomes more apparent ,i.e. Tibial torsion , femoral anteversion.
May I also ask why you treat juvenile intoeing?
Tony Achilles
-----Original Message-----
From: A group for the academic discussion of current issues in podiatry [mailto:[log in to unmask]] On Behalf Of john weir
Sent: 08 November 2004 16:37
To: [log in to unmask]
Subject: Re: Intoe gait in childres and transverse plane motion of the tallus
Clive,
Have a look at Algeo's range of 1st phase orthotics. The have one called a slimflex plus which is even better than a frelen and comes in a range of sizes from child's 8 to adult 12. they are a contoured EVA insole with a strengthened heel. I find them great and "cheap" for kids. You can grind out under 1st met head area to create a kinetic wedge effect.
John.
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From: A group for the academic discussion of current issues in podiatry [mailto:[log in to unmask]] On Behalf Of Clive
Sent: 05 November 2004 10:11
To: [log in to unmask]
Subject: Intoe gait in childres and transverse plane motion of the tallus
When treating juveniles with orthoses for intoe gait I have observed that where there is abnormal subtalar joint pronation, even when there are other internal position influences proximal to the foot and functional hallux limitus, treating the frontal plane factors makes a difference which may be profound both in gait and stance.
May I assume that this is because abnormal STJ pronation caused by frontal plane pathology leads to the talus to internally rotating for longer than it should in the stance phase as the foot approaches heel off, and that this internal roation carries the leg with it, exerting a significant medial rotatory force on the foot contributing to the intoe postion?I have to acknowledge that where present the treatment of functional hallus limitus always makes things even better.
Initially I found it difficult making very small chairside temporary orthoses with kinetic wedges. What seems to work for me in many cases is adding a full length forefoot extension of 3mm medium density eva to an Alphathotic (for those that don't know it - a small high density eva device with frontal plane intrinsic posting designed for children), with an area cut out under the first MTPJ and a first met cut out on the alphathotic. The forefoot extension is a bit floppy on its own and adding a thin layer of 0.5 mm stiffer material plantar to the forefoot extension seems to help.
Does anyone have a better way of making small children's temporary chairside devices incorporating a kinetic wedge or similar means of letting the first MTPJ move plantar to the other mets? I have yet to find the paediatric equivalent of the ever useful and affordable "Frelen" insole.
Clive Chapman
(Who aged 65 has now retired from employmet with the NHS and between naps potters a little in his private practice at home!)
telphone 0208 885 2289
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