I had a client come in to see me in clinic yesterday and wasn’t sure if I would be able to help him or not. He had found my contacts online and thought I would be his next resort after not getting a clear answer from his doctor.
My first assessment of the day was referred to me from a physiotherapist who knew of me but had given my name as somewhat of a last resort, if nothing else seemed to work. Plus the physiotherapist mother, who is a chiropodist was all booked, so I was the “next best” specialist to go and see!
As I look back on my week, there is one client that stands out that I thought I should share. “Kate” was my last client of the day. This petite woman walked into my office limping on her right side. As she began to tell my what she had done, I knew right away this wasn’t the typical plantar fasciitis case.
I find the best part of what I am trained to do is not only be able to help people get back to their active lifestyles pain free but the best part is when I see them come back for another pair because they have found success with the treatment plan I have designed for them. In this particular case, I have seen this individual go from a very severe infection where three toes were lost to being able to properly ambulate with comfort. Without his orthotics, “Carl” would not be able to walk without pain.
As we go through our training to become certified pedorthists, we learn the difference between structural and functional leg length discrepancies (LLD). When dealing with a functional LLD, there is a muscle imbalance in the lower limb and when dealing with a structural LLD, there is a true anatomical difference in the bones of the lower limb. The rule of thumb when treating a structural or functional LLD (errs on the side of caution if there is a concern of some amount of functional LLD) is to add a heel lift only 60% of the actual LLD. Trauma induced or post surgery LLD can be corrected 100%. This is because an external force has developed this LLD and the body has not adapted to this sudden shortened limb. The end result can be asymmetric problems of the lower back and on the side of the longer limb. In the past, I have treated many LLD.
For all the different pathomechanics we as certified pedorthists learn while in training, we are taught what the most common and least common pathomechanics are and this week in clinic I was lucky enough to see a foot type that is somewhat uncommon. I was fortunate enough to witness a biltateral hallux varus. You may be familiar with its opposite - hallux valgus: the great toe migrates toward the 2nd toe. A hallux varus is a deformity of the great toe joint where the hallux is deviated medially away from the first metatarsal bone. This can sometimes be a surgical, over-correction of a bunion but in this case “Fred’s” bilateral hallux varus were congenital and he was experiencing a lot of pain in both his 1st MTP joints and both great toes.
Many people that I see usually end up in my office after many months or sometimes even years of chronic pain in their feet or lower limb that they just can’t handle anymore and finally are looking for someone to help them deal with their pain. On occasion though, someone will come into my office after performing an activity they knew they shouldn’t have done - like lift a heavy box and throw their back out. In this case, “Frank” came into my office doing this exact same thing only it was a tearing sound he heard in the bottom of his left foot from an activity he knew he shouldn’t have done but realized that after he did what he did.
About a month ago, I had a client come to see me to inquire about me fixing the top cover on an older pair of orthotics he had received from a previous orthotic dispenser. His big toes had worn right through the top cover and he was looking for someone to repair it for him. These orthotics were 4 years old and were fabricated from a company that was too far for him to travel back to. This being said, it’s almost like a non spoken ethical code in our profession that you don’t work on other professionals orthotics if the client is in driving access to them. This is because I don’t know the previous treatment plan that was designed for them and do not want to step on any toes when I am not fully educated on their previous treatment plan.
When seeing feet on a daily basis, I don’t think much of it when I see certain foot deformities until a third party gets a glimpse of that particular foot while my client is competing a gait analysis for me. This is what happened when my receptionist came around the corner looking down out the report she was looking at and then caught the sight of this particular foot deformity. Without her even thinking an “oh my” came out! My client, “Peggy” was already subconscious about her feet and didn’t want to walk around the office for me to begin with. I reassured her that no one but myself would be observing...and then that happened. She scurried back into the examination room sat down very embarrassed at this point. I was thankfully able to calm her down and put her at ease with what had just happened. I was able to complete my assessment and this is what I found:
I have a client that has been coming to see me for the past two years with severe pain in both feet and pain that is radiating all the way up to his lower back. He is obese and doesn’t have a very active job or lifestyle. He has thick callousing on the first and fifth MTP joints bilaterally and does occasionally experience numbness in the toes while weight bearing for a long period of time which has gotten progressively worse over the time that I have been seeing him to constant numbness all the time.