Today, I had the opportunity to treat a client who back 6 years ago broke her right pelvis while being in the barn needling her cattle. Side note: For some people who have never experience standing beside a 600+ lbs animal, you don’t realize how small you. Then on top of their enormous size add their increased stress level because of being pinned between two metal gates so that someone can inject their seasonal immunization. I commend anyone who has the confidence to go up against these animals. So, my client, “Jill” had one of her cattle knock her down and in the process she broke her left pelvis. This incidence caused a chain reaction for the next 12 years. One after the other, she ended up breaking her right hip 9 years later then her right ankle a 2 years after that.
Jill was certain she wouldn’t have broke her hip or ankle if it wasn’t for her original pelvis fracture 12 years earlier.
During my assessment, this is what I found:
Non-weight bearing
- Functional pes planus
- Forefoot alignment was in varus
- Hypermobile ankle and subtalar joint
Weight bearing
- Neutral Knee Alignment
- Severe Pes Planus
- Severe valgus rearfoot: L < R
- Severe Midfoot pronation: L < R
Gait Analysis
- Initial central heel contact with the ground going right into severe midfoot pronation
- Failure of subtalar joint resupination during toe off
- Noticeable lateral upper body sway in frontal plan dropping down on the L < R
- Sagittal Swing phase was normal
As specifically trained in the lower limb as I am, I think to myself, “is this a case where the cause came from ground up or did it really start hips down?” Jill’s case definitely was not an easy one and even after I designed and fabricated her orthotics, her gait still didn’t look fluid when I asked her to walk for me again after placing the orthotics in her shoes. For one, as you can see, her shoes are completely blown out on the medial side because of her severe planus foot type.
I first suggested to Jill to purchase a pair of shoes that were designed to add support to the medial side of her foot. I gave her a list of specific shoes and told her to look for the two toned colour in the midsole - grey area being firmer than the white area being soft. I then placed the orthotics into her new shoes and after watching her walk a few times in her new orthotics and shoes, I booked a follow up appointment with her to come back and see me in two weeks. When she returned, Jill complained of right medial ankle pain and said that the right orthotic just didn’t fee right. I noticed as she walked into my office that something didn’t look right and I couldn’t figure it out. After watching her for a bit walking back and fourth, Jill was still swaying side to side: L > R. I added a heel lift under her left orthotic. The swaying seemed to calm down but we still had the pain in the right ankle. I ended up placing an extremely aggressive medial post on Jill’s right orthotic and then doubled up her heel lift on the left. This time when Jill went for a walk for me, the very first comment was, “I am not getting that sharp pain in my ankle anymore!”
For Jill, her right leg was bearing quite a bit of weight and was causing her to pronate more in the right than the left to try to keep her level while she was walking but it was too much pressure on her right ankle and thats why she developed the right medial ankle pain. By bringing the ground up on the left side and off loading the right side, I was able to redistribute her weight and equal it between both sides of her body.
