I saw my next client “Rose” a few weeks back whose rheumatoid arthritis had affected all her extremities.  On top of her arthritis she had also broken her left ankle three months ago by rolling over on her ankle. She never realized that she had broken it because of the pain that she was experiencing due to the arthritis that she never went to the doctors to get it checked and kept walking on it! Rose did say she had excruciating pain and did try to treat the pain herself by purchasing an elasoplast ankle brace from her local drug store.

Rose did eventually end up going to see her doctor but it was concerning the pain she was experiencing in her right hip. While at the appointment she had just happened to mention her ankle and how it was causing her pain. It wasn’t until after x-rays were taken that she found out that she had a healing fractured to her subtalar joint. Her doctor referred her to come and see me.

So here she is sitting in my office after realizing that this pain in her ankle was a little more severe than she thought it was. Rose was no stranger to orthotics. She was already wearing a pair of orthotics that were 4 years old. She said that they did help at the time of purchasing her orthotics but now she can’t really feel the support in them anymore. Rose was wearing a pair of orthotic friendly sandals that had a heel cup around the back of her heel to give her extra support as she walk. She also has a pair of good supportive walking shoes that she uses when she goes about her daily activities.

A complete assessment was done on Rose, and this is what I found:

Non weight-bearing

• Bilateral claw toes of the 2nd, 3rd and 4th toes
• No range of motion in left subtalar joint
• Severe osseous equinous on right
• Limited plantar flexion bilaterally

Weight-bearing

• Left fallen arch foot
• Right high arch foot
• Right tibial varum
• Right rear foot in severe varus
• Left rear foot in severe valgus
• Midfoot pronation in right
• Midfoot supination in left

Gait Analysis

• Heel strike on the left as the foot made ground contact with the centre part of her heel
• The left foot was severely pronated and prolonged throughout midstance where the right foot was severely supinated throughout midstance
• The was a failure to resupinate on the left during toe off
• Her gait in general was more of a steppage type of gait where she would drop down significantly on the right side
• Crackling of the left ankle was noted due to untreated ankle fracture

A pair of custom made foot orthotics were designed for Rose. Her left orthotics was designed to accommodate her left foot especially with no range of motion in the left subtalar joint. A high lateral flange was added to the right orthotic to reinforce the lateral aspect of the right ankle. A heel lift was also added to the right orthotic to bring the ground up to her right foot and to offload the left foot so it would not be bearing the majority of her body’s weight.  Also, lots of cushioning was added to the orthotics due to the fragility of her feet.

Rose was on the right track with her footwear already with wearing othopeadic footwear that was wide enough to allow for her left foot and her orthotics.

A follow up will be conducted within a few weeks time to see how Rose is taking to her new orthotics.