We frequently add varus posting for our orthotic prescriptions but there are situations where adding valgus wedges can be useful. Conditions that may benefit from valgus prescriptions include peroneal tendon dysfunction, lateral ankle instability, lateral metatarsal pain i.e. The 4th and 5th metatarsals, medial knee compartment arthritis and calcaneocuboid sprains. The foot types that lead to these conditions include a cavus foot, a laterally deviated subtalar joint axis. Looking more proximal, tibial varum and genu varum can also lead to lateral instability.
A valgus wedge typically starts at the rear foot and extends just beyond the metatarsal level. A valgus wedge may also be used just in the forefoot. Steve Pribut,DPM, likes to use precision targeting before using a broader carpet bombing approach on adding orthotic features. That approach may also include using a neutral rearfoot post before adding rearfoot valgus posting. Besides not beveling the lateral rearfoot post,other features that can create valgus include a lateral phalange and a reverse Kirby skive. A lateral flange provides more stability by increasing the area of the base.
Orthopedic surgeons use the concept of valgus wedging in osteotomies in the knee to take pressure in the medial knee compartment. The same concept can be applied with lateral wedges in orthotics. The result is more ground reactive force applied to the lateral knee compartment.
A stepwise approach with your orthotic prescription will help ensure more consistent patient outcomes.
