This week's post presents a video of the common modifications that I will use for my supinators (contact phase). We are attempting a real mechanical change where we want them to reverse course and be a normal contact phase pronator. Sounds easy?? Sometimes. Think of all the patients with knee pain, hip pain, and low back pain that may be associated with this problem. At the foot/ankle level, inversion ankle sprains with functional instability, peroneal tendon issues, cuboid syndrome, or lateral metatarsalgia in a supinator must be corrected. And, there are more injuries or pain syndromes that I will summarize next week.
You have to think of supinators, like pronators, in terms of the degree of correction needed versus deformity seen. Are they mild supinators only brought on by poor shoe selection or orthotic wear? Are they moderate supinators with significant foot deformity, intoed gait, peroneal weakness, chronic lateral ankle instability, etc. Are they severe supinators with failed or partially reduced club foot procedures, or high degrees of tibial and genu varum. Added to this list is a failed initial attempt at controlling the supination, so more bells and whistles need to be added to the new Rx.
Therefore, where I do not break it down here, you have to think about the complexity of the motion to be reduced, and all the corrections you have available. That being said, you still can’t place the subtalar joint in its MPP (maximally pronated position) or other issues will develop. It can be a fine line, fun for some like me!!, to eliminate the lateral instability without jamming the lateral side of the subtalar joint (or sublux it over time). This analysis is quite easy as you perfect your measurements of RCSP, OCSP, NCSP, and MPP. You should be dedicated enough to these difficult patients to know where you are putting your patient’s subtalar joint, especially with any valgus wedge.
