Key Points
- Goals of Typical Treatment of a Patient Reviewed
- Common Causes of Instabilities our exams should pick up
- Develop Office Protocols for Data Collection
Next week I will come back to my discussion of orthosis classification of what is current in our industry. I am so excited to begin discussing the Medial Lateral Instability patient. But, I want to stop and review the biomechanical problems that patients present in our offices, that our orthotic Rxs are only a part of the answer.
Below are the common instabilities or causes of pain syndromes that we can make a direct and positive impact on.
Common Instabilities or Causes of Pain Syndromes that your biomechanical evaluation should pick up:
- Medial Instability due to pronation
- Poor Shock Absorption due to functioning at MPP
- Overly Loose Foot Joints due to pronation and/or hypermobility syndrome
- Lateral Instability due to supination
- Overly Rigid Foot Motion due to hypomobility or supination issues causing
poor shock absorption - Limb Length Discrepancy
- Weak Muscles
- Tight Muscles
I would love it if you could get better at both recognizing and treating these issues. This is really the most important aspect of our goals with patients. We want to make them more stable (by eliminating instability) and we want to reduce their pain while improving function.
Therefore, our historical review, gait evaluation, static examinations, and muscle strength and flexibility testing should help us understand how to approach a patient biomechanically. Of course, physical examination should occur at every visit. It is totally okay to divide this discovery over many visits while treating a patient. One example would be:
- History and Gait first visit
- Static exam 2nd visit (minimum 5 examinations
- Muscle testing for strength and flexibility 3rd visit
- 4th Visit, evaluation of common shoe worn
You have to see what will work for you, but some protocol that your staff knows by heart can make sure that nothing is ignored in a day of shorter visit times.
What makes life easier is the development of protocols for these instabilities and pain syndromes! An obvious and common problem is over pronation and posterior tibial tendon pain. First visit, medial ankle pain by history, overpronation in gait, and pain on contraction against resistance on physical examination. Second visit for static examination you can focus on causes of over pronation: MPE, Forefoot Varus, Rearfoot Varus, Equinus, Long Leg, etc. Third visit muscle test for ankle strength including posterior tibial, and ankle flexibility. Fourth visit or shoe visit to see if the shoes they are wearing are part of the problem. These protocols for a biomechanical approach to injuries can lessen the stress on you due to their routine nature.
