Varus Tilts are used to get patients less everted in RCSP or especially to attempt to get the patient more in subtalar joint neutral.
Varus Wedges stocked in the office can begin to varus the patients at the first visit
With all patients, as I hear their complaints and watch them walk and/or run, I am immediately designing their perfect orthosis in my mind. I categorize these patients by what correction I need to obtain stability. These are A) need to achieve or maintain heel verticality, B) need to achieve less of an everted heel, C) need to achieve markedly less everted heel, D) need to achieve a heel inverted postition, E) need to achieve less of a heel inverted position, and F) need to achieve markedly less inverted heel position. Of course, what the demands for the right foot may be different from the left foot.
I have defined my Gold Standard orthosis as Heel vertical and forefoot deformities balanced out. This is called the Root Functional Orthotic Device or the Root Balanced Device. This is how A is achieved. Balance the heel to vertical and balance out any forefoot abnormalities. B is achieved with Root Pronation A (varus tilt of 3 degrees is applied). This is accomplished in 4 ways as orthotic Rx writing has evolved. On the Rx form, to achieve Root Pronation A, you can ask for 3 degrees inverted intrinsically balanced, you can ask for the heel balanced first to vertical and then 3 degree extrinsic rearfoot and forefoot varus posting, you can ask for the heel to be balanced to vertical and then add a 4 mm medial Kirby Skive, and you can ask the lab for a 15 degree Inverted Orthoses (that I had something to do with designing). Now, I need your help. What has worked for you when 3-4 degrees of less eversion is needed? Please comment. Each week coming we will go one by one through these 6 common Rx variables. Rich
