Whoa! It is amazing what the human frame can withstand…
This 300 pound individual is retired from working with tow trucks from a towing company as well as a service station. He believes working with the tow trucks, particularly jumping out of them contributed to the O.A. of the ankles.
He has osteoarthritic ankles, a rear foot varus of 15 degrees left side, 5 degrees right. He is currently in the New Balance 1040 shoe. He would like some new orthotics built. He Fowler tests positive on his current orthotic set up (with the foot on the ground, dorsiflex the foot at the 1st metatarsal phalangeal joint (ie big toe joint), simulating terminal stance; the orthotic should hug the arch through the range of motion; ie about 45-60 degress of great toe dorsiflexion, which he incredibly has). He is unable to one leg stand because of the O.A. on the ankles and pain.
He has bi-lat. internal tibial torsion, Left > Right and moderate tibial varum, L > R. He has very little internal rotation of the hips bi-lat. Ankle dorsiflexion is about 5 degrees bilaterally.
He is currently in an older New Balance motion control shoe. You can see how he has worn the shoes into varus. More neutral shoes hurt his feet; attempts to put his rear foot into valgus causes increased ankle pain. Exercise compliance is minimal.
WHAT WOULD YOU DO?
The Gait Guys. Teaching and educating with each post.