Case of the Week 29/06/98: What people said...

Please note that there is more than one potencial source of ankle inversion
when considering varus foot deformity. Tibiales posterior is a common source
but out of phase tibiales anterior, EHL and even the plantarflexors can all
produce an ankle inverting force. In our experience in non CP spastic
varus(stroke and head injury) the tibiales posterior is involved only 30 to
35% of the time. Tibiales anterior and EHL are involved in 50 to 55%  and a
combination of the anterior and posterior muscles is seen in 10 to 15%.
Dynamic EMG evaluation of all the possible contributing muscles to this
deformity is very important prior to any surgical intervention.

A. Esquenazi
Gait & Motion Analysis Laboratory
MossRehab Hospital/Albert Einstein Medical Center
1200 West Tabor Rd. Philadelphia PA 19141 USA
Phone:  215 456 9470
Fax:    215 456 9084

A Member of the Albert Einstein Healthcare Network 

In determining the reason for the varus feet I would like to know more
information about the foot itself. In a non-weightbearing exam is the
plane of the plantar surface-forefoot parallel to that of the heel? If
it is valgus compared to the heel, and the foot is fairly rigid, it will
cause the apparent varus condition as the natural angle of the foot
compensates to level ground. An orthotic insole with the foots natural
angle in the forefoot would reduce the compensatory gait.

Randall Barna, C. Ped
Pres. Footform Labs

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