I would love now to end this discussion on Achilles management, and at the same time, begin a discussion on all of the KevinRoot Medical Pathology based orthotic devices labeled P1 through P14. Listed below are the specifications for P1 Achilles Tendon injuries. These 14 devices are a great starting point (and perhaps the only orthotic device that the patient will need) when treating these injuries. As we look at each one, I will suggest common modifications that practitioners will use and when to use them. These Pathology-based inserts can always be modified by other factors in the patient’s needs like forefoot padding due to being a ball of the foot runner or multi-directional sport athlete and always up on the ball of their feet.
As you can see, the P1 is a stable Root designed insert due to:
- Solid Semi-flexible polypropylene for a great base
- 18 mm deep heel cup for varus and valgus tilt correction
- A Root Balancing of Forefoot Deformities
- No frame fill in order to have flexibility in the arch (assuming most Achilles patients are active patients)
- Solid Rearfoot post to work with the deep heel cups for even better frontal plane stability typically with zero motion
Common Modifications to the Order form:
- As mentioned above, 1/8 inch neolon full length topcover for patients with a lot of forefoot loading
- This 1/8 inch neolon can be matched with 1/8 inch myolite forefoot extension for even better forefoot protection (usually only in deep athletic toe boxes)
- 1/8 inch heel lift both sides (unless unilateral achilles is on the short side of limb length discrepancy)
- Tight Plantar Fascia (bowstring on examination) may need a 2 mm plantar fascia groove
- Patients with pronatory (heel valgus, etc) tendencies add a 4 mm medial heel skive and increase the heel cups to 21 mm
- Patients with supinatory (heel varus, etc) tendencies add a lateral frame fill and valgus onlay to sulcus (top cover needs to be full length or sulcus length)
- Patients with functional hallux limitus add a 1/8 inch myolite Reverse Morton’s Extension (aka Dancer’s Pad) and 1/8 inch Dynamic Wedge
- Add 4 degree varus post motion when there are shock absorption issue like rigid foot, knee arthritic complaints, low back pain
- The list can go on as you individualize for each patient, but these are the most common ones to P1
Next week I will discuss P2.
