Pes Planus and Associated Anterior Knee and Low Back Pain
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There are many things I like about this article. First, it goes with my functional classification of deformities into mild, moderate and severe categories. We should be able to look at feet, especially in walking, and classify them as normal function, mild pronation, moderate pronation, and severe pronation. Due to the higher injury rate seen in this study in the moderate to severe pronators, we need to have higher corrections for these patients in our orthotic designs and more rigid criteria of what shoes that they should wear for their main activities.
The article clearly states that moderate and severe pronators have more anterior knee pain and low back pain. And we can do something about this. The authors imply the anterior knee pain was patello-femoral pain highly linked to pronation. Low back pain, moderately tied to pronation, is something that Dr. Merton Root 60 years ago treated frequently, yet modern day Podiatrists seem to shy away from if the low back pain is primary.
When you give orthotic devices to patients, ask the patients what are all of their present low back and lower extremities symptoms. Then, at the 6 month followup visit, ask them again about each one of their symptoms. How has your knee been feeling since the orthotic devices were given to you? How has your low back been feeling since the orthotic devices? Etc. You will be surprised at the positive responses.
I will end with a suggestion on orthotic prescriptions for these patients with pes planus and over pronation tendencies.
Normal Foot Function: Root Balanced Device, 4 mm polypropylene, standard width, rearfoot post 4 degrees inverted with 4 degrees of motion, 15 mm heel cup, 3 mm arch fill (default)
Mild Pronation noted: Root Balanced Device, 4 mm polypropylene, standard frame, rearfoot post no motion, 18 mm medial heel cup 15 mm lateral, 3 mm arch fill
Moderate Pronation noted: Root Balanced Device, 4 mm medial heel skive, 4 mm polypropylene, wide frame, rearfoot post no motion, 18 mm medial and lateral heel cups, 1.5 mm arch fill (unless rigid arch)
Severe Pronation noted: 25 degree Inverted device, 5 mm polypropylene, wide frame, rearfoot post no motion, 21 mm medial and lateral heel cups, medial heel skive 3 mm or set 2 degree rearfoot and forefoot varus posting.
