CASE STUDY: FLAT FEET WITH POSTERIOR TIBIALTENDON DYSFUNCTION (PTTD)
41 year old female complaints pain & swelling at inner side of left ankle since a year. Pain was gradually increased. Initially it use to hurt on prolong standing & walking eventually pain got worst. Now not even able walk few steps also.
- Swelling was present around left navicular area
- Grade III tenderness at the navicular area
- Clawing of toes left side
- Medial Arch- Flat Bilaterlly (Flat Feet)
- Transvrse arch reduced
- Subtalar joint- Overpronation bilatrally more on lfert side
- Navicular drop- Present bilaterally
- Navicular drift- Present bilaterally
- Calcaneum (Posterior view)- Eversion bilaterally more on left side
- Knee- Valgus
- Gait Pattern- Poor heel to pattern
- Heel Strike- Medial heel strike
- Stance Phase- Overpronation at the sub-talar joint bilaterally
- Limp on left side
Treatment & Advice:
- Complete rest for one week with cold pack 4 time a day over affected area for 20 min. each time.
- Advised to wear sport shoes (Even indoor) with firm heel counter (Stable Shoes) few days as concidering her pain & sevirity of flat feet.
- Prescribed Bio-Advanced medium density orthotic insole in her shoes & also to reduce stress on Tibialis posterior muscle tendon.
1st Follow up after two week
- Demarkeble changes seen. More than 50% of pain was reduced.
- Added correction in orthotics to further enhance arch support.
- Advised to continue with cold pack.
- This time 90% pain reduced.
- Now slight discomfirt only after long stand or walk.
- Adviced Strive orthotic footwear for short distance (Near by) & continue the sports shoes for out door.
- Exercises for strengthening tibialis posterior muscle.
No pain & Adviced to continue with orthotics
Feedback of Patient's husband