Orthotics Make Hip Pain Worse?

43 Year old female (Ingrid) with chronic left hip pain around greater trochanter.

I have a patient who is a small train-wreck. She has foot, ankle, and hip issues, all on the left.

She’s been wearing Sole Supports for two months, which have helped her foot and ankle. She called our office today and said her hip pain, which has been fairly dormant with load management + treatment, has been flared up for two weeks. She wakes up with this pain and it dissipates over the day.  She didn’t wear the orthotics one day and her hip pain went away and she believes this is the reason why.  Has anyone encountered this before? Perhaps her degenerated hip prefers being in relative internal rotation?

Tests: SHF + KHE were full, although SHF produced “pinching” in the anterior hips bilaterally.  SLR was full.  AD has increased over time to about 4.5″ bilaterally and is plateaued there.

Provocative: Symptoms are worst getting out of bed in AM. Standing makes it worse than sitting. Not doing a re-exam, I don’t have other provocative movements.

X-ray Left Hip: incidiental ligamentous calcification 1 cm in length above greater trochanter.

MRI Left Hip: Minimal joint effusion. Mild chondral wear over femoral head with small lateral ostephyte. Labrum is mildy degenerated superiorly and anteriorly, but not frankly torn. Mild spurring of the superolateral acetabulum. Alpha angle of 60 degrees.

There are small calcifications around the greater trochanter and mild edema consistent with calcific tendinitis of the distal gluteus minimum and possibly medius tendon.  Minimal trochanteric bursitis.