This topic contains 3 replies, has 2 voices, and was last updated by 
Christopher Stepien April 26, 2018 at 4:44 pm.
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Christopher Stepien
Without giving 1st order and 2nd order details of a case, I have a woman who had a tri-malleolar fracture, had surgery, finished PT, and is still in pretty severe pain and can hardly walk.
She has significant adhesion and I have reason to believe treatment and load management would help (I’m looking for a single to a double).
My question involves Sole Supports:
She can’t dorsiflex enough for me to push the foam in (-4″ in AD). Has anyone encountered this? Does SS have any options for patients like this?
Seth Schultz, DC
My understanding for implementing Sole Supports is only after any relevant adhesion has been reduced. With that type of fracture I would check all posterior ankle ligaments as those are likely to get damaged. Make as much progress as you can with function/reduction of adhesion then evaluate for support after.
Brandon Cohen DC, CSCS
Chris, it sounds like you are looking to use the orthotic as a load management technique as you work through reducing the adhesion. This seems reasonable to me in extreme cases, and -4″ dorsiflexion seems pretty extreme. If this is used, I would also expect there to be a need for a second casting towards the end of treatment as you will presumably improve the ranges.
I’ve never done it, but we do similar things with other load management ideas. There may also need to be an extended break-in period if she’s loaded with adhesion.
Christopher Stepien
TY Seth. I agree with you under normal circumstances.
Yes, Brandon, that’s what I’m going for as any support to unload her ankle could help treatment be more impactful because she’s so overloaded. I hadn’t considered the 2nd casting and will discuss with her when I see her next.
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