Re: Trimming Input


Lavinia Fiscaletti
 

Hi Julie,

I've added a couple of mark-ups to Maggie's album:

https://ecir.groups.io/g/CaseHistory/album?id=277769&p=Created%2C%2C%2C20%2C2%2C0%2C0

As has been mentioned, her toes are too far out ahead of where they need to be so need to be taken back to move the breakover closer to the tip of the frog. She has thin soles and sinking on both - which go hand-in-hand. Both show capsular rotation - which is when the distance between the dorsal wall and the dorsal edge of the coffin bone increases as you travel from top to bottom. The LF has a broken back HPA, with the palmer angle being too low. RF shows some slight bony column rotation, with the palmer angle being too high. There's some medial flaring of the LF. Because of the detached walls from the laminitis and sinking, the trim needs to take the walls out of weight bearing, leaving them level with the soles. Lower ONLY the heels on the RF while leaving the sole alone, esp. in the front half of the foot. On the LF, leave the entire bottom of the foot alone except for backing up the toe.

LF DP: Green line follows the angle of the new growth to the ground. Blue area is the flaring wall that needs to be removed.

LF dorsal: As on the radiograph, remove the flare in the blue area.

LF lateral composite: On the radiograph side, pink line shows where the bony column should line up, while the purple line follows how it actually does. Pink line ends where the bottom of the sole should be if it was thick enough. Note that the purple line dips down and back away from the pink one. This is a broken back HPA., which compresses the front of the joint space while stretching the back side and jamming the navicular bone up into P2. The green line follows the angle of the new growth down toward the ground - this is NOT a trim line, it's just a visual of where the dorsal wall should be. Blue line is were to bring the toe back to, with the blue X being the excess horizontal length. Remember that the sole is too thin, so only back the toe to the point where that blue line intersects with the ground in the rad - not to where it ends below the foot. Red line indicates not to touch the bottom of the foot anywhere along it, as there is already too little material there. Lime line below the red one shows where the bottom of the foot should be. Yellow line #1 runs thru the coronary band, while #2 points to the extensor process. The distance between them denotes the amount of sinking as they should be overlapping, or at least very close together.
On the photo side, the green and red lines are the same as on the rad. The blue area corresponds to the blue X, which is the excess toe that needs to be brought back.

LF sole: Solid blue line shows where to bring the toe back to - which is inside what appears to be the "White Line". Blue hashes indicate the material that needs to be removed. Do not remove anything inside the red area as there is already too little there.
 
RF lateral composite: Same general idea as the LF. On the rad side, Pink line again shows how the bony column wants to line up, while the purple line follows how it does. Pink line ends where the sole should end if it were thick enough. On this foot, notice how the purple line bulges ahead of the pink one. This is bony column rotation, the opposite of a broken back HPA. Blue line at the toe indicates where to back the toe to, with the blue X being the excess toe ahead of where it needs to be. Green line shows where the dorsal wall should be - this is NOT a trim line, just a visual. Red line means don't touch that area of the bottom of the foot except to make sure the walls are level with the sole plane. Dark blue line shows where to lower the heels from mid-foot back, n a wedge-shape. This means the bottom of the foot won't be flat like it would to attach a shoe - which is fine. Yellow line #1 runs thru the coronary band, while #2 points to the extensor process. The distance between them indicates the amount of distal descent (aka sinking).
On the photo side, green, red and dark blue lines are the same as on the rad. Blue area at the toe corresponds to the blue X on the rad, which the excess horizontal toe length that needs to be removed to push the breakover back closer to where the bony column needs it to be.

RF sole: Blue solid line in the toe is where to take the toe back to. Blue hashes all around the perimeter indicate the excess foot that needs to be removed. Lime lines across the back half of the foot indicate where the foot needs to be lowerde some to correct the bony column rotation. DO NOT lower the foot inside the red area except to make the walls level with the sole plane if needed.

She should be in padded boots at all times until she can add the missing sole depth and move comfortably. Any boot she wears should have aggressive bevels added to the treads at the toes and across the backs of the heels. She may feel more comfortable with a bit of a wedged pad in the LF until that HPA is corrected. She definitely should have a flat pad in the RF boot. You may need to experiment to find what she likes the best.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Join main@ECIR.groups.io to automatically receive all group messages.