Sex: F, Age: 10 years
Following the onset of pain and swelling of the right foot, a specialist visit was performed by 04/2008 during which a diagnosis of bilateral pronatory syndrome, affecting the right foot to a greater degree, was made. Therefore, the physician suggested:
- Dorsal plantar and latero-lateral x-ray of both feet in full weight-bearing position;
- Plantar orthesis with a 16 mm dome and hindfoot supinatory wedge;
- Hindfoot-restraining shoes but of soft materials
On 05/2008 weight-bearing x-rays were taken of both feet and the report reads as follows: “Normal morphology, structure and trophism of the bone segments under examination. Tarsal and forefoot joints are normal bilaterally. Non-flat plantar arches”.
A follow-up visit with confirmed the previous diagnosis of bilateral pronatory syndrome greater in the right foot. She recommended:
- “Right foot surgery for the lengthening of the Achilles tendon and application of retrograde endorthesis screw (calcaneo-stop surgery).
- plantar orthesis
- hindfoot-restraining shoes
According to Dr X, the avoidance of said surgery might lead to frequent and severe pain, swelling, valgus foot (for which surgery is not advisable before age 20, after full growth) increasing of foot pronation etc. Also, in Dr X view and contrary to the x-ray report the patient’s feet have low arches since the tilt angle does not reach 10°. Consequently, she endorses surgery of the right foot complemented by the application of a short leg cast for 1 month.
4 months later, the same procedure should be performed on the left foot.
Given the patient’s age, the doctor believes shoes insoles might be beneficial but do not correct the condition.
A further orthopedic specialist, who was consulted, deems the use of a shoe insole more appropriate for the time being while the surgical procedure might be reconsidered at a later date on reassessment of the clinical evolution of the condition in time.