| strong> | | | | shoes insoles might be beneficial but do not |
| Following the onset of pain and swelling of the | | | | correct the condition. |
| right foot, a diagnosis of bilateral pronatory | | | | A further orthopedic specialist, who was |
| syndrome, affecting the right foot to a greater | | | | consulted, deems the use of a shoe insole more |
| degree, was made. Therefore, the physician | | | | appropriate for the time being while the surgical |
| suggested: | | | | procedure might be reconsidered at a later date |
| - Dorsal plantar and latero-lateral x-ray of both | | | | on reassessment of the clinical evolution of the |
| feet in full weight-bearing position; | | | | condition in time. |
| - Plantar orthesis with a 16 mm dome and | | | | The parents were not sure about the diagnosis |
| hindfoot supinatory wedge; | | | | and contated for professional online second |
| - Hindfoot-restraining shoes but of soft materials | | | | opinion. The case was sent for another evaluation |
| One day later weight-bearing x-rays were taken | | | | by a leading Orthopaedic Surgeon. |
| of both feet and the report reads as follows: | | | | The expert found the x-rays normal and I did not |
| “Normal morphology, structure and trophism | | | | see any sagging of the medial column. He agreed |
| of the bone segments under examination. Tarsal | | | | with the report of the radiologist and disagreed |
| and forefoot joints are normal bilaterally. Non-flat | | | | with the statement of the doctor about the result |
| plantar arches”. | | | | of the x-rays. |
| A follow-up visit confirmed the previous diagnosis | | | | “It is true that in severe cases of pronation |
| of bilateral pronatory syndrome greater in the | | | | and flat feet one should consider elongation of the |
| right foot. The doctor recommended: | | | | Achilles tendon and using arthroeresis technique. |
| - “Right foot surgery for the lengthening of | | | | However in such severe cases the x-rays should |
| the Achilles tendon and application of retrograde | | | | show the sever deformity. It is in contrary to the |
| endorthesis screw (calcaneo-stop surgery). | | | | x-rays that were sent to me. |
| - plantar orthesis | | | | I have a feeling that the diagnosis is different |
| - hindfoot-restraining shoes | | | | from the one that was suggested in the medical |
| According to the doctor, the avoidance of said | | | | summary.” |
| surgery might lead to frequent and severe pain, | | | | The expert asked the parents to send him |
| swelling, valgus foot (for which surgery is not | | | | photos of the feet, standing from the front and |
| advisable before age 20, after full growth) | | | | from the side, to help him to be more accurate |
| increasing of foot pronation etc. Also, in | | | | with the diagnosis. |
| doctor’s view and contrary to the x-ray | | | | “Her differential diagnosis can be: beginning of |
| report the patient’s feet have low arches | | | | Coalition symptoms. I need to know the range of |
| since the tilt angle does not reach 10°. | | | | movement of the sub Talar joint. It can be also |
| Consequently, she endorses surgery of the right | | | | some general problem like beginning of rheumatic |
| foot complemented by the application of a short | | | | symptom. For that she has to be examined by a |
| leg cast for 1 month. | | | | pediatrician and do some specific blood tests. |
| 4 months later, the same procedure should be | | | | In the mean time, I suggest pain killers and soft |
| performed on the left foot. | | | | shoes with soft insoles inside and mild elevation of |
| Given the patient’s age, the doctor believes | | | | the medial longitudinal arch of the feet. |