28 year old female born with spina bifida, a rare birth defect that occurs when a baby’s spine does not form normally, and the spinal cord and the nerves that branch out of it may be damaged as a result. The patient presented with congenital vertical talus deformity of the Left foot, a condition that occurs in 10% of patients with spina bifida. It is characterised by a rigid rocker-bottom flatfoot with a malalignment of the hindfoot and midfoot. The hindfoot demonstrates equinovalgus, with the calcaneus everted on the talus. The talus is nearly vertical and the talonavicular joint is subluxated , with the navicular dorsally and laterally on the talus.
The patient underwent a talonavicular fusion in 2014 in order to reduce the chronic midfoot pain caused by the deformity and to improve foot function. She has limited toe-off control on the Left and places excessive force on the metatarsal heads to push off the forefoot what walking. There is fat pad atrophy on the Right forefoot due to overcompensation of the functionally limited Left foot. She has utilised various custom footwear and orthoses supports over the years with varying degrees of success.
The young woman attended a consultation with one of our Certified Pedorthists with a pair of ankle high custom boots and a custom made polypropylene ankle-foot orthosis (AFO) on the Left. The Left boot was wide and bulky in an effort to accommodate the AFO, and she expressed she still experienced chronic pain in the midfoot and ball of foot.
The Certified Pedorthist developed a plan to produce a pair of calf-high custom made boots with an integrated custom AFO in the Left boot and bilateral custom foot orthotics. Integration of the AFO within the leather upper of the boot allows for a streamlined and thinner device that can be concealed within the footwear, reducing much of the bulk that she had seen in previous custom boots. The bilateral EVA base foot orthotics provide the required hindfoot support and control, along with sufficient offloading of the plantar pressure that was causing debilitating pain when weight-bearing. A rigid rocker was applied to the Left orthotic to assist with toe off and provide greater toe clearance on the outsole of the boot.