Shoe Therapy This is an 89-year-old female who presents to the office with chief complaint of pain and effusion of the right ankle. Initial onset of the problem was approximately one month ago. Apparently, the patient accidentally everted her foot forcibly while getting out of the bathtub. Since the injury, she has noticed that the contour of her right foot has changed somewhat. She was prescribed Ibuprofen 400mg. one tab po b.i.d. The patient has been applying Bengay, which she finds to be soothing.	by Jay Lieberman DPM, FACFAS, Director of Podiatric Medical Education Northwest Medical Center Margate, FL

PAST MEDICAL HISTORY: This includes osteoarthritis and poor circulation.

MEDICATIONS: She admits to taking B12 tablets, Centrum Silver, and Premarin 0.3.

ALLERGIES: NKA

SOCIAL HISTORY: The patient is not a smoker, nor does she consume alcohol. She consumes both coffee and tea.

PAST FOOT/ANKLE SURGERY: There have been no surgeries or hospitalizations related to the foot.

REVIEW OF SYSTEMS: This is within normal limits.

NEUROVASCULAR EXAMINATION: The patient's neurovascular status is intact. Pedal pulses are graded +2/+4 bilateral. Proprioceptive sensoriums are intact. The skin is supple and well hydrated. The nails are hypertrophied, discolored, and lysed consistent with tinea ungum.

LOWER EXTREMITY EXAMINATION: Clinically one notes an effusion inferior to the tibial malleolus of the right foot. There is palpable tenderness following the course of the posterior tibial tendon. There is a small dimple in the tendon, just inferior to the malleolus. The patient finds it impossible to maintain a toe raised position. On gait analysis, there is a virtual collapse of the medial column noted throughout stance phase.

ASSESSMENT: Possible rupture of the posterior tibial tendon.

PLAN: A low profile cast boot was dispensed today. The patient will be sent for a MRI to determine the integrity of the tendon.

MRI: A MRI of both the foot and ankle revealed "full thickness tear of the posterior tibial tendon in the region of the medial malleolus, extending for approximately 3-4 cm where the distal tendon edge is re-identified extending to the insertion".

Whether it be an orthotic, a gauntlet, or an ankle brace, compliance is extremely important. Foot Solutions carries a variety of orthopedic and comfort shoes that will accommodate various appliances and increase compliance.

Foot Solutions is a national chain that now boasts 250 stores worldwide.  Many of their franchisees are certified pedorthists. They have an excellent knowledge of shoe types and are experts in fitting your patients.  At Foot Solutions, elderly people or non-surgical candidates can readily find shoes which will accommodate for bunion deformities and digital contractures.  Foot Solutions carries many shoe types that come with rocker bars already incorporated into the sole of the shoe.  In addition, depth shoes, inlays, custom and standard orthotics are available for your patients.  There is a great advantage to dispensing a device and having a shoe readily available that the patient can comfortably wear.  There are also shoes that maintain posture, control chronic fasciitis, and retrocalcaneal heel pain. Customizations such as Thomas Heels, medial counter buildup, custom crest pads and soft tissue supplements are also available.  Check out the front of the store and you will always see business cards for local podiatrists.  Foot Solutions wants very much to be symbiotic with the podiatry community and has recently become a corporate member of the APMA and will be exhibiting at their 2009 annual conference. Foot Solutions™ Health and Wellness Franchise is a franchise company with more than 250 locations worldwide. The world’s largest and #1 ranked health and wellness franchise, focusing on foot care and proper fit. Foot Solutions™ provides a full line of quality shoes, arch supports, and foot care accessories for all customer lifestyles. www.footsolutions.com