Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with bilateral foot pain and progressive loss of the medial longitudinal arch. Symptoms are exacerbated by prolonged standing and weight-bearing activities. Reports fatigue in the midfoot and medial ankle region, with no history of acute trauma. Pain is described as a dull ache, improving with rest and orthotic support.
Clinical Examination Findings
Bilateral examination reveals collapse of the medial longitudinal arch in both standing and non-weight-bearing positions. Forefoot abduction noted (too-many-toes sign). Hindfoot valgus present bilaterally. Tenderness noted along the posterior tibial tendon insertion. Flexibility of the subtalar joint is preserved. Neurovascular status intact distally.
Treatment Protocol
Conservative management initiated including custom-molded orthotics for arch support, physical therapy focusing on posterior tibial tendon strengthening and intrinsic foot muscle exercises. Recommendation for supportive footwear with medial arch reinforcement. Non-steroidal anti-inflammatory drugs (NSAIDs) as needed for pain management. Follow-up in 6 weeks to assess progress.