Post Tibial Tendonitis - Fallen Arches - Workshop Live Blog Recap

Tony Chiappetta
Tony Chiappetta

Post-tibia tendonitis is something that a lot of people deal with. Especially people that have naturally lower arches or flat feet have a higher chance of developing this in their lifetime. Tony has been working with this customer for the last three to four months. The customer was set up with a great pair of custom orthotics and Redwing Boots. This guy is a hard worker. As a farmer, he doesn't take his boots off from seven in the morning till about seven at night.

With this kind of lifestyle and type of foot, post-tibia tendonitis can be pretty common and is a condition seen plenty of times at Chiappetta Shoes. This customer is an F23 on the right and F24 on the left for the quadricep foot typing system.

The difference between the two-foot types is the large forefoot versus where the midfoot bones are in an unlocked position. The foot type allows the arch to flatten as well as the toes to displace to the outside. The damage that happens with post-tibial tendonitis is that the heel bone can continue to shift inward. We want to help the foot stabilize.

So to solve this issue, Tony will add a medial wedge to the orthotic. When the orthotic was first built, Tony used a 1/8" multi-cork to build a natural wedge, which is placed through the whole medial arch. So it's not just a scaphoid pad, medial wedge, or rear foot wedge. It was built for the whole foot.

Fast forward to today, a customer mentioned that their mornings still feel kind of tense. His knees are really sore and pressure builds up by the middle of the day. He also mentioned irritation within the knees, and mid to lower back.

Sometimes when we hear we have a fallen arch, we can over-support the foot. You have to think about the customer in terms of what the body can handle by itself. And oftentimes, we have our notions of what adjustments we want to do, but you don't want to rush to judgment or correction. You want to let the body do as much as it can without over-correcting the situation. And that's a big part of our process.

Our adjustment, in this case, is to pull back on the initial correction to allow the foot to gradually get used to the support in the orthotic. To get there, Tony will jump on the grinder to reduce the medial wedge and lower the wall height by a little more than 1/16th of an inch. This will reduce the pressure for the customer, but keep the contour of the custom orthotic.

Before and after adjustment to the medial wedge and wall height

Now that the new adjustment has been more relaxed, it's still important to keep the met pad on due to the splaying of the forefoot to keep the toes relaxed. The next thing to consider is the footwear that the orthotic is in. In this case, the customer is wearing a great boot; the Redwing 608. (Available In-Store at Chiappetta Shoes) The Redwing 608 is a great boot in quality and support. When you have a great supporting boot, plus a great supporting insert, there's a chance your foot might be receiving "too much support."

The double support led to the customer feeling like he was rolling off of his 3rd through 5th toe. When we have situations with a flatter foot, oftentimes what you're going to get is a propulsion issue. In this case, the forefoot varus doesn't allow the foot to walk off the big toe as normally as possible. The solution to this is a small layer of THK, which is a thermoplastic material that Tony will add to the first gray area. THK is super thin and it adds a good amount of rigidity.

The next enhancement to the shoe is giving the leather a nice shine job. At Chiappetta Shoes, we use a product called Leather Balm by Fiebings. A product we have on the shelf at Chiappetta Shoes (in a much smaller size container) is Mink Oil. Fiebing's Mink Oil is a natural byproduct that softens, preserves, and waterproofs all articles of smooth leather and vinyl. The mink oil prevents stains and protects the leather as well.

Ruby Leather Company Mink Oil Paste - $9.95

The more liquid version works really well too, but that can be a little too greasy sometimes. The point of using it is to prevent the cracking of the leather. Now, let's move back to the orthotic where we are adding the THK to the forefoot for extra support as the foot is pushing off. The THK is only 1 millimeter thick and doesn't add too much weight to the shoe.

THK before cut/over to after placed on orthotic and cut

Doctors, chiropractors, PT guys need to be cognizant of the spatial usage within shoes. It's important to consider the constraints of the environment when you're working with women with dress pumps versus men with boots. It's all relative to how much space you have to work with on the inside. To prep the THK, it needs to heat up for about 90 seconds. That means gloves will be needed since it has adhesive on one side because it can get really sticky and really hot! ????

Now that the THK is on the orthotic, it's time to move to the grinding machine to blend the thermoplastic into the orthotic. Once that's completed, the adjustment is finished to help solve this customer's foot pain.

That's it for today's workshop live blog recap. To recap, Tony solved a post tibia tendonitis foot with an F23 and F24 alignment. Tony reduced the amount of support because the body couldn't handle it. The body was strong enough to stabilize on its own. Plus, the support of a redwing 608 boot was over-rotating the feet to the outside. This caused irritants in which were dialed back. Tony went back to a neutral adjustment by lowering the walls, shaving off part of the met pad, and then adding the THX to the orthotic. View the full video of the process below!

To catch other orthotic adjustments live, follow Chiappetta Shoes on Twitch, Youtube, and Facebook. Check out the last Orthotic Live Blog Recap by clicking the image below. ⬇️

If your feet hurt, make an appointment by clicking the link below to meet with one of our pedorthists to solve your foot pain. All consultations are free of charge!

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