I have a client with supination of the foot. The ankle appears to be tipped to the outside, and he stands on the outside border of the foot. His foot is turned inward. This is obviously throwing off the alignment of his entire leg, and I imagine it's probably affecting his hip. What type of doctor should I recommend he see? Should I recommend inserts? Do you have any suggestions on specific exercises?
By the way you've stated your question, I'm going to assume this is only occurring unilaterally? You were correct in your observation that this may be affecting the hip. In fact, in may stem from it. Consider the following.
- Is there a hip hike on the side of the supinated foot? If so, the supination is simply the body's way of creating the extra length needed to accommodate for the hip hike. If there is indeed a hip hike, there will be repercussions at the knee as well.
- Does the client have an athletic/injury background that involves numerous ankle sprains/injuries (specifically the lateral ankle)? If this is the case, and it has gone unchecked/treated, this can cause the medial calf muscles (medial fibers of the gastroc/soleus, tibialis post/anterior, etc.) to go into permanent spasm creating the altered posture.
- Is your client having pain? This would warrant immediate referral out. A HIGHLY SKILLED physical therapist should posses the knowledge to assess and treat the problem. Particularly look for the credentials O.C.S. behind her/his name. This is the American Physical Therapy Association signifier for "Orthopedic Certified Specialist."
- I would in no way "recommend" any type of insert at this time as this is only a "bandage" to the real problem (poor flexibility, poor neuromuscular efficiency and a weak core).
- For now, simply focus on flexibility, specifically in the CALVES, PSOAS, TFL, IT BAND and ADDUCTORS (see the PTontheNET.com Flexibility Library for detailed descriptions and pictures).