Ferdinand Bardamu's Profile

1. When can "that" be used as the relative pronoun?

2. Which positions of the prepositions are possible in the relative clause?

It would be my assumption that following a PTT partial tear the patient would (1) Lose the ability to eccentrically control pronation moments (following heel strike in gait) and (2) have increased pronation moments across the STJ axis as a result of the reduced ability of the PT muscle contraction to supinate the foot.



Over time this would result in shorterned/contracted soft tissue dorso-laterally and lengthened/elongated plantar tissues/ligaments medially (Davis' law of soft tissue adaption). The consequence of this over a 3-6/12 period being an inverted FF attitude (supinatus deformity) when examined non-weightbearing.

You basically answered the question correctly. However, when I said "time-dependent load deformation characteristics of ligaments", I was specifically referring to stress relaxation and creep of ligaments, both of which are time-dependent properties common in viscoelastic substances, such as ligament, tendon, cartilage and bone.



If there was a posterior tibial (PT) tendon tear, the PT muscle/tendon complex would weaken which would decrease the ability of the patient to generate an internal subtalar joint (STJ) supination moment. As a result, the foot would tend to pronate more at the STJ which, in turn, would increase the ground reaction force under the medial metatarsal heads. This would cause increased medial metatarsal ray dorsiflexion moments, increased tensile forces in the plantar ligaments and decreased tensile forces in the dorsal ligaments of the medial column during weightbearing activities. As a result, over time, the ligaments plantarly that are being stretched more will elongate and the ligaments dorsally that are being stretched less will shorten. This will cause an apparent dorsiflexion deformity of the medial metatarsal rays, relative to the lateral metatarsal rays which will, in turn, cause an increase in an inverted forefoot to rearfoot position during non-weightbearing examination than before the PT tendon injury occurred.

Ian, how might you then best design a custom foot orthosis to try and reverse this "forefoot supinatus"? In other words, where would it make more sense to put increased orthosis reaction force on the plantar foot with an orthosis, given this mechanical scenario, if your goal was to reduce the inverted forefoot deformity in this patient over time?

If my goal was to design the orthosis to decrease the soft tissue contracture of the forefoot which resulted in the forefoot to rearfoot relationship being more inverted than normal, I would design the orthosis as follows:



1) increase the orthosis reaction force (ORF) plantar to the medial calcaneus to increase the external subtalar joint (STJ) supination moment, and



2) increase the ORF plantar to the medial longitudinal arch to increase the external STJ supination moment and increase the external medial forefoot plantarflexion moment. By placing ORF in the proximal medial arch, the ground reaction force in the medial metatarsal heads will be decreased which, combined with the increased ORF proximally, will increase the medial forefoot plantarflexion moment.



Both of these orthosis modifications would help increase the chance of the patient showing a gradual increase in everted forefoot to rearfoot relationship, or a decrease in inverted forefoot to rearfoot relationship, over time.

Out of interest how do you feel about FF Varus postings? Is there particualr situations when you feel they are important/beneficial or maybe situations where they are completely inappropriate in your experience?

They are essential in people who have lateral column overload/ sinus tarsi pain/ genu valgum and are unable to evert far enough to get significant load on the medial column without abductnig their tibia. I should also clarify what I'm talking about.

I'm talking about something under the 1st metatarsal head and maybe the hallux depending on the shoe.

This is different from the classical Rootian intrinsic post which does not work for this condition because with an intrinsic varus forefoot post the arch of the orthosis will be very high and it will try and support the deformity by pushing on the arch which can be very painful.

Enligt Fastighetsmäklarnämnden som utövar tillsyn över registrerade mäklare så har mäklaren egentligen inte gjort något fel när säljaren fått handpenningen.

Då köparen satt in pengarna hos mäklarfirman så styrs de av ett depositionsavtal som reglerar vilka krav som ska uppfyllas. Vanligtvis får säljaren rätt till handpenningen så fort köparen blivit godkänd som medlem i bostadsrättsföreningen, vilket skett i detta fall.

Erik Olsson fastighetsförmedling är inte medlem i branschorganisationen Mäklarsamfundet

det kan vara svårt som mäklare att ta ställning till sanningshalten i ofördelaktiga påståenden om en kund.

Att mäklaren inte varit makarna Muda behjälplig när tvisten uppstått är inte fel.

– En mäklare får inte i sin opartiska roll vara den ena parten behjälplig mot den andra, säger Jonas Anderberg.

Förutom att stämma säljaren för att hävda sin rätt till lägenheten har familjen Muda även tvingats stämma mäklaren på Erik Olsson för att få tillbaka handpenningen som krävs för att lösa säljarens lån då säljaren inte har några utmätbara tillgångar.

Mäklaren hos Erik Olsson har en ansvarförsäkring som täcker skador som mäklaren orsakar, men mäklarens juridiska ombud menar att mäklaren inte gjort något fel och då måste familjen stämma mäklaren för att ansvarförsäkringen ska falla ut.