A TT patient with a painful grade 1 osteochondral defect would benefit from which alignment change?

Outsetting the foot by 3 mm is beneficial in the case of a transtibial (TT) patient with a painful grade 1 osteochondral defect because it helps to reduce the load and stresses on the affected area of the limb. This adjustment can lead to several biomechanical advantages, including improving the alignment of the residual limb with the ground and promoting more natural weight distribution during gait. By slightly moving the foot outward, the load can be better balanced, potentially alleviating discomfort caused by the defect.

In contrast, other alignment changes may not provide the same relief. For instance, insetting the foot could inadvertently increase pressure on the medial aspect of the residual limb, compounding issues rather than alleviating them. Lowering the heel height mainly affects the center of gravity and may not address the specific alignment issues associated with the osteochondral defect. Raising the toe break might change the timing of foot flat during gait but does not directly relate to addressing the stresses on the area impacted by the defect, and could also lead to walking difficulties. The chosen alignment change aims to create a more comfortable and functional prosthetic experience for the patient.