Rothbarts Foot linked to Higher Torsion Values of the Talar Neck

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For many years, I have been presenting my research on Rothbarts Foot and the PreClinical Clubfoot Deformity (in Europe, termed Progressive collapsing foot deformity). I have linked the etiology of these two genetic foot aberrations to the failed completion of the ontogenetic torsion of the talar head (for RFS) and the failed completion of the ontogenetic torsion of the posterior aspect of the calcaneus (PCFD). To put it mildly, my research was not well received on this forum.

Fast forward 20 years. My research is now being validated by research teams across Europe. A paper recently published in Archives of Orthopaedic and Trauma Surgery, using 3d radiographs, they linked PCFD to higher torsional values within the talar neck - exactly what I have theorized since 2002.

Flury A., Hasler J., Beeler S., et al 2022. Talus morphology difers between fatfeet and controls, but its variety has no infuence on extent of surgical deformity correction. Archives of Orthopaedic and Trauma Surgery 142:3103–3110​

 

Brian, I think you made a mistake in thinking that this study was talking a foot with lack of rotation, what Root termed forefoot or rearfoot varus. This article describes a flat foot with a valgus heel deformity.

 

In all due respect, I suggest you reread the paper. Figure 2 on page 3107 states (regarding the talus - control vs PCFD): "an increased valgus alignment (of the talar head) in the frontal view"

I have attached part of Figure 2 taken from this paper. The talus on the right is the control, left a PCFD. You can easily see the increased rotation of the talar head in the PCFD.

In the conclusion of this paper, it stated:

• Regarding talar head morphology - there was a "medial deviation (31.7° and 33.5°; p = 0.04) of the talar head in relation to the body in PCFD patients compared to controls."
• "Only the talus was investigated in this study."

So, I am baffled by your statement that this article describes a flat foot with a valgus heel deformity. Could you elaborate?

 

It's quite simple Brian. The first line of the paper says "Progressive collapsing foot deformity (PCFD) is a complex 3-dimensional (3-D) deformity with varying degrees of hindfoot valgus,... "

The flatfoot they are talking about in the paper has a hindfoot valgus.

What you describe is a lack of, or a failure of, valgus rotation creating, what Root et al described long before you did, a rearfoot or a forefoot varus foot. Varus is the opposite of valgus.

 

Based on 3d radiographs, this paper statistically links morphological changes in the talar head to progressive collapsing foot deformity.

Based on my human embryological studies. I have suggested this same link since 2002.

Confusingly, the terminology is different. What the European Orthopedists term progressive collapsing foot deformity (sometimes referred to as hindfoot valgus), I have termed Primus Metatarsus Supinatus deformity (or PreClinical Clubfoot Deformity if the calcaneus is concurrently impacted).

If my memory serves me, based on conjecture only, a link between forefoot varum and an ontogenetic retention of talar torsion was published by Hlavac (1970), before Root. However, this is very different from my research.

Specifically, Forefoot varum is not PMSd. Forefoot varum (impacting all 5 metatarsals) cannot exist in the human foot. PMSd (impacting only the 1st metatarsal) does exist in the human foot. I have discussed this in great detail in several publications. (Rothbart 2002, 2004, 2022)

Bottom line - utilizing 3d radiographs, my research has been confirmed in European orthopedic publications.

• Hlavac HF 1970. Compensated Forefoot Varus. Jour Amer Pod Association Vo. 60:229
• Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
• Rothbart BA 2004. Postural Distortions. The foot connection. Online Journal of Orthodontics, May 10; 6(1): 1-8
• Rothbart BA 2022. Etiology of the Clubfoot Deformity, PreClinical Clubfoot Deformity and PMS foot deformity. Published Online: International Academy RFS lab, Researchgate June.

 

Yes, things do get confusing when you make up new names (and name them after yourself) for already named entities.

You have described a foot type as a lack of valgus rotation. You predicted that this foot would lead to progressing flat foot deformity. This study showed that progressing flat foot deformity had a greater valgus rotation than normal. The study you quoted at the start of this thread is evidence disproving your theory.

 

Again, in all due respect, what you are saying is an oxymoron.

The above illustration taken from the paper depicts the incomplete torsional development of the talar head linked to PCFD.

However, I invite you to disprove my research. I would be very interested in hearing your arguments disproving my embryological research - not general statements - but specific points of fact. I am all ears.

 

Original research can result in the introduction of new terminology. That has been the case with my research.

Below is another study (Silva 2020) which uses 3d radiographs to visualize medial column supinatus in the foot.

Up until recently, the only proof I could offer to the existence of medial column supinatus (which inchoates gravity drive pronation) was from my research in human embryology. On this forum, this was highly criticized and rejected.

Now that mcs is a fact, the foundation of my research is established.

Silva TA, Baumfeld DS, et al. 2020. Understanding the Rotational Positioning of the Bones in the Medial Column of the Foot: A Weightbearing CT Analysis. Foot & Ankle Orthopaedics 5(4), Conference AOFAS.