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Rearfoot Alignment and First Metatarsal Rotation

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Oct 13, 2021.

  1. NewsBot

    NewsBot The Admin that posts the news.

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    Association Between Hindfoot Alignment and First Metatarsal Rotation
    Neil Bakshi, MD, Jesse Steadman, BS, Matthew Philippi, MD, ...
    Foot & Ankle International August 5, 2021
     
  2. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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  3. NewsBot

    NewsBot The Admin that posts the news.

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    The Rotational Positioning of the Bones in the Medial Column of the Foot: A Weightbearing CT Analysis
    Eli Schmidt et al
    Iowa Orthop J. 2021;41(1):103-109.
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Association of Normal vs Abnormal Meary Angle With Hindfoot Malalignment and First Metatarsal Rotation: A Short Report
    Jesse Steadman et al
    Foot Ankle Int. 2022 Jan 24
     
  5. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Rotational positioning of the bones in the medial column of the foot, this is the hallmark in both the PreClinical Clubfoot Deformity and the Primus Metatarsus Supinatus (aka Rothbarts Foot) deformity. On the weight bearing, gravity drive pronation forces the entire medial column of the foot into pronation.
     
  6. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    In many cases, research does not precede clinical experience. Rather the avant garde is clinical experience. Clinical experience brings to light previously unreported pathology, or novel effective interventions that research has not yet investigated. In time research is initiated to "officially" validate these reported observations/interventions (or not).

    I have spent over 50 years of my life practicing Podiatric medicine while concurrently spending a great deal of time in research (and publishing). In 2002 I published on two previously unrecognized abnormal genetic foot deformation, linking them to the development of chronic musculoskeletal pain. (My protocols in treating these two deformations are now being used by hundreds, if not thousands of healthcare providers across the globe)

    Much of my research was field based, seeing countless numbers of patients, observing commonalities, devising new ways to quantify and qualify my findings.
    • I was one of the first, if not the first researcher to link pelvic position to foot function.
    • I was one of the first, if not the first researcher to link malocclusion to foot function.
    • I was one of the first, if not the first researcher to link cranial distortions to foot function
    • I was one of the first, if not the first researcher to link alteration in CNS activity to foot function
    • I was the first researcher to present a detailed ascending postural distortion model, foot to jaw, linked to gravity drive pronation
    As a young Podiatrist, back in the 1970s, I published many papers in the Podiatric Journal. New ideas were welcomed and applauded by my compeers. How things have changed. Just review the comments generated on this forum on any of the research areas enumerated above. Snake oil is the term that comes to mind. The same or similar demeaning comment was thrown at Ignax Semmelweis MD for having the audacity to suggest hand hygience before performing surgery.

    However, I am pleased that other research teams are now starting to report similar findings (Cummings, Hartz, Gholamreza). Schmidt’s current study that links the axial rotation of the medial colunn of the foot to pathology, is the hallmark of both the PreClinical Clubfoot Deformity and Rothbarts Foot.

    It reminds me of a saying (that comes to mind): Good things come to those who wait. And how I have waited.
     
    Last edited: Jan 29, 2022
  7. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Another study was just recently published, a Case-Control cadaver study which confirmed the axial plane rotation of the entire medial column of the foot (Dibbern et.al.)

    Over the years, I have been involved in many debates on this forum in which I described my findings regarding the structural deformations pathognomonic of Rothbarts Foot, namely the axial rotation (supinatus) starting at the head and neck of the talus and extending proximally to the hallux. Several senior members would repetitively respond, using derogative terms. Snake oil comes to mind.

    It was also suggested that Rothbarts Foot was simply an elevatus of the 1st metatarsal or what Root termed forefoot varum. This axial twist along the entire medial column of the foot is quite distinct from 1st metatarsal elevatus or what Root termed forefoot varum. Hopefully, this confusion has been put to rest on this forum.

    Other research teams are now investigating medial column structural relationships which I have published on over the past 20 years. Hopefully, this will open up discussions (not juvenile diatribes) on the RFS.

    • Dibbern K., Briggs H., Behrens A., et.al. 2021. Reliability of coronal plane rotation measurements in the medial column of the foot: a cadaveric study. Journal Foot and Ankle 15(3):252-260.
     
    Last edited: Jan 30, 2022
  8. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Etiology of Primus Metatarsus Supinatus Deformity (Rothbart)
    • The Premature Arrest in the torsional growth of the medial column of the foot - talar head and neck to hallux (Dibbern et al, Schmidt et al)

    PMS Etiology.jpg

    • Dibbern K., Briggs H., Behrens A., et.al. 2021. Reliability of coronal plane rotation measurements in the medial column of the foot: a cadaveric study. Journal Foot and Ankle 15(3):252-260.
    • Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
    • Schmidt E.,Silva T., Baumfeld D., et.al. 2021. The Rotational Positioning of the Bones in the Medial Column of the Foot: A Weightbearing CT Analysis. Iowa Orthop J. 2021:41(1):103-109.
     
  9. Except the Schmidt study and the Dibbern study both report that all the bones in the Medial column are pronated in association with “hyper-pronation” whereas you maintain that the 1st metatarsal is supinated in the Rothbart foot. Not quite sure how you think these studies support your opinion when they appear to be showing the rank opposite.
     
  10. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Cite the publication where I made that statement. FYI, supinatus is not the same as supinated.

    The hallmark of RFS is the axial rotation of the medial foot column. Both Schmidt et al and Dibbern et al confirm this axial rotation. In 2002 I presented a protocol for measuring this axial rotation. In 1997 Cummings confirmed the accuracy of this measurement.

    By the way, I am Brian A Rothbart. I am not pretending to be someone else.

    It may appear bazaar that I would need to make such an affirmation. But, to quote you from a discussion on Occams Razor or the Law of Parsimony, reply 166, (see below) one can easily understand the necessity:

    "Thanks Hilary, or should I say “Brian”? Funny as funk. Your old games are just that Brian. Go on then “Hilary” introduce yourself to us, tell us who you are and where you come from, what gave you the impetus to sign up to podiatry arena to write that post, then i’lll find that old post that Kevin Kirby put up from a disgruntled patient of Brian and post that back up.

    it’s not a difficult question Brian, the more you obfuscate, the easier it gets."

    From your past amusing behaviour, you can understand why I just want clarify that it is me that is answering your mistaken comment, not some factitious person appearing from the Netherlands.
     
    Last edited: Jan 31, 2022
  11. You might need to give us your definition of “supinatus” versus “supinated” since as I recall supinatus relates to an acquired soft tissue contracture, I thought we were talking about osteology here? Or is “Rothbart’s foot” an acquired soft tissue contracture?
    Anyway: “Primus metatarsus supinatus” aka “Rothbart’s foot”

    “ The overall rotational profile of medial column bones was found to be in absolute pronation, most pronounced at the navicular and proximal first metatarsal, with significant differences in the amount of pronation when comparing most of the medial column bones.”- Schmidt et al. 2021.

    On what planet does this research support you?

    Think you gonna be waiting much longer for the adulation your ego craves so very much. BTW, you never did answer that question instead you resorted to your old tactic of getting someone to come on here and obfuscate on your behalf. I guess announcing yourself as “Brian A. Rothbart” is an improvement upon you inappropriately using the title “Professor Brian A. Rothbart” as you continued to do here for so very long, despite it’s inappropriate use by yourself being repeatedly pointed out to you. Funny how when Hilary came in here she was referring to you as “Professor Rothbart”, wonder where she got the idea that you held that title?

    BTW, you’ve already played the “start a new thread” card, lol
     
    Last edited: Jan 31, 2022
  12. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    ~

    Nonsense. I will repeat my question - cite where I maintain that the 1st metatarsal is supinated in the Rothbart foot.

    Simon, Just a quick question, are you ok, are you taking any drugs? I ask this question only out of concern. Some of your recent comments (see above) appear disjointed. As a senior member of this forum you have a good reputation. However, your recent behavior appears out of sync with your history of brilliance.
     
    Last edited: Jan 31, 2022
  13. And who can forget the “nonsense” response. Absolutely pissing myself. In other words you are clueless once again, Brian. Before you start “big-upping” yourself Brian, you might want to actually read and more importantly, understand what the research actually showed.

    For the casual observer, note how Brian has not addressed any of my points or questions thus far here…
     
    Last edited: Jan 31, 2022
  14. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Simon, I am now very concerned about your behavior. Your remind me of a close friend, later diagnosed as having a dissociative identity disorder. Please, don't get me wrong. I am not implying you have this disorder. I am just concerned with your current behavior. That's all, nothing more.

    Signing off for the night. Hopefully your current behavior is transient, and in the morning your old brilliant mind will return.
     
  15. Ladies and gentlemen, I give you Brian Rothbart. BTW, I took a screen shot of that for the record.

    I’m guessing your “friends” “dissociative indentity disorder” was due to his undiagnosed “Rothbart’s foot” just like Robin Williams suicide, according to you. Enough bullshit obfuscation Brian, in what way does the Schmidt study support your hypothesis? It doesn’t hence the obfuscation on your part. Next…

    To reiterate: “You might need to give us your definition of “supinatus” versus “supinated” since as I recall supinatus relates to an acquired soft tissue contracture, I thought we were talking about osteology here? Or is “Rothbart’s foot” an acquired soft tissue contracture?
    Anyway: “Primus metatarsus supinatus” aka “Rothbart’s foot”

    “ The overall rotational profile of medial column bones was found to be in absolute pronation, most pronounced at the navicular and proximal first metatarsal, with significant differences in the amount of pronation when comparing most of the medial column bones.”- Schmidt et al. 2021.

    On what planet does this research support you?”
     
    Last edited: Jan 31, 2022
  16. efuller

    efuller MVP

    Very funny Brian. Again you claim to be saying the exact opposite of your message. If you did not want to imply... don't write it.

    Again deflection from the question that was asked.
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Correlation of Different Methods of Measuring Pronation of the First Metatarsal on Weightbearing CT Scans
    Matthew S Conti et al
    Foot Ankle Int. 2021 Aug;42(8):1049-1059
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Side-to-Side Difference of Metatarsal Rotation in Normal Individuals
    Alexander Duff, MBBCh, Kae Sian Tay, FRCSEd (Ortho), Ali-Asgar Najefi, FRCS (Tr&Orth), ...
    Foot & Ankle International March 31, 2022
     
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