Rothbarts Foot and PreClinical Clubfoot Deformity

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Weight Bearing CT scans (Silva et al 2020) have demonstrated the rotational distortions (supinatus) within the medial column of the foot that I have been publishing about over the past 20 years. Medial column supinatus is the pathognomonic finding of the PreClinical Clubfoot Deformity and Rothbart's Foot.

It is now important to discuss how to treat these two abnormal, genetic foot structures that result in debilitating chronic muscle and joint pain.

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.​

 

The generic proprioceptive insoles sold by the company in Tacoma Washington should only be used when treating Rothbarts Foot. They are counter indicated when treating the PreClinical Clubfoot Deformity.

In my clinical practice I have treated patients who, after they bought the generic insoles from the Washington state company, their musculoskeletal symptoms increased. In every case, these patients had the PreClinical Clubfoot Deformity.

I believe this company does not differentiate between these two-foot structures and recommends them for any individual with a medial column supinatus.

Unfortunately, both abnormal foot structures display medial column supinatus. Hence, the healthcare provider should run the appropriate tests to differentiate which structure is present. And then dispense the appropriate proprioceptive insole.

 

Another paper demonstrating the supinatus of the talus.

A 59-year-old patient underwent subtalar fusion, talonavicular joint and first tarsometatarsal joint fusion, medial displacement calcaneal osteotomy, and gastrocnemius recession in an attempt to stabilize the collapse of the medial column of the foot. Unfortunately, they did not address the supinatus of the talus. This resulted in medial column instability, noted in the 6-month PO x-rays.

3d x-rays taken preop demonstrated talar supinatus.

This is another example of a severe Rothbart foot deformity.

Kin J, Rajan L, Henry J et al 2023. Incidence and predictors of valgus tibiotalar tilt after progressive collapsing foot deformity reconstruction using subtalar fusion with concomitant procedures. Archives of Orthopedics May 2023.​

 

This is the proprioceptive insole I designed to treat RFS (Rothbarts Foot Structure). It is counterindicated when treating PCFD (PreClinical Clubfoot Deformity)

The medial edge has an elevation of 3-9mm (determined at the time of examination). The lateral edge is skived down to 0mm (not simply an elevation).

 

Attached is a diagram demonstrating the convergence of Rothbarts Foot, PreClinical Clubfoot deformity and Clubfoot deformity.

A micro wedge is one method of differentiating these embryological foot structures form one another. The exact micro wedge reading delineating a plantar grade foot from Rothbarts foot or Rothbarts foot from PreClinical Clubfoot deformity, are fluid.

For example, a patient with a micro wedge reading of 16mm could either be a severe Rothbarts foot or a mild PreClinical Clubfoot deformity.

The diagnosis and intervention for that patient is determined by further clinical tests, e.g., Leg Rotation and Muscle testing, Gait analysis and/or Computer Postural analysis.

 

The foot structure you were born with greatly determines your overall health. For example, a plantar grade foot (what you would think of as being a ‘normal’ foot) is linked to having healthy muscles and joints and overall good health. Whereas 3 other foot structures can cause problems ranging from simple foot pain (Morton’s Foot) to chronic pain and other problems throughout the body (Rothbarts Foot and PreClinical Clubfoot Deformity.

On my patient website I have discussed the differences in structure, function, appearance, prevalence and treatment specific to each of these four distinct foot structures.

Note: this website page was written nearly 10 years ago, before 3d X-rays were available that could visualize the medial column supinatus. And at that time, I stated it was not possible to visualize mc supinatus on standard 2d X-rays.

This has all changed! Starting, just a few years ago, medial column supinatus resulting from talar supinatus has been visualized using 3d WBCT.

Medial column supinatus is the hallmark finding of Rothbarts Foot and PCFD. Healthcare professionals, IMO, must be able to recognize and treat these common embryological foot aberrations.

 

I have attached a copy of the above webpage (The Plantar Grade Foot vs Morton's Foot, Rothbarts Foot and the PreClinical Clubfoot Deformity) in PDF format, in case you are unable to access my website.