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Supination Terminology

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Donna, Feb 28, 2008.

  1. Donna

    Donna Active Member


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    Hi everyone!

    At our weekly staff inservice yesterday, we were discussing the categories for the more difficult types of patients to treat. We had them grouped as 4 categories: cavus, planus, skewfoot and hypermobile (these categories can obviously overlap).

    When we were discussing cavus cases, and were racking our brains trying to think if there is an "official" term for feet with forefoot valgus that seem to become more cavus the older they get. :confused: It seems that perhaps as the midfoot develops degenerative change and stiffens with age (a lot present with DMICS), so it looks like feet with forefoot valgus present then have increased subtalar joint inversion (with more inverted RCSP in Bx assessments) to allow the everted forefoot to compensate and make ground contact. Does this make sense? Or have I described this really badly here?:confused:

    We have been describing it loosely as a "progressive supination disorder", but does anyone have any better terms or better ways to describe this phenomenon?

    Regards

    Donna :)
     
  2. Donna:

    There are many systems by which to classify foot deformities/posture. I was trained with the Root et al system which I think does a better job than any other in classifying multisegment deformities of the foot. There is also the terminology of pes planus and pes cavus, which can then be further subdivided into foot types which, to me, have always seemed less precise methods of describing foot shape. We also have Tony Redmond's Foot Posture Index (FPI), which describes foot posture during weightbearing, but by numerically combining the 6-8 criteria used in the FPI, the FPI misses out on the potential problem that different parts of the foot may look supinated and other parts look pronated.

    I also developed the classification method of determining the spatial location of the subtalar joint (STJ) axis which is probably the best method of determining how foot deformities or foot posture affects the external STJ moments acting on the foot during weightbearing activities. However, the STJ axis location method is, by itself, not too specific on the overall shape of the foot, which seems to be what you are looking for.

    My opinion of the best way to classify the foot you are describing would be to say that the foot has a rigid forefoot valgus deformity, with possibly a first ray/medial column with increased dorsiflexion stiffness, increased longitidunal arch height and an inverted calcaneus during relaxed calcaneal stance. If the foot has progressively became more inverted at the calcaneus and higher arched with age, I would say that the patient had a progressive cavo-varus foot deformity. Of course, you could also describe the change in forefoot to rearfoot relationship with the Root et al system, describe the change in foot posture over time with the FPI or describe the change in STJ axis location over time using my system.

    Hope this helps.
     
  3. Donna

    Donna Active Member

    Hi Kevin,

    Wow! Thanks for such a detailed reply! I like your description of "progressive cavo-varus foot deformity", it is much more anatomically descriptive than calling it a "progressive supination disorder"! We have been looking at the existing terminology used in the practice (I joined here in January) and thinking about possible ways that we can better describe our patient's anatomy and injuries.

    Regards

    Donna ;)
     
  4. BRo

    BRo Welcome New Poster

    That is a fantastic way to describe it biomechanically, but if it is a "progressive cavo-varus foot deformity" it opens the neurological can of worms
     
  5. Trent Baker

    Trent Baker Active Member

    Kevin,

    Do you have any literature on your "classification method of determining the spatial location of the subtalar joint (STJ) axis which is probably the best method of determining how foot deformities or foot posture affects the external STJ moments acting on the foot during weightbearing activities"?

    It sounds interesting and very usefull.
     
  6. DSP

    DSP Active Member

    Hi Trent,

    I hope this helps:

    The Subtalar Joint Axis Locator: A Preliminary Report
    Spooner and Kirby J Am Podiatr Med Assoc.2006; 96: 212-219

    Subtalar Joint Axis Location and Rotational Equilibrium Theory of Foot Function
    Kirby J Am Podiatr Med Assoc.2001; 91: 465-487
     
  7. Trent Baker

    Trent Baker Active Member

    Thanks that's great.
     
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