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A Short History of "Evaluation and Nonoperative Management of Pes Valgus"

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Nov 17, 2013.


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    For those that are interested, I first coauthored the book chapter "Evaluation and Nonoperative Treatment of Pes Valgus", along with Dr. Don Green, back in 1990, and it was submitted to the publisher 23 years ago in October 1990 (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992.)

    Steve DeValentine, DPM, who I was working with at the South Sacramento Kaiser Hospital doing a foot orthosis clinic a half day a week, had asked me and Don to do this chapter on the evaluation and treatment of children's flatfoot deformity for his upcoming book. It ended up that I wrote and illustrated most of the chapter and Don wrote and had an artist illustrate the part of the chapter on planal dominance. This was during my 5th year of podiatry practice and I was relatively unknown at the time. Steve DeValentine was taking a big chance on asking me to be primary author at the time since I had never written a book chapter and I reluctantly accepted the challenge. However, since I didn't know much about the history of flatfoot evaluation and treatment, other than the narrow amount of information I learned at CCPM, I needed to read papers for about two months before I could even begin to write the chapter.

    In going back through my old files, I found a drawing and a photo which was published in the chapter that may be of interest.

    The first one is my drawings from figure 13-5 C & D showing how a foot with ligamentous laxity will flatten in the medial longitudinal arch until the plantar ligaments and plantar fascia become tight to resist further arch flattening. This was from the day when I was doing all my drawings with black ink on drawing paper, and was well before the time when I started doing all my illustrations on a computer with, at first, a CAD program called GenCad, and later with the software program I still use to this day, CorelDraw. A great amount of work went into the 15 hand drawn illustrations (including many more individual drawings) for this chapter. I thought it may be valuable for all of you to see how much degradation occurs in image quality between when illustrations are produced for publication and to when they are eventually published. For this chapter, and the other chapters and papers I have written, it is not uncommon to have the illustrations require just as much total time as does the writing of the chapter/paper.

    The second item is the original photo I submitted for an illustration of the Supination Resistance Test, a test which I created during my Biomechanics Fellowship in 1984-85 and first described, along with the Maximum Pronation Test in this book chapter. This photo was taken in my first office that I shared with three orthopedic surgeons. The photo was of a young boy that had been referred to me for custom foot orthoses, those are my fingers doing the Supination Resistance Test. One of my office staff took the photo. The image quality of the photo is much better than what was published also. You are all welcome to use the image for any lectures you may do on the Supination Resistance Test.

    It is interesting to note, that during the research and writing for this chapter in 1989 to 1990, where I also first described the mechanism of action of the Blake Inverted Orthosis, I began to experiment with the Medial Heel Skive Orthosis Technique. I had been using the Blake Inverted Orthosis Technique since 1982 since this was when a few of us CCPM podiatry students began helping Rich Blake, DPM, who was our Biomechanics Fellow at the time, make these orthoses for his patients. The Medial Heel Skive Orthosis Technique was my idea to create a more simple and less complicated method to introduce a varus heel cup shape into the heel cup of an orthosis without the time-consuming and complicated positive cast work that was required of the Blake Inverted Orthosis Technique. I began experimenting with the Medial Heel Skive with the late Paul Rasmussen, owner of Precision Intricast Orthosis Lab, at the Lab in Lodi, California, in 1990.

    Just thought that since it has been well over two decades since this all these events happened, and many of you have not been practicing podiatry that long, that a little history lesson might be valuable since these facts will otherwise be lost once I'm no longer able to remember them and/or describe them.
     
  2. Lab Guy

    Lab Guy Well-Known Member

    Kevin,

    The drawings opened up but only the upper part of the photo opened, the rest was blocked. Maybe it is my computer.

    I am very thankful for all of your contributions to bringing much greater understanding to biomechanics!

    Steven
     
  3. Steven, I've reformatted them to be a little smaller. Try this.
     
  4. Lab Guy

    Lab Guy Well-Known Member

    Photo opened up. Thanks!

    Steven
     
  5. Griff

    Griff Moderator

    Kevin:

    Huge thanks for this picture of you performing the manual supination resistance test. A topic I continue to have a keen interest in and I'll certainly use this photo in future presentations to give some historical context. Very kind of you to give permission to do so.

    Cheers

    Ian
     
  6. One of the other clinical tests that I invented and first introduced in the chapter that I coauthored with Don Green (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992.) was the Maximum Pronation Test. I have attached the original photo taken in 1990 that I submitted with the chapter for publication which shows me demonstrating to a flatfooted child how they should move their feet into a maximally pronated position, with their knees extended. Note the child's peroneal tendons are clearly visible during the test since the only muscles which can be effectively used to exert increased magnitudes of subtalar joint pronation moment in both feet simultaneously are the peroneal muscles. Again, for those who want to use this photo for their lectures, you have my permission to do so.

    The Maximum Pronation Test is helpful in determining whether the patient's feet are maximally pronated at the subtalar joint (STJ), or not maximally pronated, during relaxed bipedal stance. I still use this test on all patients that are being evaluated and casted for custom foot orthoses since it provides me with information regarding the summation of external and internal STJ pronation/supination moments acting on the foot during standing. If the patient's calcaneus, when performing the Maximum Pronation Test, pronates less than 2 degrees, then I assume that their STJ is maximally pronated while in relaxed bipedal stance.

    My Spanish podiatric colleagues, Javier Pascual Huerta and Juan Manuel Ropa Moreno, and I used the Maximum Pronation Test to separate two groups of subjects for research on their responses to varus and valgus orthosis wedging in research published in the Journal of the American Podiatric Medical Assocation in early 2009 (Pascual Huerta J, Ropa Moreno JM, Kirby KA: Static response of maximally pronated and nonmaximally pronated feet to frontal plane wedging of foot orthoses. JAPMA, 99:13-19, 2009). The study showed that the response to foot orthoses is variable between individuals. Maximally pronated subjects did not exhibit the same response to frontal plane wedging of foot orthoses as did nonmaximally pronated subjects with 10° wedging. This research suggests that possibly STJ axis spatial location, which helps determine the internal and external STJ pronation and supination moments during weightbearing activities, may be an important factor in determining the response of feet to frontal plane orthosis wedging modifications.

    I would think that further research use of the Maximum Pronation Test to help separate out "foot type groups" may help shed more light on the known variability of foot kinematic responses to foot orthoses.
     
  7. Kevin.

    1990 I was still at school 5 years away from being able to call myself a Pod, but not many 16 years knew what that wanted to be when they grew up.

    I am sure there will be a couple more decades or more of Pods going how did he think of that, and explain it so well.

    Thanks Kevin.
     
  8. Jawilliamson_2000

    Jawilliamson_2000 Welcome New Poster

    This was a great chapter. Read it 20 years ago. Always would have liked to have seen a picture of the patient standing on the orthotics without shoes, for comparison purposes.

    Thanks
    JA Williamson PhD
     
  9. Hannahcullen89

    Hannahcullen89 Welcome New Poster

    Great article, very informative!
     
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