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Can foot orthoses reverse hallux valgus?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jan 26, 2010.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Hallux valgus and the first metatarsal arch segment: a theoretical biomechanical perspective.
    Glasoe WM, Nuckley DJ, Ludewig PM.
    Phys Ther. 2010 Jan;90(1):110-20.
  2. Admin2

    Admin2 Administrator Staff Member

  3. Can anyone email me the full text of this one. Any Options on the highlighted section ?
  4. In order for foot orthoses to reverse hallux valgus they have to create a net adduction moment on the hallux at the 1st MTPJ; a net abduction moment of the 1st met at Lisfrancs joint and de-rotate the met and hallux- end of story.
  5. "Theory is advanced that collapse of the arch with vertical orientation (tilt) of the first metatarsal axis initiates deformity. To counteract the progression of hallux valgus, we use theory to discuss a possible mechanism by which foot orthoses can bolster the arch and reorient the first metatarsal axis horizontally."

    The idea that collapse of the medial longitudinal arch precedes hallux valgus is not supported by all data. I discussed this in my PhD thesis. I don't have a copy of my thesis at work, but will post more on this tonight.
  6. Thanks Simon I was thinking how do they change the Hullux postion?, and you clearly have broken it down to more detail and further up the chain, why do people put papers forward with topic such as this? Is it just to get their name in lights ?
  7. Because good news is always more appealing than bad.

    Say you can cure headaches using insoles without supporting data, your a trailblazer. Say that someone else can't, you're denigrating the profession.

    That's why people are often surprised by the reception of new ideas on PA.

    But as a wise man once said, if nothing bad ever gets said, nothing good gets done.
  8. "Kilmartin and Wallace used footprinting techniques in their study of the significance of pes planus in Juvenile hallux valgus. Their study population consisted of 96 eleven-year old school children of mixed gender (32 with bilateral hallux valgus, 64 with no abnormality of the 1st MTPJ). No statistically significant difference was found between the arch indexes of the two groups. they concluded that the height of the arch had little importance in juvenile hallux valgus and that the role of pes planus in hallux valgus was questionable."

    Greenberg (1979) concluded that there was more pronation than normal in hallux valgus following his radiographic study investigating their association. However, certain methodological weaknesses exist in this study: 312 radiographs were taken of subjects awaiting hallux valgus surgery. The radiographs were divided into severe and mild hallux valgus. 1st MTPJ angles were measured to make this distinction (severe = >28 degrees, mild = <11 degrees). However, an angle less than 11 degrees would be considered as clinically normal by many previous workers. Greenberg (1979) measured the following radiographic angles: calcaneal inclination angle, talar declination angle, lateral talo-calcaneal angle, dorsoplantar talo-calcaneal angle, cuboid abduction angle and talo-cuboid angle. Kilmartin acknowledged the frequent use of the first four angles as an index of subtalar joint pronation, but expressed concern regarding the validitiy of the latter two angles.

    Greenberg (1979) made comparisons between his own results and normal values obtained by another worker. No statistically significant difference was found between the normal and hallux valgus results except the cuboid abduction angle and the talo-cuboid angle. These two angles were reportedly unique to this study, so it is unclear how Greenberg (1979) made comparisons for these angles."
  9. Anyway, I should welcome a copy of the full text of the article too, if any one can help?
  10. So would not have passed a Spooner peer review ?
  11. I don't know, I haven't read the paper yet. If memory serves, one of the best pathomechanical theories I read on hallux valgus was by Snijders et al.- biomechanics of hallux valgus and spread foot. Foot and ankle 1986; 7:26-35, but this is going back a while- I may read it now and pick holes in it.
  12. BTW, all of that has to happen inside a shoe that might be shaped like a winkle-picker:D:bash:
  13. Sorry posting at the same time you were faster then me.

    Do you have a copy of the Snijder article I went a Googling but only got an absract.
  14. Graham

    Graham RIP

    I've invented the orthotic for this. I just put a mirror surface on the orthoses and it's reversed!:pigs:
  15. No, I gave the majority of my paper copies of articles away to students.
  16. Lmao!
  17. Alex Adam

    Alex Adam Active Member

    The studies in this subject always fail in the methodology of the orthotic maufacture and so the results are bias.
    If we correctly control the foot and balance the STJ and MTJ and the patient carries out the necessary muscle strengthing exercises then halting and in some case the reduction of the deformity can be achieved.
    As for describing the foot as an arch, surely we are well past that, all one needs to do is look at De Vince's image of the foot, it allows us to realize the foot is a series of pullies and canterlevers. Identify the force vectors and the mechanical advantage of tendons, muscles and joint axis' and manufacture a device to counteract the pathology that alters the joints, Wolf's Law, not compromising the lower limb structure we can definitly reduce the forces to stop or reverse the pathology ( stage 3 and less).
  18. TedJed

    TedJed Active Member

    Make sure you assist the reversal of the HAV by releasing the soft tissue contractures that develop on the lateral aspect of the 1st MtPJ through manual therapy (by the patient and practitioner). Otherwise there will be greater resistance to the change(s) that will hinder progress.

  19. Alex Adam

    Alex Adam Active Member

    Totally agree, the failures I have seen have been contributed by the lack of soft tissue release. The difference between a 45 min op compared to a 90 min op with soft tissue release and tendon transfer.
  20. TedJed

    TedJed Active Member

    Have you tried non-surgical release of soft tissues?
  21. Alex Adam

    Alex Adam Active Member

    No, tell me more. Are you suggesting an article??
  22. TedJed

    TedJed Active Member

    It's only a single case study Alex... but it's a big part of our practice.


    Attached Files:

  23. Alex Adam

    Alex Adam Active Member

    Thank you for that I like your technique, I use a strengthening of adducto Hallus and EDB using a digital dorsiflexion under tension and adducting the hallux and digits, abductus, and then controlling the plantarflexion.
  24. TedJed

    TedJed Active Member

    Such fine motor control can be frustrating for the patient to master but I find it plays an important role in the initial correction and long term maintenance of correction. Nice to hear of your application of this type of muscle control Alex.

  25. Alex Adam

    Alex Adam Active Member

    LOL yep the patient get a tad frustrated but if they persivere we get great results. Any time you're in Melbourne let me know happy to show you around and you can check out the practice/laboratory.
  26. TedJed

    TedJed Active Member

    Will be running an FMT course at La Trobe in June so look out!
  27. Here is the full article for those who want to read it and see what it says. Thanks again Björn

    Attached Files:

  28. OK, read the article, according to the paper it all comes down to the axial position of the 1st met cuneiform joint. As the paper points out and I also noted this back in my thesis, whether the 1st ray dorsiflexes and inverts or dorsiflexes and everts is contentious in the literature. However, as we know from Nester, an axis is created by forces and forces drive motion. Where are these forces coming from? Free body analysis time. If memory serves, Eric already did this.
  29. efuller

    efuller MVP

    Again, people unclear on the concept of axis. An axis is an imaginary line that describes the motion. It cannot limit the motion. Ligaments and bony surfaces limit the motion about a joint. I stopped reading at the quote.
  30. I think we're on the same page, Eric :drinks
  31. efuller

    efuller MVP

    Nice circular logic. At least they tried to define hybermobility of the first ray. Do you think there is going to be a correlation between widening of the first and 2nd metatarsal angle in HAV?

    When are they going to do the anatomical dissections to find the pin of the hinge that forces the bones to move about the axis????

    If anyone want to see a good article about how forces cause bunion see the Snijders articles in the cites for the above article.

  32. Yesterday I wrote:
    Great minds..... know a good paper when they read it.
  33. has anyone got a copy of said article my man can´t fix me a copy as it´s not electronic as it´s too old. Any of Simon´s old students anyone
  34. efuller

    efuller MVP

    There were two articles by Snijders. He was lead on one and second author on the other. They are both cited in the article that led this thread. They were right next to each other in the cites.

    Sorry. My paper copy is quite buried.

  35. still loking for these two papers if anyone can help
    But came across this one by some of the same authors which focus on the Displaced of Flexor Hallucis Longus Tendon in Hallux Valgus

    thought it might be of interst to some.

    Attached Files:

  36. Griff

    Griff Moderator


    I had a quick look if I could access them and no dice - Foot & Ankle stopped publication in 1993 and is not indexed for MEDLINE (as I'm guessing it ceased existance before the internet was common place). It was continued by Foot & Ankle international, which I do have access to but its online back issues only go back a decade.


    Your only hope may be if someone scans on their original paper copy - you'll have to beg Eric to dig thorugh his archives ;)

  37. Thanks for looking Ian, appreciate that you took the time.

    I´ll cross my fingers for a scanned copy as It does sound like a much read.
  38. It probably was. But only in certain circles.
  39. Frederick George

    Frederick George Active Member

    Orthotics and bunions. Root and Weed told us students that they could reverse or at least stop bunions. But how can you tell if you've stopped a bunion from progressing?

    When all you have is a hammer, the whole world looks like a nail.

    In addition to soft tissue contractures, there are soft tissue failures ie. the transverse metatarsal ligament.

    All joints in the foot are multiaxial, which is the problem with simple models.

    A hopeful idea that has come around again, like Earth Shoes.


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