Hallux valgus and the first metatarsal arch segment: a theoretical biomechanical perspective.
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Glasoe WM, Nuckley DJ, Ludewig PM.
Phys Ther. 2010 Jan;90(1):110-20.
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Can anyone email me the full text of this one. Any Options on the highlighted section ?
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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. -
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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. -
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." -
Anyway, I should welcome a copy of the full text of the article too, if any one can help?
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So would not have passed a Spooner peer review ?
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Do you have a copy of the Snijder article I went a Googling but only got an absract. -
I've invented the orthotic for this. I just put a mirror surface on the orthoses and it's reversed!:pigs:
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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). -
Ted. -
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.
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Have you tried non-surgical release of soft tissues?
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No, tell me more. Are you suggesting an article??
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It's only a single case study Alex... but it's a big part of our practice.
Ted.Attached Files:
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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.
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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.
Ted. -
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.
Alex -
Will be running an FMT course at La Trobe in June so look out!
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Here is the full article for those who want to read it and see what it says. Thanks again Björn
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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.
Eric -
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Sorry. My paper copy is quite buried.
Eric -
still loking for these two papers if anyone can help
thought it might be of interst to some.Attached Files:
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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.
http://www.ncbi.nlm.nih.gov/journals/3758?ordinalpos=1&itool=EntrezSystem2.PEntrez.Journals.Journals_ResultsPanel.Journals_RVDocSum
Your only hope may be if someone scans on their original paper copy - you'll have to beg Eric to dig thorugh his archives ;)
Ian -
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. -
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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.
Cheers
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