Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Cocked up hallux following lateral wedging for peroneal symptoms

Discussion in 'Biomechanics, Sports and Foot orthoses' started by penny claisse, Jun 27, 2007.

  1. penny claisse

    penny claisse Member

    Members do not see these Ads. Sign Up.
    Patient is a 40 year old rugby coach with bilateral lateral lower leg and lateral foot pain, worse on left side, over last few months when whenever he is on his feet. Stands with marked bilateral rear foot varus, more marked on the left, plantarflexed first rays but average medial longitudinal arches. Forefoot to rearfoot position is valgus. Many ankle inversion sprains as a child. Varus heel position is fully correctable with coleman block test.

    Wearing Frelen insoles with lateral and forefoot 4 deg lateral wedging is comfortable and he feels that his feet are 'well balanced' for the first time. He can even run up and down the pitch.

    However when he rests his feet ache laterally and first thing inthe morning both halluces are cocked up and stiff so that he has to stretch them down - then they can function.

    Question is - how can I now progress him and reduce the aching when he rests and prevent the ?EHLs from dominating the hallux position.

    Any thoughts please?
  2. Ted Dean

    Ted Dean Member

    Without seeing the foot or the insoles, I think the lateral discomfort could be either overposting on the lateral side or more likely the 1st met doesn't have enough space to drop down into and is pushing him back to the lateral side. Try a flat 1/8 addition to the base, with a submet 1 cutout extending distal to the end of the insole. However,this may make his shoes very snug.
    The ehl cramps are probably due to the fact that he needs to overuse them for clearance in swing phase. If this is the case can therapy give him more ankle dorsiflexion, if not a shoe with higher heel height and greater forefoot rocker will give him more clearance and lower the demands on the ehls for clearance.
  3. efuller

    efuller MVP

    I'd agree with the over posting comment. A possible explanation of the cocked up hallux is increased FHL use to incease medial load to offset the too high load. Ask the patient to stand and evert their foot without moving their leg and look at the height off of the ground along the 5th metatarsal. Is the forefoot valgus wedge higher than that height? I've made too big of a wedge before and have seen the lateral forefoot ache.


    Eric Fuller
  4. moe

    moe Active Member

    What is the STJ axis in the transverse plane position? On rest can you see his peroneal brevis tendon? Anterior talus (in talo-crural) and distal fibula tender?
    Last edited: Jun 29, 2007

Share This Page