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Forefoot stability test

Discussion in 'General Issues and Discussion Forum' started by Herdy, Jun 11, 2008.

  1. Herdy

    Herdy Welcome New Poster


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    G'day,

    was wondering if anyone could explain the forefoot stability test and implications of findings of the test on orthotic prescription?

    any help would be greatly appreciated

    cheers
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Your email is still sitting in my inbox! (the inbox is overflowing at the moment). I was going to reply and then start a thread here on it (see my mention here)!

    The 'Forefoot Stability Test' was first described to me by Charlie Baycroft and my initial reaction was to dismiss it as being over simplified and it 'can't be that easy'. But for a number of reasons we did play with it at one of our Boot Camps, and it predicted the forefoot posting that everyone had on their orthotics (of those that had orthotics), so prompted a closer look at it.

    The test involves having the patient/subject/whatever stand and then raise up on to their toes. Form the front observe the initial direction the the dorsal midfoot area heads in. As they come up the dorsal midfoot either goes medially, straight up or laterally.

    Charlie does advocate doing the test a bit differently:
    There is no doubt when you do this test, there are differences between people. It then comes down to what do these differences mean for function and mean for foot orthotic prescribing? (see my comments in the thread on the lateral forefoot elevation test for the role of a theoretical interpretation of a clinical test).

    How to interpret the test?:
    - could be a relfection of Bojsen mollors high gear low gear concept (a theoretical framework that is not accpeted by everyone)
    - could be due to the timely of windlass onset (immediate vs delayed)
    - could be something else

    How to use it to make orthotic descions: It has to be used in the context of other clinical tests, but the assumption is that orthotic prescription variables are used to modify what the test is showing, depending on how you want to theoretically interpret it.

    Charlies comment in the quote above "The device should improve forefoot stability and reduce the tendancy to inversion" - can probably be interpreted as being "reduce the tendency to use Bojsen-Mollors low gear axis during propulsion" (if you accept what BM is saying)
     
  3. Dhonuill

    Dhonuill Member

    Hi there, I'm wondering if my, rather subjective, 'test' would be relevant to this discussion?

    I ask patients to stand with feet evenly weighted and toes elevated in windlass, then ask them to focus on three specific parts - the heels (bearing approx 90% body weight), the 1st metatarsophalangeal joints (bearing approx 5% body weight) and the 5th metatarsophalangeal joints (remaining 5% body weight), thus forming the feet into what I call a "tripod". In observing how easily the patient can achieve the task, or otherwise, I investigate varus/valgus deformities further.

    I have two questions arising from this, then: (1) would you agree that an 'ideal' foot would be able to achieve this tripod, with STJ in NP and the 1st & 5th MPHJs equally weighted and, if so (2) would you regard this test as being a legitimate, albeit subjective, indicator that further frontal plane assessment is warranted?

    Fergus Paton, C. Ped
     
  4. Bruce Williams

    Bruce Williams Well-Known Member

    Craig;

    thanks for the explanation. I do have some other questions though.

    For me, when I see a patient invert the forefoot, I would tend to utilize a Forefoot valgus posting device of some sort. I would also interpret this as potentially avoiding the 1st mpj due to FnHL, of course!

    Stable neutral heel lift would tend to need very little posting of the forefoot I would think.

    What about medial deviation? I'm not sure if I have ever seen that,or if I have I did not fully recognize it. What would be the cause and the potential treatment?
    If the patient has PTTD they will be unable to get the heel to rise. Same with the peroneals, and you would expect to the foot to lateralize due to increased firing of Tib Ant and Post.

    I curious as to your response.
    Cheers
    Bruce
     
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