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Dudley Mortons Toe (and love of money) the root of all Evil

Discussion in 'Biomechanics, Sports and Foot orthoses' started by ka5djh, Jul 9, 2009.

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  1. ka5djh

    ka5djh Member


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    Pathology of the 1st metartarsal bone

    {ADMIN NOTE: I Have merged two threads here as there were parallel discussions going on. Sorry if this thread is a bit disjointed}

    I have been taken to task by some about my absolute feeling that the Dudley Mortons Toe (short 1st or hypermobile 1st) is the major cause of alot of foot problems. I stand ready to start a spirted discussion to help you, help your patients learn about this.

    But in the morning please check any 10 charts of yours at random to see what % o f your patients have a short 1st or hypermobile first.
    I am looking foreward to a interesting discussion

    P.S. I have been a DPM for 34 years and have treated about 25,000 people

    Dr. Burton S. Schuler
    Panama City, FL
     
    Last edited by a moderator: Jul 13, 2009
  2. twirly

    twirly Well-Known Member

    Re: Pathology of the 1st metartarsal bone

    Hello ka5djh,

    :welcome: to Podiatry Arena.

    :good:

    http://www.mortonstoe.com/mortonsfoot.html

    If you do not receive replies to your question in the Introductions area of the forum please consider reposting again i the General Issues & Discussions section. Not all of our members view introductions regularly & the intro' posts do not apear on the home page as other posts do. Many thanks.

    Kind regards,

    Mandy.
     
    Last edited: Jul 9, 2009
  3. I have been taken to task by some about my absolute feeling that the Dudley Mortons Toe (short 1st or hypermobile 1st) is the major cause of alot of foot problems. I stand ready to start a spirted discussion to help you, help your patients learn about this.

    But in the morning please check any 10 charts of yours at random to see what % o f your patients have a short 1st or hypermobile first.
    I am looking foreward to a interesting discussion

    P.S. I have been a DPM for 34 years and have treated about 25,000 people

    Dr. Burton S. Schuler
    Panama City, FL
     
  4. I'll start.

    You said.

    Leave alone the short 1sts, Lets say ALL my patients had a hypermobile first ray. Does that indicate:-

    1. That they are patients (have a pathology) because they have a hypermobile first.

    2. They have a hypermobile 1st because they have some form of other pathology.

    3. Neither of the above

    There are two reasons I would "take you to task." One is that you presume causality from correlation. The other is that unless you can offer a demographic cross sectional study you may be simply observing the conjugation heuristic.

    Look forward to that debate :drinks:boxing:.

    Robert
     
  5. Dr. Burton S. Schuler of Panama City, FL

    Maybe you should explain what you have written in your book in a short, scientific manner stating research that you have done to back up your ideas so those who have not read your book understand where you are comming from.

    Michael Weber
     
  6. Griff

    Griff Moderator

    Dear Dr Schuler,

    I bet you have.

    This should be fun.

    Just a heads up... you just might want to take a little squizz over some of these threads regarding "hypermobility" before Dr Kirby comes along...

    Good luck

    Ian
     
  7. ka5djh

    ka5djh Member

    Re: Pathology of the 1st metartarsal bone

    thanks mandy
     
  8. Griff

    Griff Moderator

    Taken from http://whyyoureallyhurt.com/

    Erm...I think we can work that one out Dr... and just how do you patent a piece of felt and 2 bits of tape??
     

    Attached Files:

  9. DaVinci

    DaVinci Well-Known Member

    Snake Oil. This has shades of Rothbart!
     
    Last edited by a moderator: Jul 9, 2009
  10. Griff

    Griff Moderator

    Re: Pathology of the 1st metartarsal bone

    Nice hyperlinks Mandy ;)
     
  11. Oh Lor', I'd not seen the website.

    Some gems.

    Including the jaw. Shades of Rothbart indeed.

    Well thats that cleared up then.

    Damn that pronation.

    Oh very dear.

    Does anyone else get the idea that more than a few of these things, (Rothbart, Glaser, this,) are just rehashes of old concepts which have since been superceeded? Its almost like somebody who has heard of cars, but never seen one, gets a good look at a model T Ford, gets excited at how much less poo it creates, and how much faster it is than his horse, then rushes out to tell all his mates (who are already driving in ford Mondeo's) how great this exciting new thing is!

    And there I thought this was something new!:mad:
    :sinking:

    Regards
    Robert
     
  12. Enough of this cruel, unsupported barracking. Lets get down to specifics.

    Dr Schuler.

    You Said
    How would you suggest we reconcile this with research like this

    Which show the opposite?

    Regards
    Robert
     
  13. Dr Schuler

    You said:-

    How do the muscles of the lower leg "work against" the muscles of the head and neck?

    How was the figure of 30% improvement arrived at? Or is it a guess?

    Regards
    Robert
     
  14. Dr Schuler

    You state that a 1st ray which is hypermobile, and therefore dorsiflexes under GRF, is a bad thing (in fact THE bad thing).

    You further state

    Do you feel that this hypermobility can be aquired in adulthood or is Davis Law incorrect?

    If we accept that davis Law (and Wolf's Law) IS correct and that bone and ligament will stretch / change according to forces acting upon do you see a problem in treating a condition caused by a hyperextendable 1st ray with a device which will increase dorsiflexion moments in that very structure?

    In other words, if the problem with the first ray is that it is too dorsiflexed (or able to me too dorsiflexed), should we be seeking to dorsiflex it MORE?

    Regards
    Robert
     
  15. Dr Schuler

    You speak of plantar fascitis.

    Will dorsiflexing the 1st metatarsal with a toe pad (as you advocate)

    A: Increase, or

    B: Decrease

    The tension in the Plantar fascia (specifically the medial slip of the planter apeurneurosis) after the heel lifts and the windlass mechanism comes into force.

    Regards
    Robert
     
  16. Dr Schuler

    You advocate the use of the toe pad (to dorsiflex the 1st metatarsal) for a wide variety of pathology including 1st MPJ problems.

    Do you feel that dorsiflexing the 1st toe will

    A: Increase, or

    B: Decrease

    Internal planterflexion moments at the 1st MPJ during gait. And if A ; (a clue, Check out the work of a bloke called Howard) do you think this might increase interosseus trauma and predicate Function Hallux Limitus.

    Regards
    Robert
     
  17. Dr Schuler

    You said:-
    I'll admit to being confused here. I understand the concept that a hypermobile or short 1st metatarsal might reduce a substantial portion of Ground reaction force medial to the Sub talar axis. This might reduce supination moments across the STJ and the "abnormal pronation" you speak of might ensue.

    However I don't understand how, if Mortons toe refers to a long SECOND toe Rather than a short FIRST toe, how this will be. How can a problem with a long second toe be defined entirely by the length / behaviour of the first?

    In a nutshell, is Mortons toe (or mortons foot syndrome if you prefer) caused by a long second toe or a short / hypermobile first?

    Regards
    Robert
     
  18. Dr Schuler

    One chapter of your book is entitled:

    Would you mind elaborating on that, with particular reference to the literature on orthotics which shows resolution rates around 65% and improvement rates over 80%?

    Do you have any such literature to show that the toe pad DOES work?

    Regards
    Robert
     
  19. Dr Schuler

    You said

    Would you say that mortons toe (by your definition of the second toe being longer than the first) exists in

    A: A minority of feet

    B: About half of feet

    C: The majority of feet

    D: The Vast majority of feet.

    If you answer C or D, that mortons toe is present in the majority of feet, do you feel this might explain the fact that it appears in the majority of feet WITH HEEL SPURS.

    Or, if A or B Is it really so much of a big deal?

    Regards
    Robert
     
  20. Dr schuler

    You said

    Given the research which shows that Pre fabricated orthotics can acheive real improvement in assorted foo pathology do you feel that these claims are truly fraudulent?

    Do you feel your generalisation of people selling them is accurate?

    Regards
    Robert
     
  21. Dr Schuler

    You said

    Do you feel it appropriate that you are telling the reader (ie anyone who has felt wonderful with insoles) that their problem is in fact, mortons toe? Do you now contend that 100% of foot pain is caused by this?

    Regards
    Robert
     
  22. Dr Schuler

    You said:

    Do you therefore further contend that, in all cases, a 1st met shaft pad will "stop the arch from falling"?

    Regards
    Robert
     
  23. Dr Schuler

    You said

    Is this a fair (nay ethical) statement or is it a tad misleading? Have their been other "experts in the human foot" who came AFTER Morton who thought that their might be something to this whole orthotics idea after all?

    Regards
    Robert
     
  24. Dr Schules

    You said

    Why do you use orthotics when

    Regards
    Robert
     
  25. Professor Payne

    I said

    Am I banned :eek:

    Ok I'll stop now. That should start us off. Dr Schuler, your replies. Take your time. One at a time is probably best.

    Regards
    Robert
     
  26. Robert:

    A little too much caffeine this evening??:rolleyes:
     

    Attached Files:

  27. Robert's making a run for top-poster spot. :dizzy:
     
  28. twirly

    twirly Well-Known Member

    Re: Pathology of the 1st metartarsal bone

    Many thanks Ian :D

    A very nice man helped me ;)

    :drinks

    Grasshopper.
     
  29. Griff

    Griff Moderator

    Dr Schuler,

    You said

    Regretting it yet?? Get involved in the fun and we promise we'll keep Robert on his leash... for now...
     
  30. twirly

    twirly Well-Known Member

    I can see it now..................... Presenting Mr Robert Isaacs MVP

    <Most Vexed Podiatrist>

    Very good reading.

    Thank you Robert :good:
     
  31. Jeez - give the man a chance. I want to hear what he says about infertility! :empathy:
     

    Attached Files:

  32. [​IMG]
     
  33. drsarbes

    drsarbes Well-Known Member

    OK
    I did a cursory review of the first few patients I saw yesterday afternoon:
    One Charcot arhtropathy, two warts, two fracture rechecks (one with all 5 mets fractured, one with spiral oblique 5th met), three heel spurs/fasciitis, one tarsal tunnel, two post op bunionectomy, one post op achilles repair/exostectomy, two pyogenic paronychias, one post op tibial sesamoid excision, one post op peroneal tendon repair, one post op MBA STJ arthroreisis, one fibular fracture check, and a post op joint replacement 1st MTPJ.

    I don't think any of them had any Dx where the underlying etiology was a hypermobile or short first ray.
    MAYBE the joint replacement, although it was unilateral and he has normal function on the left. We assumed it was post traumatic.

    Steve
     
  34. DR Schuler

    You answered Ian in another thread, but I FEEL that you seem to be talking down in your posts almost how a adult would talk to a child who does not understand something which you see as simple.

    I dont care how many patients you have seen or how long you have been a DPM. We are all professional people who come together to discuss foot related problems.

    I would like some science behind some of your claims You can see above that you have many questions to answer to show us with the science behind your ideas, but comming out with sweeping statments will not cut the mustard.

    Most people here have moved on from Root mechanics as the science behind them is flawed.

    Michael Weber
     
    Last edited: Jul 10, 2009
  35. srd

    srd Active Member

    Re: Pathology of the 1st metartarsal bone

    I am looking forward to seeing replies to this thread. I have a R/1st short met myself and had developed a reasonable dorsal exostosis of the 1st met cunieform joint while I was still wearing school shoes. I still can't tolerate laces.
    SRD
     
  36. ka5djh

    ka5djh Member

    Re: Pathology of the 1st metartarsal bone

    It is very simple . If you have a Morton's Toe your foot will pronate. Until you control this problem you can get any problem associated with the foot, including dorsal exostosis of the 1st met cunieform

    good luck Dr. Burton S. Schuler,
     
  37. Griff

    Griff Moderator

    Re: Pathology of the 1st metartarsal bone

    However what isn't proving simple is to actually engage you in a conversation/discussion which you said you came here for. Or maybe even get you to answer some questions.

    Please go to the following threads and actually contribute to the discussion and answer the questions Dr Schuler:

    Dudley Mortons Toe (and love of money) the root of all Evil
    No 1 Best seller

    Thank you

    Ian
     
  38. ka5djh

    ka5djh Member

    Michael
    I agree Root is flawed, Before root there was Dudley Morton

    The science behind dudley morton work is the following
    1. Two Journal articles from 1927 and 28, Jounral of bone and Joint Surgery (google them)
    2. The Human Foot 1935 Columbia University Press
    3. Human Locomotion 1952 Wilkens and Wilkens (also reprinted in UK same year)

    If you need more let me know. But this is a good place to start

    Just because something os OLD, doesn't mean it is not true.

    I have nothing to prove, I am just the messenger, the work of Dudley Morton MD stands on its on.
     
  39. ka5djh

    ka5djh Member

    Re: Pathology of the 1st metartarsal bone

    Here is some of the science, Morton wrote many more articles abou t the foot and how it works between the 1920-1950's

    Morton, Dudley J. The Human Foot, its evolution, physiology and functional disorder. New York: Columbia University Press, 1935.

    MET Morton, Dudley J. Metatarsus Atavicus: The Identification Of A Distinctive Type Of Foot Disorder, J. Bone Joint Surg. Am 9: 531 – 544, 1927.


    Morton, Dudley J., Fuller, Dudley D. Human Locomotion and Body Form; a Study of Gravity and Man, Baltimore: Williams & Wilkins, 1952.
     
  40. And before Morton there was? And after Root there was? Neither of these two individuals are the be all and end all. Personally, I am reasonably familiar with the publications of Morton. Could you tell me the sum total of the number of subjects he reported data from in these published studies?

    Could you point us to some "modern" research that supports the conjectures of this undoubted scholar?

    Nor does it mean that it is TRUE.

    Personally, I have few problems with Morton's theories, but I don't think that understanding foot pathology either begins or ends with his work. We've learnt a great deal about the foot since the first half of the last century. Morton's extensions have their place, as do reverse Morton's extensions, as do the all of the prescription variables in the great palette of foot orthoses designs, but I wouldn't prescribe the same orthosis, with the same modification for every cockatoo that knocks on my door- would you? In my experience a Morton's extension on it's own, i.e. the felt shaft pad in the picture posted previously in this thread, does little to help someone with PT dysfunction or for that matter, many , many of the complaints my patients present with.
     
    Last edited: Jul 12, 2009
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