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Forefoot Valgus or Pronatus?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Sammo, Dec 7, 2009.

  1. Sammo

    Sammo Active Member

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    Just been thinking, which is always dangerous.. especially on a Monday. And a friday..

    We used to talk about forefoot Varus and Valgus. Then we decided that Varus was a misnomer because the forefoot wasn't fixed in that position. However, we still use the term forefoot Valgus freely.

    I just had a patient who had an everted forefoot (forefoot Valgus some would say) but it was flexible. He had some pretty free movement about the mid tarsal joint in all axes.

    Is this not then a forefoot Pronatus rather than a forefoot Valgus?

    Am I missing something?


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  2. Hi Sam.

    We still have a forefoot Varus it´s just that It is very very rare. A forefoot varus is fixed ie bone cause and a supinatus is flexiable ie soft tissue cause.

    As for your other question I will abmit Ive never heard of a forefoot Pronatus.
  3. Sammo

    Sammo Active Member

    Hi Michael,

    Thanks, I understand that a Varus is a osseous deformity of the forefoot. Maybe I wasn't clear enough in that sentence.. Squeezing pod arena in between patients and all....

    My question is we seem to be very particular with the use of the word Varus, but not valgus with regards to the forefoot. I just added the "-atus" bit of supinatus to pronation to get pronatus. I'm not even sure it is a word, but I'm using it to outline the point. The point being does forefoot "pronatus" exist (i believe it does) and if so why aren't we using it as a term (or another word with the same meaning) or are we already and it just hasn't made it to me yet?

  4. I guess It from the development of the forefoot alignment issues .

    ie varus is Bone.

    Supinatus is a muscle developement cause which then causes lengthening and shortning of ligaments ie Davis law.

    So if we look at Valgus and ´pronatus´

    Valgus a Boney/osseous cause of aligment of forefoot to rearfoot

    Pronatus would indicate that the change has been caused by soft tissue, and I´m not sure that the soft tissue can have the same effect to evert the forefoot against the rearfoot and Davis law comes into effect due to the fact that during weightbearing the GRF will cause the forefoot to invert against the rearfoot and then stretch the muscle and ligaments the other way so you can not get Davis law effects occuring.

    Unless the patient has a very lateral STJ axis and does not weightbear on the medial aspect of the forefoot.

    Hope that make sense

    Thats my 5 cents Morning here too !!
  5. Sammo

    Sammo Active Member

    Theorising wildly, and leaving it a little vague on purpose...

    A possible pathway for pronatus to develop:

    - A pt's foot develops with limited calcaneal eversion (aka laterally deviated STJ axis) due to, lets say, genetics (pt's father has a high arched foot, pt inherited that foot structure). O/e say they have 20/-5 degrees Inversion/Eversion.

    - The forefoot needs to be in a marked position of eversion for the medial column to contact the floor during gait, or put another way the medial column must plantarflex to reach the floor during gait, as there is inadequate amount of rearfoot eversion, stj pronation.

    - Perhaps there is also an element of a excessive load on the lateral column of the foot forcing the forefoot to evert around its longitudinal axis.

    - I sometimes see these patients, with the high arched foot type, where as the forefoot starts to load on the lateral column during gait, the knee internally rotates very quickly to allow the medial column to then come into contact with the floor, because there is not enough pronation/eversion available at the rearfoot.

    - This gives the high arched foot appearance, but the forefoot is still mobile. You look at the forefoot and it is in eversion relative to the rearfoot when NWB. On further examination you note that the 1st ray has very little, if any passive plantar flexion left, but plenty of dorsiflexion - effectively being at end RoM.

    - I think we call this position Valgus. Should it be Pronatus or some such similar? Anyone else seen this or has my imagination run away with me again?
  6. Sam, I have previously read the term "pronatus" in an antique text, but I could not tell you where. If I get chance I'll look through some of the older books in my collection and see if I can find it.

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