Forefoot Varum, a Theoretical Construct

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Forefoot Varum is a theoretical construct based on a hypothesis rather than physical reality or a proven fact. An acquired soft-tissue adaptation may lead the novice to believe he is dealing with a Forefoot Varum deformity. However, skeletal studies have proven that a true bony forefoot varum does not exist embryologically.

Unfortunately, traditional clinical measurements are skewed by casting techniques or underlying soft-tissue adaptation.

When will Forefoot Varum be finally put to rest on this forum?

Rothbart BA 2025. Foot Embryology, pdf conference presentation

 

Root's Biomechanical model, which he introduced nearly 80 years ago, was a very important stepping stone in our understanding of foot function. Before his work, the field of foot biomechanics did not exist in Podiatry. He is the father of Podiatric Biomechanics.

But embryological research, specifically on the human foot, has proven his theoretical foot constructs to be flawed. However, this does not attenuate the importance nor brilliance of his work.

 

Rothbarts Foot and Root's forefoot varum are not the same foot structure.

Forefoot Varum

Root defined forefoot varum as a structural inversion of all 5 metatarsals and associated phalanges. The slope of the inversion is medial (highest) to lateral (lowest).

Rothbarts Foot

Rothbarts Foot is defined as a structural inversion (supinatus) of the entire medial column of the foot, which includes not only the 1st metatarsal, but also:

• The Talar head and surgical neck
• The navicular,
• The internal cuneiform,

Root's forefoot varum does not encompass the talus, the navicular, or the internal cuneiform.

It is beyond my understanding how one might think they are both the same structure.

 

Clinicians adhering to the Foot Neurophysiological Postural Model (FNPM), it is paramount that the morphology (shape) of the foot is fully understood. Without this understanding, the clinician would not know where to apply the plantar sensory inputs. It is these sensory inputs that are relayed to the Cerebellum where the posture is adjusted. If the foot's sensory inputs are correct, the posture is globally improved. If the foot's sensory inputs are incorrect, the posture is globally worsened.

For example, a patient with Rothbarts Foot:

• The clinician diagnoses this foot structure as Rearfoot Valgum (a theoretical foot structure that does not exist). He placed medial wedges underneath the heel bones to support the posture (e.g., following the protocols of the Foot Biomechanical Postural Model). Posture deteriorates.

• The clinician diagnoses this foot structure as Rothbarts Foot. He placed the sensory inputs along the medial column of the feet (e.g., following the protocols of the Foot Neurophysiological Postural Model). Posture Improves.