gDay
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I recently attended a Danenberg presentation which was both highly informative and interesting. At this conference there were a couple of topics that challenged my understanding of treating different conditions.
1. Dr Danenberg advocated the use of 1st ray cut outs and Reverse Mortons extensions in cases of Hallux Rigidus and Limitus. Traditionally I have used Mortons extensions with those pts who have less than 35 deg of pain free motion. My thinking was that you couldnt get blood from a stone, so if the Motion was not physically present then trying to enhance it was futile, and you couldnt reverse O/A changes which were the result of chronic 1st MPJ disfunction issues.
I beleive the point made by Dr Danenberg (and I hope I am not misrepresenting his views) was that if you promoted proper 1st MPJ function then over time boney remodelling could take place to allow (if not normal) functional 1st MPJ motion. Dr Danenberg also highlighted the fact that to date there is no evidenced based outcome studies supporting either treatment rational which is pretty ordinary for our proffession considering we treat it on such a regular basis.
2. Of perhaps most concern (and I know its been discussed here previously) is the ascertion that many Podiatrists (myself included) are perhaps doing more harm than good by some putting patients in2 rigid custom orthotics that may weaken the intrinsic musculature of the feet (please refrain from using PTTD and Rigid F/F Varus as exceptions Cuase I already know they are exceptions).
I look forward to hearing your views, especially on the 1st point.
MrT
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