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Since 2004 I have initiated multiple discussions on the link between axial rotation of the talar head and instability/collapse of the ILA. The most repetitive comment, at that time, was there is no evidence to prove this link.

With the introduction of the WBCT, this has changed. In the past few years multiple publications have validated this link. The most recent appeared in Foot and Ankle Orthopaedics (Jaeyoung et al Feb 2023).

Axial rotation of the talar head is the hallmark anatomical landmark in the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot). In Europe this deformity is termed Progressive Collapsing Foot Deformity.

Anyone prescribing foot orthotics should be aware of this structural deformity and how to deal with it effectively.

• Jaeyoung K, Lavan R et al. 2023. Axial Rotation of the Talus in Progressive Collapsing Foot Deformity: A Weightbearing Computed Tomography Analysis. Foot Ankle Orthopaedics 8(1): 2473011423S000 10.1177/2473011423S00012

 

My understanding is that progressive collapsing foot deformity and adult acquired flat foot are the same thing . The aetiology of this condition is multifactorial and poor foot strength is one of these factors . Since footwear weakens the muscles of the foot it makes sense to me to strengthen these in cases where flat foot deformity is developing.

Strengthening exercises have been demonstrated, in randomized controlled trials, to help with pain reduction and function in flat feet . Indeed, strengthening exercise seem to be more effective in treating flat feet than orthotics devices.

It might be argued that people are not prepared to commit to long term exercises. I would counter that by saying that patients have a right to know about things they can do to reduce the pain in their feet.

 

For the past twenty years I have discussed this link in my research (and multiple publications). Until recently, the main recurring challenge (from my compeers) was the lack of radiographic evidence to prove this link. Now, with the availability of 3d radiographs, this link has been visualized.

The need for Podiatrists to be aware of this foot structure and how to treat it should be included, IMO, in the 4 year podiatric curriculum. It is one of the most common causes of foot pathology seen in the Podiatric practice (HV, hammertoes etc). Early treatment, using proprioceptive insoles, can prevent the need for later surgical interventions.

 

Can ill fitting footwear influence patterns of talar development in children in the same way as other aspects of foot development can be negatively impacted by shoes which are too short.

 

Possible, but not likely

 

Footwear that is too short often affects the hallux angle . If osseous relationships at distal end of the MLA are affected by short shoes in children, why not at the proximal end .

 

Outside my area of research