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My (20 years old) patient is overloading on both 5th MTPJs, with slight callous. Her feet are mobile (almost hypermobile) and I cannot see any obvious structural or functional abnormality. There is no sign of rear foot inversion or eversion, but I am inexperienced when it comes to assessing fore foot to rear foot relationship. I wondered whether to try a pre-made 3/4 length orthotic like the Vasyli blue custom (4 degrees medial rear foot post) and adding a 4 degrees valgus fore foot post to try to lift the 5th MTPJ and get the 1st MTPJ to take more loading? I am just returning to practice and biomechanics is new to me in terms of hands on clinical practice. Any advice welcomed!

 

There are two types of feet that can have high pressures on the fifth metatarsal head. One is the oversupinator type foot (laterally positioned STJ axis). This foot supinates very easily and needs high pressure on the fifth met head to prevent rolling into inversion.

The other foot type that tends to have high pressures beneath the 5th met head is the foot that runs out of eversion range of motion before the medial forefoot bears significant amounts of weight. In classic Root et al terminology this is a partially compensated varus.

These two feet need to be treated differently. One way to tell the difference between these two feet is the maximum eversion height test. In google type <podiatry arena: maximum eversion height> There is a thread that describes the test.

Let me know if you have any questions about this.
Eric

 

Hi Eric

Thanks so much for this. I will check out the maximum eversion height test as you suggest. I will also need to learn how, in practice, to test for the location of the STJ axis. I've had a go with one or two patients, but without really identifying where the axis lies!

Best regards

Andrew