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new to forefoot valgus posting

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Art likoff, Mar 13, 2019.

  1. Art likoff

    Art likoff Welcome New Poster


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    I feel like I have just woken up after being asleep for years. I do not understand how forefoot varus has become forefoot valgus. I have just taken a suspension cast and measured a 4 degree forefoot varus. And yet i read that your readers haven't seen a forefoot varus in years. I have Bruce Williams blogs on using valgus posting but I do not understand the valgus concept he refers to.
    I am thinking that with my 4 degree varus ,maybe you are posting four degrees on the lateral column in a valgus post to negate the varus. Can that be right?
    Please help my get up to speed
    Arthur Lukoff
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    7
    Yep; forefoot varus only makes up 1-2% of foot types.

    I use way more valgus or lateral forefoot posting than medial.
     
  3. Art likoff

    Art likoff Welcome New Poster

     
  4. Art likoff

    Art likoff Welcome New Poster

     
  5. Art likoff

    Art likoff Welcome New Poster

    I have been to Howard Dananbergs office multiple times before he retired to Vermont and had my first ankle adjustment and cuboid adjustment from Bruce Williams. At that time neither on of those Podiatrists were using valgus posting.
    this is not what I was taught by Drs Langer or Schuster.
    Can you point me in the right direction to the rational why and how Valgus posting works.
    Thanks for you consideration
    Dr Arthur Lukoff
     
  6. efuller

    efuller MVP

    Hi Arthur,
    Folks are beginning to question the idea that a non weight bearing measurement, with the foot in a position that is not the same position that is in when it is weight bearing, is not the best way to decide what modifications to put into an orthosis prescription.
    I wrote a piece for podiatry today on which measurements I believed should go into making decisions for an orthosis prescription.

    https://www.podiatrytoday.com/guide-orthotic-prescription-writing-tissue-stress-theory-approach

    Much of what is in that article has been discussed here on the arena.
     
  7. efuller

    efuller MVP

    A lot of the rationale can be found in a paper by Kogler. He looked at tension in the plantar fascia in cadaver feet with and without wedges. There was a reduction in the tension in the plantar fascia with a valgus forefoot wedge. For a theoretical explanation of why tension in the plantar fascia is important see my windlass paper.

    J Am Podiatr Med Assoc. 2000 Jan;90(1):35-46.
     
  8. efuller

    efuller MVP

    A valgus forefoot post is similar to Dannanberg's kinetic wedge in how it works. His explanation is different, but he did use something like a valgus wedge.
     
  9. Freeman Churchill

    Freeman Churchill Welcome New Poster

    My understanding ( please correct me if I am wrong ) is that by posting the forefoot in varus, when there is not an osseous forefoot varus, is that you simply invert forefoot and increase the midfoot forefoot instability. By pronating the forefoot relative to the mid and rearfoot, creates stability, and decreases the lengthening/lowering of the plantar fascia and medial arch complex. That is as simplified as I can put it. Increasing the mechanical advantage of the peroneous Longus, hence stabilizing first ray may be a big part of it.
     
  10. efuller

    efuller MVP

    Midfoot stability is not a defined term. How would you measure it?

    If you are using a classic forefoot varus post, there is an internal inconsistency. There should always be "instability" with a forefoot varus post regardless of whether or not the foot has a forefoot varus. The classic post supports the foot behind the metatarsal heads. After heel lift there is no more support. The forefoot varus post is supposed to support the foot with the metatarsal off of the ground. This inconsistency is one of the many reasons I don't like to use forefoot to rearfoot measurement as a guide to what I do with my prescriptions for orthoses.

    The peroneus longus muscle is a pronator of the STJ. If a valgus wedge puts the STJ and midtarsal joint at end of range of motion of pronation, then the peroneal muscles cannot pronate the STJ further. When the peroneus longus muscle contracts it will simultaneously, create a plantar flexion moment on the first ray and a pronation moment at the STJ. Whether or not a joint will move depends on the net moment at the joint. The peroneal muscle is just one source of moment at both of those joints.
     
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