Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

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


    Members do not see these Ads. Sign Up.
    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:
    8
    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.
     
  11. Eliane Perseval

    Eliane Perseval Welcome New Poster

    Hi Craig,
    I am currently following your biomechanic bootcamp and reaching the forefoot varus there is something I don't quite get :
    Taking for granted it is a varus, so fixed and bony, we have to apply a medial forefoot wedge to get the floor to meet the 1st met head and avoid the rearfoot to compensate in valgus. What I don't understand is why we should use a rigid orthotic device, which ultimately would inverts the rear foot?
    If the varus is measured with the subtalar joint in neutral, why would we need to bring the mid and rear foot into varus along with the forefoot? A flexible orthotic would seem to make the job and support the forefoot while keeping the rearfoot in neutral so I really cannot pinpoint what I missed in your explanation.
     
  12. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    A flexible orthotic with a forefoot varus post will just dorsiflex the first ray and invert the forefoot on the rearfoot and probably have no effect the rearfoot.
     
  13. efuller

    efuller MVP

    A different way of looking at things. What is this foot's problem. A forefoot varus (or a rearfoot varus) that, in stance, does not have enough eversion range of motion to fully load the medial forefoot, will tend to have the problem of very high loads under the lateral foot and/or sinus tarsi pain. It is hard to predict what problems a varus foot will have when it does have enough range of motion to fully load the medial forefoot.

    How to tell if you have a partially compensated varus foot (not fully loaded medial forefoot): Have the patient stand and put your fingers under their medial arch and move your fingers out toward their first toe. If you can get your fingers under their first met head (without the patient using their muscles to invert their foot) then they will need a forefoot varus wedge under the forefoot. A device that ends behind the metatarsal heads cannot do this. Also, you can attempt to get your fingers under the 5th metatarsal head. In the partially compensated varus foot, you will not be able to get your fingers under the fifth met head. If you do, your fingers will hurt because there is so much force on them.

    In the foot where there is not enough force on the first met head, you want to put more force their. In feet where there is too much force on the first met head, you want to put the force somewhere else.
     
  14. Eliane Perseval

    Eliane Perseval Welcome New Poster

    Thanks for your answer Craig,
    It is going down do what I don't understand : Why do you want to have an effect on the rear foot?
    If I take an hypothetical case where the only issue would be the forefoot varus, therefore the mid foot would be too fixed to correct and will naturally be in a dorsiflexed position. Then the rear foot would be inverted by such a rigid orthotics. If my aim is be to keep the STJ in a neutral position it would fail it's purpose, wouldn't it?
     
Loading...

Share This Page