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I have found by trial and error that using a soft padded topcover on orthotics (neolon, spenco) can sometimes make an orthotic prescription for functional hallux limitus (FHL) ineffective. Using naugehyde or vinyl topcovers appears to be more effective at eliminating the FHL. I often use a kinetic wedge forefoot extension, first ray cutout filled with PPT (poron). It seems to me that these padded topcovers dampen the entire foot so that the soft cutout part under the first ray is no longer that different than the harder crepe forefoot extension. ::craig:I have verified this using F-scan in shoe pressure testing. Has anyone else experienced this phenomenon? Your comments are very welcome!

Dr. Mike DeBrule

 

Mike:

Been using spenco topcovers for a quarter century now for conditions such as functional hallux limitus and haven't noted any of problems you have described above. I also use EVA, vinyl and leather topcovers, depending on the application.

 

Hey Dr Debrule

I suspect much would depend what you were sticking the topcovers onto.

Perhaps the reason for the difference in your findings and Kevins is in what lies beneath the cover.

Personally I use simples (poron / plasterzote pyramid valgus pad, varus heel wedge or poron tadpole and 3mm poron from heel to sulcus with reverse mortons cut into it) as a first line treatment for FnHl with considerable success (although obviously it depends on whats causing the fnhl

Regards
Robert

 

show us a pic Rob pretty please!

 

being a saggital guy I found that the neoprene or 1/8 puff did seem to reduce the effectiveness of the reverse mortons and first ray cut away.

Now I always add a 1/6 or 1/8 poron layer to sulcus with no poron over the first ray cut away before I add my cover.

Much better;)

regards

 

Dear Graham,

It is nice to find someone who agrees with me. I was starting to think I was dreaming this whole thing and needed to click my heels 3 times. For a hypothetical example, consider what would happen if the topcover were 2 inches thick. This would render your orthotic modifications for hallux limitus or posting etc. worthless. So, I think there has to be a happy medium for choice of material and thickness of topcover.

Mike

 

Mike,

Not an easy thing for us Saggital Plane thinkers!

 

True enough!

Had you considered joining the Tissue stressors? There's LOADS of us. And you still get to do saggital plane thinking (just only when its the cause of the problem ;))

We will also send you a badge, a monthly newsletter and a membership card. You get 10% off in Shuropody stores and you get to speak to Eric and Kevin at conferences. Its a cool club :drinks:D

Regards
Robert

 

Robert,

Thanks Robert. I am a closet tissue stress guy. Obviously biased towards saggital influences but do utilze most of the tools in the shed as required.

I first met Kevin and Eric at the Weed Seminar in 1998. Always a privalidge to talk to them and others.

Regards

 

Robert:

Graham isn't a bad guy. Just a little bald on top:rolleyes:, but his heart is in the right place.:D

I appreciate all the jabbing that Graham gives me since he is one of the few that can do so without actually being mean and personal.

One funny incident I remember is that Graham and I were lecturing together at a Canadian conference about ten years ago and I was doing a gait examination on a subject with Graham observing. I started adding felt padding to the plantar foot to demonstate the gait changes that occurred in the subject with the plantar felt padding.

Even though we were using different frames of reference by which to explain the mechanical effect of the pads I put on the bottom of the subject's feet, Graham told me that he would treat the patient very similarly using Sagittal Plane Theory. Goes to show you that we aren't always too far away from each other in what we do for our patients, no matter what theory is used to arrive at the treatment decisions.:drinks

 

Kevin,

I remember looking at this young guys' photo in the brochure and wondering what the hell happened when we met face to face:dizzy: At least the suit was the same age as the photo:drinks

regards

 

The photo from 10 years ago is now gone....the recent photo I now hand out for conferences is full of all the bald spots, grey hair and wrinkles that greet me every morning in the mirror. Where's that PhotoShop Miracle Worker when you need one!!