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Rearfoot valgus

Discussion in 'General Issues and Discussion Forum' started by nicholas, Sep 11, 2005.

  1. nicholas

    nicholas Member


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    My question is this, if you have a rearfoot valguswhen and by how much is it appropriate to post the rearfoot and by how many degrees. Thinking about the structural forefoot patho;ogies that arise from this foot type it would seem that the earleir the intervention ther more chance of reducing the chance of future structural pathology developing. Obviuosly great caution would be taken when attempting to bring about functional changes with consideration to the affect that bring about these changes would have on other areas of the kinetic chain.

    So my question is,
    1. would supplying rearfoot posting to a young person with rearfoot valgus be appropriate as this would reduce the pronation they would experience, and therefore the destructive forces occuring in the forefoot .
    2. If it is approppriate to post the rearfoot, then by how much. If, say the neutral calcaneal stance was 10 degrees valgus and 15 degrees relaxed stance, then would you post the rearfoot to 10 degtrees and thereby have the sub talar joint in the neutral positiion when in relaxed stance. this would, of course, reduce the degree of pronation but would this be enough to reduce the forces acting upon the forefoot enough to prevent pathological changes. And, if not then would it be appropriate to post the fearfoot to, for example neutral. And my quesation is , would this be the right thing to do, or would the result of doing this result in a foot that no longer overpronated but as a result of the degree of posting required to do this would result in a sub talar joint that was excessively inverted in relaxed stance and therefore laterally unstable.
     
  2. nicholas

    nicholas Member

    i said would it be appropriate to post the rearfoot to neutral, what I meant was post it to vertical and therefore cause it to sit 10 degrees inverted in relaxed stance and therefore lasteral instability.
     
  3. nicholas

    nicholas Member

    Is there any one out there that can give me an answer to my question. The previous thread is a correction of a mistake that I made in the 1st thread.

    Please will one of you great omnipotent podiatrists out there give me some advice to my humble question. It may seem like a simple or even obvious question but I am new to this game and therefore still prone to asking silly questions.
    Your advice would be well appreciated. Nick
     
  4. Craig Payne

    Craig Payne Moderator

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    I have never seen a rearfoot valgus.

    However, I would imagine that the foot is completely flat WITHOUT any compensatory motion, so not sure if you would even want to post it.

    However, are we talking about the same thing? The tradtional defn of a rearfoot valgus is when the frontal plane posterior bisection of the calc is everted relative to the posterior bisection of the lower third of the leg when the STJ is in its neutral position (ie the uncompensated postion). A lot of literature talks about rearfoot valgus as the rearfoot being everted during stance (ie the compensated position) - they both very different beasts.
     
    Last edited: Sep 14, 2005
  5. nicholas

    nicholas Member

    Yes I mean the tradfitional version. Therefore if you( hypothetically speaking)had a rearfoot that was 10 degrees valgus when in NCSP and 15 degrees valgus when in RCSP then would it be appropriate to medially post the calcaneum up to 10 degrees so as to reduce the pronation by 5 degfrees even though this would result in a RCSP that was sitting in neutral. Furthermore, would it be right to post the rearfoot even further than this, to vertical for example( this was my original question) as this would reduce the pronation even further even though this would in effect place the STJ in a varus position when in relaxed stance and lead to lateral ankle instability.
     
  6. Craig Payne

    Craig Payne Moderator

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    6
    Theoretically and traditionally, you should always post the rearfoot to hold the STJ in it defined neutral position - ie NCSP. So, in your eg post it to 10 degrees valgus.

    However we now know that NCSP/STJ neutral is not the ideal position for a foot to be posted at (and foot orthoses posted to do that never did it anyway)
     
  7. Felicity Prentice

    Felicity Prentice Active Member

    I have seen REALLY everted rearfoot positioning in people with advanced rheumatoid arthritis - to the extent that you could almost call it rearfoot valgus. But this is due to destruction of articular congruity, and actual loss of articular surfaces and pathology of periarticular structures. In any event, posting to a valgus position would not be helpful.

    It is a wee bit dogmatic along the Root/Orien/Weed credo to adhere to rigid definitions of where the STJ 'should' be - especially in light of the interesting and confusing new findings in research regarding orthoses and what they actually acheieve. If someone appeared to have a naturally everted rearfoot, then I would be inclined to go gently, and consider what effects this rearfoot position is having on other joints and surrounding soft tissues. You may find a softer EVA type device more helpful - in which case posting by degrees is usually not as fundamental.

    Just my thoughts, and sadly anecdotal at that.

    cheers,

    Felicity
     
  8. Craig Payne

    Craig Payne Moderator

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    I said
    Felicity said
    You are right...I have probably seen a few of those.
     
  9. Mark Egan

    Mark Egan Active Member

    Nicholas

    I am not sure if this is along what you are asking. But I feel theory is just that theory each case should be assessed on individual merits so a person with a RF VL as you have described might not be able to tolerate the perfect NCSP or is unwilling to wear the shoes that would be needed to apply the neccessary control or they might. As a podiatrist lecturer I had at QUT (Phil Perlmann) used to often say "don't forget that the foot is connected to the body" so the functionality of the whole system i.e. body needs to be looked at when deciding on Rx options such as orthotics. I also find discussing with the patient what they do activity wise and what they wish to achieve points me into Rx options, as does temporary measures such as padding and strapping before the $ of orthotics.

    With all this said using the theories eg. Root etc at least give you a starting point to trial.

    Regards
     
  10. mazzoncini

    mazzoncini Member

    Just thought I'd add a few thoughts. Most hindfoot valgus pathologies in children are caused by a generalized ligament laxity problems, and the structural HF VL pathology is increased when compensating by this very factor. Therefore when treating children you can be a little more aggressive in your hindfoot correction with the use of eg. A Kirby skive, but always using a deep heelcup. In the elderly patient that presents with a arthropathy which causes hindfoot valgus deformity eg. RA, OA, I would rather use an accommodative orthotic and not a Root device which tries to maintain STJ neutral.

    Overcorrecting HF VL is generally dangerous because of lack of STJ natural pronation in shock absorption can lead to various other knee and lower back problems which is best avoided. In sports activities where high impact is of primary concern, once again over correcting HF VL is also not recommended.

    Hope to have helped you in some way.

    Regards
     
  11. Craig Payne

    Craig Payne Moderator

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    Just to avoid any confusion:
    You are talking about a hindfoot valgus in its compensated position. The original question in this thread was about the rearfoot being in valgus in its STJ neutral position.
     
  12. mazzoncini

    mazzoncini Member

    Dear Craig the point I was trying to make was that when compensation occurs in HF VL in children the compensated position of the STJ goes well over the normal ROM limits due to ligamentous laxity and therefore more aggressive correction under the medial tuberosity of the calcaneum can be well tolerated without causing any further forefoot pathologies. What I would like to also point out is that the 2:1 inversion:eversion ratio that we use to calculate NCSP isn't always applicable as Kevin Kirby has clearly outlined in some of his papers. So, HF posting to maintain the NCSP isn't necessarily a functional solution. One needs to assess each case individually and be flexible when making orthoses for children.

    Hope to have cleared any misunderstadings.

    Regards
     
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