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  1. srd Active Member


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    Hi,
    I was talking to a collegue the other day about using a first ray cut out. He said he had heard that there was a way to test for whether a small cutout (ie just medial anterior border) or a full ray cut out (ie. length of the 1st metatarsal) would be indicated. I had not heard this before and he could't remember details. Has anyone got any info on this??
    Thanks Susan
     
  2. Craig Payne Moderator

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    Re: First ray cut out

    AFAIK, this is just a hypothesis that has not been tested, but I do use it clinically...

    When you do the FnHL test (will stick with the old terminology for this thread!), you usually load the hallux and the first met head. If the test is positive for FnHL, what you can try is to start sliding the thumb that is on the met head proximally along down the first met shaft and keep repeating the FnHL test .... at some point, the first MPJ suddenly gives way .... the hypothesis is that this is where the first ray cut out should go, as that is where the edge of the orthotic has to go to get the first MPJ working.

    The validity of this has not been tested; but it does make theoretical sense .... at the end of the day, when you do this test, there is a wide variation between those who are positive to the test for FnHL in the position of the thumb on the first met shaft in which the first MPJ suddenly 'gives way' .... that has to mean something ???
     
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  4. Bruce Williams Well-Known Member

    Susan;

    I don't know if I originated this test or not, but everyone I've ever shown it to seems to have never seen it before. I jokingly call it the "Williams Test". :rolleyes:

    Craig described it very well. I just load the 1st met adn test the extension resistance of the hallux and then continue to move proximally under the 1st met, along the PF / Long Flexor band, until there is little to no DFion resistance of the hallux. At this point I will make a mark and in a hard plastic device, this is where I will start my 1st Ray Cut Out.

    Anecdotally, it seems to correlate well in relation to medial arch height. This means the lower the medial arch, the farther back the c/o needs to go, in most cases.

    I think I originally showed this to Craig in Australia 3 years ago. If someone knows of this being done before and has taught it to others I will stop taking credit for it!
    Bruce
     
  5. Craig Payne Moderator

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    Yes. I should have given you credit for it - I usually do when I talk about it.
     
  6. Bruce Williams Well-Known Member

    Thanks Craig, I appreciate it.
    Bruce
     
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