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Tibial varum measurement

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Atlas, Jan 28, 2005.

  1. Atlas

    Atlas Well-Known Member

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    This relatively subjective measurement has been quite difficult for me to 'get on top off'. It was quite difficult for me to pen the heel bisection and even more difficult for me to pen the distal third of leg bisection. The calf bulk often throws me.

    Ala Root, I was in the shower the other day, and discovered that I could clearly visualise my tibial varum looking down at my feet. Can I use the anterior border of the tibia as a reference? Does the literature suggest any other means in addition to posterior bisection?

    Am I onto something, or am I fantasising about M.Root in the shower?
  2. nicpod1

    nicpod1 Active Member

    Tibial Varum

    There are a lot of meaurements that remain on e.g. orthotic lab assessment/prescription forms that, in my view, are negated by more pertinent measurements and I think tibial varum is one of them.

    Why do we need to measure it, when we are measuring every other angle and appearance of the foot in walking/running. Ultimately, the prescription of orthoses are going to equate to measurements of the foot - not the leg/thigh/knee/hip etc - these areas are to be noted for thier ROM, QOM, strength, flexibility etc in order for the clinician to ascertain how much 'correction', 'support' or 'stability' can be achieved by influencing the foot to affect the biomechanics.

    No matter what you do with Orthoses and other therapies, things like tibial varum are never going to change (unless surgically/tauma), so I think it would be better to observe, rather than quantifiably measure, wouldn't it.....................or not?????
  3. Atlas

    Atlas Well-Known Member

    If what you say is right Nicpod1, rearfoot orthotic angle for a runner need not be different from a walker. If you are right, tibio-varum has little impact on orthotic prescription.

    The accepted view (right or wrong) is that running, with its narrower base of gait, simulates increased tibio-varum. With increase tibio-varum ( or decreased base of gait with running), I thought demanded a rearfoot angle to to prevent the subtalar joint compensating into a relative pronation, despite appearing vertical.

    If it is relevant to orthotic prescription, we need to measure whether it exists, and to what degree/severity.

    But, in some way I agree that we can over-measure/analyse to the point of clinical inefficiency.
  4. admin

    admin Administrator Staff Member

    Didn't Rich Blake show that the so called running limb varus was a myth?
    The myth of running limb varus
    S Tristant and RL Blake
    Center for Sports Medicine, Saint Francis Memorial Hospital, San Francisco, CA 94109.
  5. Atlas

    Atlas Well-Known Member

    Sorry, I don't have access to the full transcript of Blake's paper. What does it actually refute? The narrower base-of-gait of a runner? The tibial verticality at heel strike?

    I have accepted that the greater the distal tibia is removed from vertical, the greater the rear-foot correction inversion angle needed to align the tibio-talar-calcaneal relationship. Hence augmenting subtalar joint neutral etc....
  6. nicpod1

    nicpod1 Active Member

    Hi Atlas,

    Everyone is entitled to their opinion but in biomechanics I have certainly seen that there are no set rules - I believe in a 'treat what you can logically justify is causing the problem, or IS the problem, not what is THEORETICALLY the problem'.

    e.g. I attended a 1/2 marathon last year, with international competitors in attendance. I was treating the athletes after the race and so had time on my hands before-hand and went up to the start to take a promo photo. On the way up to the start-line a runner ran past on his toes............he came in 3rd and came for treatment afterwards and I mentioned before he sat down that I had noticed him toe-running - on examination, BOTH ankle joints where fused....he was in no pain!

    The guy should have had problems walking, let alone running - ACCORDING TO THEORY.

    No matter how much tib varum there is, it is not going to change it's magnitude (unless Ricket's sets in!) and you are not going to correct it - so why not just measure those things that you can influence?

    PS Fantasising about these things in the shower probably shows that things have gone to far - mind you - probably so does writing on this forum!

    Best wishes!
  7. The study done by Tristant and Blake was done at a jogging speed, not a running speed. As the speed of running increases, so does the tibial varum increase. This is more readily seen as one approaches 6 min/mile pace, where the runner is actually "leaping ahead" from foot to foot, attempting to minimize center of mass displacement by bringing their stance phase foot directly under their center of mass.

    Take some videos or photos of a high school or college cross country team while running a fast training run or race if you want to see what I am talking about.
  8. Atlas

    Atlas Well-Known Member

    I agree more than you realise. Someone who is prepared (in certain circumstances) to use rear-foot valgus posts and/or forefoot varus posts does not adhere at all to the latest research paper or consensus theory dogma.

    My interest in an extrinsic factor such as tibial varum, is that it may help explain to me, why one pair of orthotic devices work for one set of feet and symptoms, whereas the same type of force introduction will not do so well for a similar set of feet (similar supination-resistance testing, STJ axis position and angle, NCSP, RCSP etc....) and symptoms.
    Last edited: Feb 2, 2005
  9. Brent Jarrett DPM

    Brent Jarrett DPM Active Member

    ...the tibial varum you visulized is real and measurable in most everyone... not so sure that it is an acceptable concept amongst our colleques...so perhaps you are on to something...The varus angulation you observed in the shower actually occurs in most to approximately 20 degrees off the midline, and is best measured between horizontal surface of the knee joint and the horizontal surface of the ankle joint... You may be intersted in a page on my web site that describes the science behind my research over the last 20 plus years that describes tibial varum as the reason most humans need orthotic.
  10. Griff

    Griff Moderator

    Hi Brent,

    I did go on your website and but could not find the page you refer to (all I could find were several pages about how your orthoses improve posture; are you referring to foot posture?) - anyway could you provide a hyperlink for the page you describe above please?


  11. Brent Jarrett DPM

    Brent Jarrett DPM Active Member

  12. I don't know of any research on the repeatability of measuring Tibial Varum but from personnal experience I find to to be horrifically variable! My old boss used to regularly hit 20 degrees. My last band 6 measured almost without exception between 6 and 8 degrees. I'm usually somewhere in the middle (when I bother).

    Again we must ask, what use a measurement if one cannot rely upon its accuracy?

    I think the yawn was a bit harsh ;). I quite like the frontal plane slice and the measurements of the angles. Although this...

    Is perhaps a little... much.

    Nothing wrong with trying to quantify the morphology of an insole. I think that's a great idea and could add much to the science.

    But I think the belief that this will extrapolate to its EFFECTS is the height of foolishness, especially when its such a simplistic tool for measurement.

    I think its a start, and possibly even a good one. :drinks I like it.

  13. It's a piece of piss to look at the topography of slices of orthoses in any plane, Robert. Any basic CAD software enables one to do this. It will, to an extent at least, extrapolate to the orthotic effect-Indeed, Dave Smith, Kevin Kirby and I employed a similar technique in a paper that has recently been accepted for publication in JAPMA. But none of this is what I am tired of. I'm tired of people not really saying anything, but placing a link to their website here in the hope that it will act as a marketing tool for their business.......

    And BTW, there are so many statements on that web-page that you think is possibly a "good start", that are highly questionable. Shall we count them together?
  14. No, no need to ram it home.

    I just notice the irony. Measuring biometrics is a bitch. Choose your measure and pick your repeatability study. And we write reams about it, split the atom to the nth degree and even try to shoehorn feet into types.

    The other side of the equation, the orthotic, we CAN quantify and measure... And we don't bother! Find 3 ffos from 3 labs with the same prescription you'll get 3 different morphologies.

    I just like that they've tried to look at it from that end.

    You seem testy this weekend Simon. Same old frustrations?
  15. Not really, had sex last night and everything...:D Just playing some games with myself this weekend to test my understanding. Sometimes, I like to argue against what I believe in, to see if my beliefs are well founded. Just an exercise to keep me satisfied, until I can get a surgical training post, Robert.

    But regarding this website... we may need to have words.:drinks

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