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Does anyone know of any data / studies relating to the amount of "true" F/F varus in the population? I've got a bunch of Pedorthists in the US saying that they see 100's of patients with this but thinks they getting it confused with F/F supinatus. I'm with Craig...it's rare!:deadhorse:

Cheers
Neil

 

In one cohort we looked at, true forefoot varus was only present in 1.6%
About 30% were supinatus.

 

For what it is worth, it is my opinion that a true forefoot varus is fictional, apart from as a rare anatomical deformity. There is no evidence whatsoever that talar head torsion dysfunction leads to anything whatever to do with the forefoot-hindfoot relationship - one needs to look at early papers of Lisowski, 1967 - angular changes in the primate talus to see its real function - that of peramorphic heterochrony and, essentially decreasing midtarsal joint ROM. What amuses me, except that it is not funny, is that Root et al never said that talar head torsion was responsible for this "deformity" - they only suggested that it might be. I spent about a gallon of beer one night in Manchester in about 1986 talking to Bill Orion about this and he was quite embarrassed that their "suggestion" had been adopted as living word - and once or twice in very expensive books. Forefoot Supinatus is another enigma - though different. I think most of us that "do feet" would accept now that the so called midtarsal long axis is in trouble, theoretically. Thus the time-honoured aetiology of supinatus does not add up. That does not mean to say that there is no such thing - but one must look harder. Maybe starting with what would once have been known as flexible forefoot valgus. Cheers, Rob, as problematic as ever!

 

I'm afraid it is much more complicated that this.

Forefoot varus deformity, as defined by Root et al, is when the plantar plane of the forefoot is inverted relative to the calcaneal bisection when the subtalar joint (STJ) is in its neutral position. The problem is that these measurements have such large inter-examiner errors that one person's "forefoot varus deformity" could be another person's "forefoot valgus deformity.

If an examiner draws their heel bisections more everted than normal, holds the STJ more supinated than normal, or loads the lateral forefoot more lightly than normal, then that examiner will see more "forefoot varus" than the examiner that does not do these things while examining the foot.

In addition, how does one tell a "forefoot varus deformity" from a "forefoot supinatus deformity"?? I don't know of any reliable method of determining the difference. Does anyone else??

 

The criteria we used was that if the medial site of the foot could get down to the ground while holding the rearfoot about neutral and "end feel". --> a true "Root" forefoot varus probably should not come down to the ground without rearfoot eversion ... no idea of how reliable this this

 

I believe the whole idea of "forefoot to rearfoot relationship measurements" needs a total rethinking. There are so many factors that are not considered by most practitioners when they try to measure "forefoot to rearfoot relationship" in their patients. This makes the whole discussion of "forefoot varus" versus "forefoot supinatus" to be problematic, at best.