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I have studied (2001- 07) under Dr. Chris Smith. - Prof. Emer. Ret. CCPM

Chris says the majority of feet out in the world are True Forefoot Valgus and further states that True Forefoot Varuses are rare perhaps 2% or less.

Is this possible? Doesn't preventive structures (and extrinsic muscles (Peroneus Longus-and P.Brevis - providing pull at the medial column and boney structures such as the Sulcus Tali Tuberosity providing an antaomical stopping point or end of range to the ossesous limits of motion, support the case for Varus. Note: Rule out feet that have extreme and unresolved ROM and or other conditional pathology factors that could change this hyperbole.

Or

is it that Chris see's coming into his lab, only poor casting technique giving false forefoot values of Valgus classification and therefore decides from his POV that all feet are Varus classification.

Prove or disprove - please give referenced theory or published text.

Jeff Root or Dr. Kirby what you're take on this?

Many thanks.

Marko

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not sure how i stumbled on this from 2 years ago (think it was linked in another thread), but it would be very interesting to hear the thoughts of the regular wise posters of this parish

very surprised that there was no response when it was originally posted???


edit: maybe due to the fact it is posted in the intros section rather than biomechanics

 

"True" forefoot varus, as defined by any comtemporary author,apart from as a rare anatomical entity, does not exist - it is fiction. There is no basis for its aetiology, nor for its diagnosis - whatever you may be told by those that support its existence. I am not certain as to where the notion of talar head torsion failure as an aetiology became fashionable, but it has no basis in science. I am uncertain how this helps the case for forefooot valgus, but please, do not envoke talar head torsion issues - it is clearly not in any way connected to forefoot-hindfoot relationship. You mention casting; I have tried to explain on many occasions that, in my opinion, "forefoot varus" is an artifact of the neutral casting technique; it captures an artificial relationship of the forefoot to the the hindoot - not a bony relationship, but an artifical "soft tissue bag" that surrounds it. I have been laughed out of town of more than one ocasion for saying this. Rob

 

I think one of the issues here is exactly as Rob states above - there is a lot of interchange within the terminology (one mans' varus is another mans' supinatus)

Garbalosa did a nice study in the early nineties and found that about 85% percent of his asymptomatic subjects (over 200 from memory) exhibited a "forefoot varus".

 

I couldn't agree more with Rob on this one. If we had no "neutral casting position" and were not indoctrinated into thinking that the heel had to be perpendicular to the ground etc, would we even have any cognisance of a forefoot to rearfoot relationship

Is a "true forefoot varus" any more a diagnosis than, say, a "short first ray"?

My 2p

 

You have to back the debate up and first look at the question of whether or not the measurement of forefoot to rearfoot relationship can be repeated accurately. I maintain that it can't. The problem is that the LMTJ is not a true hing axis. When you try to pronate the long axis the cuboid will evert and you will increased stiffness at that location. While holding the cuboid there, you can dorsiflex and plantar flex all of the following joints: The Talo-navicular joint, Naviculo-cuneiform joint, the first metatarsal cuneiform joint. As all of those joints move you will change the forefoot to rearfoot relationship. So, should you measure forefoot to rearfoot with medial forefoot loaded in dorsiflexion or loaded in plantar flexion or just let it float in between? The method described by Root et al, lets it float. I bet that if you could somehow line up a heel bisection (there's at least 5 degrees of inaccuracy right there) with a line that is an average of the plantar surface of the metatarsal heads, that there would be between day variation of the measurement from the different positions of the medial forefoot.

So, there's no real point in debating whether forefoot varus or valgus is more common, because it can't be measured accurately.

Eric