Response regarding arch flattening.
For the past 10 years my clinical interest has been in the geometry of the
forefoot as it affects the function of the STJ. Recently, I wrote about
[Rothbart 2002 Medial column foot systems. An innovative tool for improving
posture. JBMT Jan] an ontogenetic deviation in development [week 6pf-8pf]
that leads to a retained talar supinatus [Rothbart Foot Structure] in the
neotal. The RFS inverts and SECONDARILY raises the 1st metatarsal and
hallux off the ground when the STJ is in joint congruity [my definition of
NP]. We use microwedges to measure the amount the 1st metatarsal is off
the ground in millimeters.
We found a direct correlation between arch shape and Primus Metatarsus
Elevatus [amount of mm 1st metatarsal is off ground, standing with STJ in
NP]:
Less than 10mm ----> Stable Arch
10-20mm ----> Flexible Arch [ILA higher sitting than standing]
25-35mm ----> Flexible Flatfoot [arch sitting, flat standing]
35-40mm ----> Preclinical clubfoot deformity [ILA flat
standing or sitting]
45mm and up ----> Overt CFD [Clubfoot deformity]
It appears that RFS and Mortons Foot Structure are not necessarily mutually
inconclusive foot types. A study done in the 1940s suggest MFS at approx
40% of the North American population. A study we did in the early 1990s
suggest a RFS well over 90% of the population.
When a medial column foot system [varum wedge, not a step platform] is
placed under a RFS, the range of motion in the 1st MPJ [in most cases] is
Increased [not limited].
Comments would be most welcomed.
Brian Rothbart
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