Anthony,
The essence of my posting was that I am not clear why treating a frontal
plane deformity in a child often reduces an intoe gait. Reduction of
out-toeing as part of reducing excessive pronation I can accept - but
in-toeing? What is the mechanism that underlies the reduction of excessive
pronation leading to a less intoe gait? I was just floating a suggestion of
what may be the mechanism to see if someone out there knows why.
I accept that part of pronation is abduction, but I believe not neccessarily
as significant abduction of the foot on the ground, relative abduction yes,
but actual? I don't know. I think that what I am talking about is feet
with excessive/out of phase STJ pronation, with its components of abduction,
eversion and dorsiflexion. The foot on the ground is relatively adbucted I
know, but not always that obviouly.
Don't agree that intoe is always - or even mainly - boney in origin. In my
experience, some minor femoral and tibial internal influences may often be
there, as may an internal hip neutral - and they may not. What is there
most often I find is functional hallux limitus with the in-toe as a paart of
the compensation for that; reducing the in-toe dramatically when treated.
But I make the point again, I have found that in many cases simply treating
the frontal plane deformities contributes significantly toward reducing
intoe gait, although you would think that it would increase it by removing
the abductory element of pronation that you mention.
Why doesn't it?
----- Original Message -----
From: "Anthony Achilles" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, November 09, 2004 4:59 PM
Subject: FW: Intoe gait in childres and transverse plane motion of the
tallus
________________________________
From: Anthony Achilles
Sent: Tue 09/11/2004 09:21
To: A group for the academic discussion of current issues in podiatry
Subject: RE: Intoe gait in childres and transverse plane motion of the
tallus
Clive,
Not sure if I can necessarily see the connection between the the STjt
pronation creating an internal rotation of the leg, which subsequently
produces an intoe. The foot is far more likely to abduct and evert, and in
fact when "correcting " the excessive pronation, the primary cause of the
problem becomes more apparent ,i.e. Tibial torsion , femoral anteversion.
May I also ask why you treat juvenile intoeing?
Tony Achilles
-----Original Message-----
From: A group for the academic discussion of current issues in podiatry
[mailto:[log in to unmask]] On Behalf Of john weir
Sent: 08 November 2004 16:37
To: [log in to unmask]
Subject: Re: Intoe gait in childres and transverse plane motion of the
tallus
Clive,
Have a look at Algeo's range of 1st phase orthotics. The have one called a
slimflex plus which is even better than a frelen and comes in a range of
sizes from child's 8 to adult 12. they are a contoured EVA insole with a
strengthened heel. I find them great and "cheap" for kids. You can grind
out under 1st met head area to create a kinetic wedge effect.
John.
________________________________
From: A group for the academic discussion of current issues in podiatry
[mailto:[log in to unmask]] On Behalf Of Clive
Sent: 05 November 2004 10:11
To: [log in to unmask]
Subject: Intoe gait in childres and transverse plane motion of the tallus
When treating juveniles with orthoses for intoe gait I have observed that
where there is abnormal subtalar joint pronation, even when there are other
internal position influences proximal to the foot and functional hallux
limitus, treating the frontal plane factors makes a difference which may be
profound both in gait and stance.
May I assume that this is because abnormal STJ pronation caused by frontal
plane pathology leads to the talus to internally rotating for longer than it
should in the stance phase as the foot approaches heel off, and that this
internal roation carries the leg with it, exerting a significant medial
rotatory force on the foot contributing to the intoe postion?I have to
acknowledge that where present the treatment of functional hallus limitus
always makes things even better.
Initially I found it difficult making very small chairside temporary
orthoses with kinetic wedges. What seems to work for me in many cases is
adding a full length forefoot extension of 3mm medium density eva to an
Alphathotic (for those that don't know it - a small high density eva device
with frontal plane intrinsic posting designed for children), with an area
cut out under the first MTPJ and a first met cut out on the alphathotic.
The forefoot extension is a bit floppy on its own and adding a thin layer of
0.5 mm stiffer material plantar to the forefoot extension seems to help.
Does anyone have a better way of making small children's temporary
chairside devices incorporating a kinetic wedge or similar means of letting
the first MTPJ move plantar to the other mets? I have yet to find the
paediatric equivalent of the ever useful and affordable "Frelen" insole.
Clive Chapman
(Who aged 65 has now retired from employmet with the NHS and between naps
potters a little in his private practice at home!)
telphone 0208 885 2289
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