dorsalis wrote:
 
> PARTIAL compensation Raymond.  It cannot be fully compensated.  The
> medial column of the forefoot does not get to the ground!  Realize, you
> are only looking at the negative cast in the lab. You have to attach a
> leg to it based on the numbers which you listed.  Unless there is a
> profound component of genu valgum (in which case there would be no
> Tibial Varum), this forefoot cannot get to the ground!

Jeff replies:  What about plantarflexion of the first ray as a
compensatory response in a forefoot which is incapable of reaching the
ground.  If this patient was not able to compensate by MTJ pronation
when the STJ pronates as Ray stated, then wouldn't the 1st ray be
plantarflexing to make ground contact.  And if so, over the course of
time, would it not become an acquired plantarflexed 1st ray deformity? 
It seems there must be ground reaction on the 1st because the 1-5 and
2-5 forefoot measurements were both 12 degrees.  Unless, the 1st is
maximally plantarflexed (from an elevatus position) when it is in a
common plane with mets 2-5.

I would expect to see a forefoot varus with a plantarflexed 1st ray
deformity structurally if this foot was functioning as you suggest Chip.
What do you think?

Ray:
I don't think we have all the pieces of the puzzle yet.  There seem to
be some inconsistencies here.  Ray, what about 1st ray ROM, callous
formation, hallux ROM, and ankle dorsiflexion?  

 
Compensatorily yours,

Jeff


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