Forefoot Valgus or Plantarflexed 1st ray?
Hmmm. That IS the question, isn’t it?
We remember that Forefoot valgus is a condition where the forefoot is everted with respect to the rearfoot.
With a plantar flexed 1st ray, the forefoot is actually in varus (ie inverted) and the the 1st ray is dropped (thus, plantar flexed).
If you look at the picture, you will see the entire forefoot is everted, thus we are looking at a true forefoot valgus. The question here, is “does the 1st ray move into dorsiflexion”? This would be the difference between a flexible (plastic or rigid deformity and is a function of the rigidity of the subtalar and midtarsal joints as well as the flexibility of the 1st ray.
The literature states that forefoot valgus is the most commonly seen frontal plane deformity of the foot (McPoil 1988, Burns, 1977). We have not found this in clinical practice, but rather forefoot varus. This may be due to most folks seeing us have an issue, and more issues seem to be caused by rigid varus deformities, since they cause the knee to collapse inward.
It’s origin can be multifactorial, ranging from a congenital malformation of the calcaneocuboid joint (more on that joint here) with the absence of a calcanean process, which allows a greater degree of eversion (Bojsen-Moller 1979); over rotation of the talar neck (Sglaraato 1971), or association with a pes cavus foot in compensation to an inverted rearfoot and inflexibilty of the subtalar joint (Lutter 1981). Neuromuscular diseases are believed to cause as many as 95% of these deformities (Dwyer 1975).
The question is, what do we do with it?
- we insure that the foots mechanics are the best they can be through manipulation and mobilization
- make sure the joints proximal and distal to the foot are functioning properly
- muscle test and strengthen weak muscles (think about the poor peroneals in these folks!)
- make sure they are NOT in a motion control shoe; more flexible is better
- Make sure their shoe has adequate room in the toe box
- sometimes, we post the insole of the shoe (or orthotic) in valgus, especially with rigid deformities
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The Gait Guys. Often a valgus slant on a varus reality. Still bald. Still good looking. Improving your gait competency with each post.