| Lisa Knox
The foot core system: a new paradigm for understanding intrinsic foot muscle function
by Patrick O McKeon, Jay Hertel, Dennis Bramble, Irene Davis
Want to buff up on the intrinsic muscles of the foot and what role they play in stabilizing the human body? This article suggests we shift our biomechanical treatments from stabilizing to strengthening. A great reference and read. It's an exciting time to be treating feet. Read more
Real question, real answer:
Hope all is well! Quick question for you. Are there any modifications to an orthotic device that you would make when a patient not only has pronation issues but also has obvious hammertoes?
A few things to consider. Make sure the patient has enough vertical room in the shoe's toe box to accommodate the hammering. In addition, an Orthotic extension terminating at the sulcus with a 1/8 (3mm) extension to sulcus will allow the toes to hang off the extension creating some relative space for the contracted proximal phalangeal joint and distal phalange to drop lower relative to the metatarsal heads in the shoe toe box. A patient that overpronates and has hammertoes usually has longer toes in ratio to the arch length. It's important to have a controlling orthotic as well as strengthening exercises and posture awareness to help the patient hold the arch and rearfoot in a better alignment. If the patient is 45 years old and not in good health or 65 years old it may be easier to rely more on the orthotic. A always stress that a patient should help the orthotic help the posture by strengthening the arch and being aware of foot posture. Over time a non-fixed contraction can correct itself. One more pearl: socks can often be too tight, constricting more than shoes. Make sure the patient understands to wear socks that are as long as the foot when not stretched. Too often sock companies size the socks too tight and people wear socks too snug. This can cause a contracture if the 2nd toe is longer than the hallux (big toe).
Hope this helps.
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