| Lisa Knox

Foot Notes: August 13th, 2019

From the desk of Kevin B. Rosenbloom 
Here's a dose of what I'm pondering and enjoying this week ...

The foot core system: a new paradigm for understanding intrinsic foot muscle function
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
Calluses better than footwear
In this podcast by Nature, the interviewers spoke with some informative guests who participated in a study where their goal was to determine if plantar calluses make feet less sensitive. They also speak to Daniel Lieberman, a professor of human evolutionary biology at Harvard University, who took part in the study. The podcast is about 27 min long but you only need to listen to the first 8 minutes or so. My favorite takeaway is that no matter how thick calluses became they became no less sensitive. We can feel through our calluses just fine - of course, people with neuropathy, not so much. Listen here

Polyurethane foam: How it is made?
I used to geek out all the time when "How It's Made" would come on the television, and this was no exception. In the orthotics industry, foam is king. Variations of it are used for things like wedging all the way to the softest pads. Here is a quick video of how polyurethane foam, e.g. Myolite and Poron, is created. Watch here
Real question, real answer: 
Clinician Question:
​​​​​​​Hi Kevin,
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?

Kevin's Answer:

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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Tags: Foot Notes

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