I really have to thank the famous Oregon Podiatrist, Dr. Ray McClanahan, for bringing this to my attention. Ray is the creator of “Correct Toes™” and popularized less orthotic control (and normally no orthoses) and more big toe stability in helping his patients. As I began to experiment with Correct Toes™ and even big toe taping for stability, I began to see great improvement in my posterior tibial sufferers, even PTTD patients. I had never approached posterior tibial issues with a focus on the big toe mechanics. I will always use a corrective orthotic base, but stabilizing the end of the medial column for these patients just makes good sense.
When you look at the medial column, the first MPJ is at the distal end along with the hallux. Years ago I had learned that the medial column stability achieved by a Lapidus procedure greatly helped my posterior tibial patients, even up to Stage 3 PTTD. However, I was not going to do a Lapidus procedure for this reason, although there have been exceptions. I remember having a Stage 2 PTTD patient, who then developed tibial sesamoiditis as the medial column collapsed. As I treated the big toe joint with spica taping to limit the joint (and giving it stability), much of the posterior tibial pain disappeared. This was a severe pronator with only partial correction of that pronation with their current orthotic devices (heel valgus over 15 everted changed with orthotic devices to 10 everted).
When Dr. McClanahan was telling patients to throw away their orthoses for CorrectToes™, I assumed that he was a confused individual LOL. But, I have general rules and Golden Rules that I practice with. These help me make sense of the medical world around me. The Golden Rule (which is unbreakable) that I had to follow was to evaluate any biomechanical theory for its truth. The visionaries behind these theories are passionate, it is not all folly, so how could I add this to my practice. I will never actually throw away my orthotic treatment, but in focusing my sometimes limited brain power of stabilizing the big toe joint, I got improvement in my patients.
Golden Rule of Foot: When dealing with a medial column problem, stability can come from the entire medial column.
In a quick review, what components of a KevinRoot orthos can also help in our noble quest for obtaining medial column stability. These include (to name a few):
- Various forms of Morton’s extensions (Morton's to Toes, Morton's to sulcus
- Making the orthosis wide
- Raising the medial arch
- Add a medial arch fill
- Raising Medial Heel Cup
- Adding varus corrections like Medial Heel Skives or Inverted Cants
