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Journal of the American Podiatric Medical Association
Volume 96 Number 6 474-481 2006
Copyright © 2006 American Podiatric Medical Association

Effect of Functional Foot Orthoses on First Metatarsophalangeal Joint Dorsiflexion in Stance and Gait

Paul R. Scherer, DPM *, Jennifer Sanders, DPM *, Denten E. Eldredge, BS *, Susan J. Duffy, BS * and Ryan Y. Lee, BA *

* Department of Applied Biomechanics, California School of Podiatric Medicine at Samuel Merritt College, Oakland.

Corresponding author: Paul R. Scherer, DPM, Department of Applied Biomechanics, California School of Podiatric Medicine at Samuel Merritt College, 825 Van Ness Ave, Ste 204, San Francisco, CA 94109.

Abstract

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed. (J Am Podiatr Med Assoc 96(6): 474–481, 2006)






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Copyright © 2006 by the American Podiatric Medical Association.