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fore foot varus and now pf!

Posted by Catherine on 10/30/02 at 22:14 (098747)

I started having problems with my feet about 5 years ago, but the problem was in the joints of my big toes. I went originally to a chiropracter who advertised he did Gait Analysis, so I thought he might actually know something about feet. But he was absloutly clueless. He didn't even have me take off my shoes duing my first visit and was completly dependant on a computerised foot scan that he just read to me could not to any analysis of his own. (Not to say all chiropracters are quacks!.. I just don't personally like them ... they didn't really help my back either! Ok enough ranting) I got custom orthotics made by a Certified Orthotist. I remember him telling me I had fore-foot varus and that my big toes were lower than the rest causing hyperflexion and therefore pain of the joint. The orthotics work well - I just had to give up wearing nice shoes and had to live in running shoes with the footbeds replaced (which subsequently required a move to wearing jeans more often!).

I have been suffering from plantar facsiitis for a bit over two years now, but have suffered quietly an not formally seaked treatment. I remember the initial onset was after joining up at a new gym and walking on a treadmill one day. One of my friends is an occupational theripist and was the first one to suggest that it might be PF. When I got my last new pair of Orthotics he agreed that that is what it sounded like, but he didn't suggest modifying the orthotics for more cushining(sp?) or heal support. I don't have particularly high or low arches (I don't think), but I do have to walk around and stand for long periods on a hard deck at work now and then.

After reading all this stuff on the internet I releived to know that there is hope for improvement. I've learned so much tonight!

Now that you know my background as far as my feet go, maybe someone can give me some suggestions as how to best deal with both conditions simultaneously. I don't want to give up my orthotics because then my toes will hurt, but the orthotics are hard. I have been considering trying store bought ones that have good padding and good arch support but I don't want spend a lot of money trying different types to find they don't work. I am going to look for something that will hold my foot flexed at night. I've reciently tried sleeping on my back and shoving a pillow down to the foot of my bed so the blankets don't plantar flex my feet. That only works until the pillow falls off the end. I really prefer sleeping on my stomach. I know that is bad for many reasons besides forcing my feet being plantar flexed all night. I usually get up in the morning and hobble down the hall.

Well I need to go and get some sleep now, but I hope to hear back from someone soon.

Good Night all
Catherine

Re: fore foot varus and now pf!

pala on 10/31/02 at 08:05 (098779)

i am not a doctor. just a sufferer. when i sleep on my stomach i let my feet hang off the end of the bed a little. if i hang them off too much tho my achilles can't take the stretch for too long.

Re: fore foot varus and now pf!

Richard, C.Ped on 10/31/02 at 08:43 (098788)

Hey Catherine,
Ok...did the orthotist say forefoot varus or forefoot valgus? To check for varus, I have the patient stand and i look down their foot from their heel to the toes. I get the foot in neutral and then look to see how the first and fifth metatarsal heads line up in comparison with the heel. Forefoot varus is when the ball of the big toe is higher than the ball of the fifth. Forefoot valgus is opposite. You are describing forefoot valgus.

As with any condition be it forefoot, midfoot, or hindfoot, most of the time it should be posted correctly to keep the foot in or as close to a neutral position as possible. There are some conditions that you can not do this to.

Let me describe posting for this. Basically, if you are standing in a neutral position, there will be a gap between your foot and the floor...either forefoot varus or valgus. What you want to do is extend the posting material to basically, bring the floor to the foot. Without this, you may feel like the arch area of the orthotic is to high. Many people do not check for this, so if they hear the complaint, the shave off the arch until it feels better. With the posting, it should automatically feel better.

Just a suggestion.
Good luck!!
Richard, C.Ped

Re: fore foot varus and now pf!

john h on 10/31/02 at 10:16 (098800)

Catherine: You touched on your problem with your big toes. Is it the second joint and have you had a doctor x-ray it to find out if you possible have hallux limitus or hallux rigidus? This is not uncommon and more common in women. A couple of doctors have told me there is possible a relationship between PF and Hallux Limitur as being unable to bend the great toe in a normal manner has an adverse effect on the fascia. I had hallux limitus on both great toes and shortly thereafter developed PF. I have had surgery on one toe to correct the problem (20 minute out patient surgery). Normally if the toe pain does not bother you surgery is not necessary but if the toe pain gets bad it can be corrected.

Re: fore foot varus and now pf!

Catherine B on 10/31/02 at 18:34 (098839)

Thanks for the comments and suggestions.

Paula - The sleeping with my foot off the end of the bed has been mentioned to me by my O.T. friend. I did try it, but I have to conciously make an effort to position myself like that over a few nights to see if it really does help.

Richard in response to your question of varus or valgus. I'm 99.99% sure it was varus... I didn't know the word valgus existed until I read your response. Due to my lack of education in this area my frame of refrence may be incorrect. When I say my big toe is lower than the rest I mean that from looking above my foot towards the floor my big toes are closer to the floor than the rest when my foot is in a relaxed state held up off the ground. He said my right big toe was 8 deg. off and I think the left was 5 deg. off. To correct this the Orthotist pushed the medial joint up (i.e. towards my knee (opposite of distal but I can't recall that word right now!)) when he made the plastar cast for the first pair. And as I said the orthotics work well for this problem - when I do any serious walking with them my toes feel fine - but they get aggravated if I'm not using them. But now that I am having heal pain instead of toe pain, I'm thinking that the hard in the heel orthotics may be contributing to it.
I have a hard enough time trying to get shoes that the orthodics fit into without adding another seperate layer for padding... (soon I'll be accused of wearing lifts in my shoes for extra height and I'm not a short person).

Now for John's response.
No - I did not have my feet X-rayed and no-one has mentioned anything about Hallux limitur to me before. I need to review my anatomical terms so I understand all the jargan...I'm not sure what you mean by the second joint. The joint I had problems with was the one where the ball of the foot ends and the toe begins, not the other one closer (distally) to the end of the toe!)

I don't know if the fact that I have crackly joints may predispose me to these conditions or not. I joke that I would never be able to sneak up on someone because my feet would give me away. I can just curl my big toes and they pop. (not everytime but enough to bother some people).

Any more suggestions would be greatly appreciated.

I'm off now to the medical - home care store to see what I can see in way of some sort of night splint.

Thanks Again
Catherine

1

Re: fore foot varus and now pf!

john h on 11/02/02 at 14:20 (099045)

Catherine: the joint you mention is the joint that hallux limitus or rigids occurs.in. You can have it and have little or no pain but eventually will cause problems. It is basically just deterioration of the joint much like arthritis. It is so common in that joint they gave it a name. Several doctors have told me they think if this joint begins to lose mobility it will make you more prone to PF. I agree with that assessment. It is nothing serious but a quick x-ray and you will know what you are dealing with. Both Podiatrist and Physicians-Foot and ankle specialist can deal with this problem

Re: fore foot varus and now pf!

pala on 10/31/02 at 08:05 (098779)

i am not a doctor. just a sufferer. when i sleep on my stomach i let my feet hang off the end of the bed a little. if i hang them off too much tho my achilles can't take the stretch for too long.

Re: fore foot varus and now pf!

Richard, C.Ped on 10/31/02 at 08:43 (098788)

Hey Catherine,
Ok...did the orthotist say forefoot varus or forefoot valgus? To check for varus, I have the patient stand and i look down their foot from their heel to the toes. I get the foot in neutral and then look to see how the first and fifth metatarsal heads line up in comparison with the heel. Forefoot varus is when the ball of the big toe is higher than the ball of the fifth. Forefoot valgus is opposite. You are describing forefoot valgus.

As with any condition be it forefoot, midfoot, or hindfoot, most of the time it should be posted correctly to keep the foot in or as close to a neutral position as possible. There are some conditions that you can not do this to.

Let me describe posting for this. Basically, if you are standing in a neutral position, there will be a gap between your foot and the floor...either forefoot varus or valgus. What you want to do is extend the posting material to basically, bring the floor to the foot. Without this, you may feel like the arch area of the orthotic is to high. Many people do not check for this, so if they hear the complaint, the shave off the arch until it feels better. With the posting, it should automatically feel better.

Just a suggestion.
Good luck!!
Richard, C.Ped

Re: fore foot varus and now pf!

john h on 10/31/02 at 10:16 (098800)

Catherine: You touched on your problem with your big toes. Is it the second joint and have you had a doctor x-ray it to find out if you possible have hallux limitus or hallux rigidus? This is not uncommon and more common in women. A couple of doctors have told me there is possible a relationship between PF and Hallux Limitur as being unable to bend the great toe in a normal manner has an adverse effect on the fascia. I had hallux limitus on both great toes and shortly thereafter developed PF. I have had surgery on one toe to correct the problem (20 minute out patient surgery). Normally if the toe pain does not bother you surgery is not necessary but if the toe pain gets bad it can be corrected.

Re: fore foot varus and now pf!

Catherine B on 10/31/02 at 18:34 (098839)

Thanks for the comments and suggestions.

Paula - The sleeping with my foot off the end of the bed has been mentioned to me by my O.T. friend. I did try it, but I have to conciously make an effort to position myself like that over a few nights to see if it really does help.

Richard in response to your question of varus or valgus. I'm 99.99% sure it was varus... I didn't know the word valgus existed until I read your response. Due to my lack of education in this area my frame of refrence may be incorrect. When I say my big toe is lower than the rest I mean that from looking above my foot towards the floor my big toes are closer to the floor than the rest when my foot is in a relaxed state held up off the ground. He said my right big toe was 8 deg. off and I think the left was 5 deg. off. To correct this the Orthotist pushed the medial joint up (i.e. towards my knee (opposite of distal but I can't recall that word right now!)) when he made the plastar cast for the first pair. And as I said the orthotics work well for this problem - when I do any serious walking with them my toes feel fine - but they get aggravated if I'm not using them. But now that I am having heal pain instead of toe pain, I'm thinking that the hard in the heel orthotics may be contributing to it.
I have a hard enough time trying to get shoes that the orthodics fit into without adding another seperate layer for padding... (soon I'll be accused of wearing lifts in my shoes for extra height and I'm not a short person).

Now for John's response.
No - I did not have my feet X-rayed and no-one has mentioned anything about Hallux limitur to me before. I need to review my anatomical terms so I understand all the jargan...I'm not sure what you mean by the second joint. The joint I had problems with was the one where the ball of the foot ends and the toe begins, not the other one closer (distally) to the end of the toe!)

I don't know if the fact that I have crackly joints may predispose me to these conditions or not. I joke that I would never be able to sneak up on someone because my feet would give me away. I can just curl my big toes and they pop. (not everytime but enough to bother some people).

Any more suggestions would be greatly appreciated.

I'm off now to the medical - home care store to see what I can see in way of some sort of night splint.

Thanks Again
Catherine

1

Re: fore foot varus and now pf!

john h on 11/02/02 at 14:20 (099045)

Catherine: the joint you mention is the joint that hallux limitus or rigids occurs.in. You can have it and have little or no pain but eventually will cause problems. It is basically just deterioration of the joint much like arthritis. It is so common in that joint they gave it a name. Several doctors have told me they think if this joint begins to lose mobility it will make you more prone to PF. I agree with that assessment. It is nothing serious but a quick x-ray and you will know what you are dealing with. Both Podiatrist and Physicians-Foot and ankle specialist can deal with this problem