A Pedograph mapping case. Everyone wants to use the high tech stuff, we say you dont need it most of the time. What do you see in this case ?
Answers: Increased heel pressure, Uncompensated forefoot varus (as evidenced by a lack of ink under the first metatarsals (you could even put a Rothbart foot-type on your DDx list), increased clawing of the 2nd-3rd digits on the right, and bilateral Morton’s second toes. If you look carefully at the big toe ink presentation you can see a “pinch” callus on the left foot at the medial aspect of the hallux. This might also represent some increased pressure being exerted by the short big toe flexor (flexor hallucis brevis), the longus (FHL) would give a more distinct distal pressure and ink response at or near the tip of the toe. What you want to see is a nice ink spot that is well blended throughout the entire pad of the hallux. There is also similar hint of more use of the short flexor on the right and less of the long flexor. Overall the toes are bunched together in a group, there is not much separation, we sometimes take this as a global representation of a weaker foot.
Q: What could this transfer to as a clinical presentation (what kinds of things might you be suspicious of as you conduct your examination ?:
Obviously heel pain has to be on the list. There is a fair amount of heel pressure going on here. With a forefoot varus or, simply put, incompetence of the medial foot tripod stability structure the person is more likely to generate more medial rotation of legs. This, if not met will good pelvic and core resistance, can lead to lumbopelvic functional instability and thus low back pain. Typically, Forefoot varus clients either pronate very heavily, sometimes late (as in this case) as evidenced by lack of heavy ink printing through the arch area, or they tend to compensate and try to walk on the outsides of their feet. Anyone who delays or rushes the 3 rockers of the foot (rear, mid or forefoot rockers) is going to see compensations to the compromised the ankle rocker movement. This obviously has its complications as well. There is no good compensation. As we say, if something is not working right……..someone has to pay, eventually.
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