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Sep 22

Written by: Cherri Choate, DPM

     How much does frontal plane foot position impact higher segments of the lower extremity? Whether the changes are structural within the foot, or external within the shoe, the impact does exist because the lower extremity joints are coupled.  When adding a forefoot (FF) varus or valgus wedge to a shoe or orthotic, the impact on the ankle, knee and hip are not always considered to be significant.  In contrast, as a foot develops structural problems that lead to frontal plane changes, how much attention needs to be given to addressing changes in higher segments.  
     A number of years ago, I had a constant referral stream of patients from an orthopedist who treated knee arthritis. His only request was the application of a full length valgus wedge on the patient's shoe liner.  Routinely, I added 1/8" korex full length to the liner and in the majority of patients the knee pain resolved.  My choice of 1/8" was somewhat random, but a question to be asked is what issues could occur in the future in these patient's hips and ankles?  How much valgus or varus wedge should be applied to address a given pathology?  Even if a patient has significant forefoot varus or valgus and they are pain and symptom free, should be the pathology be addressed to prevent future issues at the knee and hip?  
    A research group recently published a paper that addressed the impact of different degrees of FF valgus wedges on a variety of lower extremity joints.  Interestingly, both wedges impacted foot motion, but the impact of the larger wedge lasted longer during the gait cyle and reached a higher segment in the lower extremity (pelvis/hip).  This information certainly makes me think twice about my material thickness choices.  It leads to me consider the probable impact of worn down shoes and collapsed orthotics and braces on multiple body segments.  Perhaps after wedge placement, short and long term reevaluation of  the knee and hip motion would help the practitioner ascertain how the wedging impacts the entire lower extremity. 
     As always, I am intrigued by the complex "coupling" mechanisms in the body.  If you are intrigued also, take a moment to read a more detailed description of this article by Souza in today's E-Journal selection.  


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