A structural deformity of the foot is often associated with significant alterations in gait, limited range of motion of crucial joints and pain in the musculoskeletal system. This facilitates a series of functional changes which gradually cause problems in maintaining balance and stability.
While there is no standard definition of ‘foot deformity’ among clinicians, it is often characterised by the presence of three or more of the following – hallux valgus, hammer toes, bony prominences, prominent metatarsal heads, Charcot arthropathy, limited joint mobility and small muscle wasting.
Malhotra et al. list the main adult sagittal plane deformities as claw toes, hammer toes and mallet toes; an imbalance between the forces of extension and flexion in the relevant joints is cited as the main factor contributing to the development of such deformities.
The authors describe mallet toe as an isolated flexion deformity of the distal interphalangeal joint and hammer toe as a primary flexion deformity of the proximal interphalangeal joint, with or without hyperextension at the metatarsophalangeal joint, but with a neutral or hyperextended distal interphalangeal joint.
Claw toe is defined as a primary hyperextension deformity of the metatarsophalangeal joint with flexion at the proximal interphalangeal joint and distal interphalangeal joint. The intrinsics shorten and are unable to produce a flexion moment at the metatarsophalangeal joint, and the extensors act unopposed.
A study conducted by Hagedorn et al. recruited participants from the Framingham Foot Study to assess the relation between foot disorders, foot posture and function. A weightbearing assessment was performed to determine the presence of hallux valgus, hammer, claw, overlapping toes, and Tailor’s bunion.
Plantar pressure scans were utilised to examine foot posture and function; foot posture was characterised using the modified arch index and the centre of pressure excursion index was used to characterise foot function.
The authors found that both foot posture and dynamic foot function were significantly associated with specific foot disorders. Planus foot posture and pronated foot function were observed to increase the risk of foot deformities in adults.
Foot deformities increase plantar pressure which serves as a potential risk factor for the onset of foot ulcerations. This can be extremely detrimental to a diabetic patient as it can eventually necessitate amputation of the affected foot.
Preventative strategies need to focus on reducing symptomatology and addressing biomechanical discrepancies, such as hyperpronation, which trigger compensatory movements of the lower limbs and place the individual at a greater risk of developing foot disorders.
Gene Mirkin, President of Foot and Ankle Specialists of the Mid-Atlantic, states that orthotics can be sometimes used to stabilise flexible hammertoes due to flexor stabilisation and prevention of excessive pronation.
The pull of the flexor tendons can be minimised when the medial longitudinal arch is sufficiently supported and the subtalar joint is prevented from pronating beyond its healthy range compared to the weightbearing surface.
MASS4D® custom foot orthotics work to support optimal foot posture and function, paying more attention to the factors contributing to hyperpronation.
The mechanical ‘leaf spring’ effect of this full-contact orthotic under the arch of the foot, applies tremendous supportive force to the plantar surface, facilitating healthy supination balanced with functional pronation. This enhances an even distribution of soft tissues, boosting proprioception capabilities and optimising joint alignment.
This is the reason for the success of MASS4D® orthotic in active rehabilitation programmes and for treating lower extremity biomechanical faults.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.