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This relatively subjective measurement has been quite difficult for me to 'get on top off'. It was quite difficult for me to pen the heel bisection and even more difficult for me to pen the distal third of leg bisection. The calf bulk often throws me.
Ala Root, I was in the shower the other day, and discovered that I could clearly visualise my tibial varum looking down at my feet. Can I use the anterior border of the tibia as a reference? Does the literature suggest any other means in addition to posterior bisection?
Am I onto something, or am I fantasising about M.Root in the shower?
There are a lot of meaurements that remain on e.g. orthotic lab assessment/prescription forms that, in my view, are negated by more pertinent measurements and I think tibial varum is one of them.
Why do we need to measure it, when we are measuring every other angle and appearance of the foot in walking/running. Ultimately, the prescription of orthoses are going to equate to measurements of the foot - not the leg/thigh/knee/hip etc - these areas are to be noted for thier ROM, QOM, strength, flexibility etc in order for the clinician to ascertain how much 'correction', 'support' or 'stability' can be achieved by influencing the foot to affect the biomechanics.
No matter what you do with Orthoses and other therapies, things like tibial varum are never going to change (unless surgically/tauma), so I think it would be better to observe, rather than quantifiably measure, wouldn't it.....................or not?????
If what you say is right Nicpod1, rearfoot orthotic angle for a runner need not be different from a walker. If you are right, tibio-varum has little impact on orthotic prescription.
The accepted view (right or wrong) is that running, with its narrower base of gait, simulates increased tibio-varum. With increase tibio-varum ( or decreased base of gait with running), I thought demanded a rearfoot angle to to prevent the subtalar joint compensating into a relative pronation, despite appearing vertical.
If it is relevant to orthotic prescription, we need to measure whether it exists, and to what degree/severity.
But, in some way I agree that we can over-measure/analyse to the point of clinical inefficiency.
Didn't Rich Blake show that the so called running limb varus was a myth? The myth of running limb varus S Tristant and RL Blake
Center for Sports Medicine, Saint Francis Memorial Hospital, San Francisco, CA 94109.
Quote:
Even though the authors believe that there are many flaws in treadmill-based video analysis, they do believe that this study shows that running limb varus is not as important a concept as previously discussed by many authors. The FootTrak system is the first system available to give biomechanical researchers the ability to document the tibia-to-vertical angle with computerized digitation. The clinician with a knowledge of biomechanics understands that functional orthotic devices are more effective on primary calcaneal motions and positions than motions and positions produced by extrinsic tibial, knee, or hip factors. Thus, functional foot orthoses tend to work better in controlling varus during running that is produced by the calcaneus, rather than the tibia.
Sorry, I don't have access to the full transcript of Blake's paper. What does it actually refute? The narrower base-of-gait of a runner? The tibial verticality at heel strike?
I have accepted that the greater the distal tibia is removed from vertical, the greater the rear-foot correction inversion angle needed to align the tibio-talar-calcaneal relationship. Hence augmenting subtalar joint neutral etc....
Everyone is entitled to their opinion but in biomechanics I have certainly seen that there are no set rules - I believe in a 'treat what you can logically justify is causing the problem, or IS the problem, not what is THEORETICALLY the problem'.
e.g. I attended a 1/2 marathon last year, with international competitors in attendance. I was treating the athletes after the race and so had time on my hands before-hand and went up to the start to take a promo photo. On the way up to the start-line a runner ran past on his toes............he came in 3rd and came for treatment afterwards and I mentioned before he sat down that I had noticed him toe-running - on examination, BOTH ankle joints where fused....he was in no pain!
The guy should have had problems walking, let alone running - ACCORDING TO THEORY.
No matter how much tib varum there is, it is not going to change it's magnitude (unless Ricket's sets in!) and you are not going to correct it - so why not just measure those things that you can influence?
PS Fantasising about these things in the shower probably shows that things have gone to far - mind you - probably so does writing on this forum!
Didn't Rich Blake show that the so called running limb varus was a myth? The myth of running limb varus S Tristant and RL Blake
Center for Sports Medicine, Saint Francis Memorial Hospital, San Francisco, CA 94109.
The study done by Tristant and Blake was done at a jogging speed, not a running speed. As the speed of running increases, so does the tibial varum increase. This is more readily seen as one approaches 6 min/mile pace, where the runner is actually "leaping ahead" from foot to foot, attempting to minimize center of mass displacement by bringing their stance phase foot directly under their center of mass.
Take some videos or photos of a high school or college cross country team while running a fast training run or race if you want to see what I am talking about.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Everyone is entitled to their opinion but in biomechanics I have certainly seen that there are no set rules - I believe in a 'treat what you can logically justify is causing the problem, or IS the problem, not what is THEORETICALLY the problem'.
I agree more than you realise. Someone who is prepared (in certain circumstances) to use rear-foot valgus posts and/or forefoot varus posts does not adhere at all to the latest research paper or consensus theory dogma.
My interest in an extrinsic factor such as tibial varum, is that it may help explain to me, why one pair of orthotic devices work for one set of feet and symptoms, whereas the same type of force introduction will not do so well for a similar set of feet (similar supination-resistance testing, STJ axis position and angle, NCSP, RCSP etc....) and symptoms.
Last edited by Atlas : 1st February 2005 at 05:06 PM.
Tibial varum measurement
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