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{ADMIN NOTE: I Have merged two threads here as there were parallel discussions going on. Sorry if this thread is a bit disjointed}
I have been taken to task by some about my absolute feeling that the Dudley Mortons Toe (short 1st or hypermobile 1st) is the major cause of alot of foot problems. I stand ready to start a spirted discussion to help you, help your patients learn about this.
But in the morning please check any 10 charts of yours at random to see what % o f your patients have a short 1st or hypermobile first.
I am looking foreward to a interesting discussion
P.S. I have been a DPM for 34 years and have treated about 25,000 people
Dr. Burton S. Schuler
Panama City, FL
Last edited by Admin : 13th July 2009 at 05:14 AM.
I have been taken to task by some about my absolute feeling that the Dudley Mortons Toe (short 1st or hypermobile 1st) is the major cause of alot of foot problems. I stand ready to start a spirted discussion to help you, help your patients learn about this.
If you do not receive replies to your question in the Introductions area of the forum please consider reposting again i the General Issues & Discussions section. Not all of our members view introductions regularly & the intro' posts do not apear on the home page as other posts do. Many thanks.
Kind regards,
Mandy.
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
Last edited by twirly : 9th July 2009 at 06:03 AM.
Reason: I'm learning how to do technology :o)
Dudley Mortons Toe (and love of money) the root of all Evil
Quote:
A new poster Put this in the "introductions" pages. I thought I'd reproduce it here where it belongs.
I have been taken to task by some about my absolute feeling that the Dudley Mortons Toe (short 1st or hypermobile 1st) is the major cause of alot of foot problems. I stand ready to start a spirted discussion to help you, help your patients learn about this.
But in the morning please check any 10 charts of yours at random to see what % o f your patients have a short 1st or hypermobile first.
I am looking foreward to a interesting discussion
P.S. I have been a DPM for 34 years and have treated about 25,000 people
Re: Dudley Mortons Toe (and love of money) the root of all Evil
I'll start.
You said.
Quote:
But in the morning please check any 10 charts of yours at random to see what % o f your patients have a short 1st or hypermobile first.
Leave alone the short 1sts, Lets say ALL my patients had a hypermobile first ray. Does that indicate:-
1. That they are patients (have a pathology) because they have a hypermobile first.
2. They have a hypermobile 1st because they have some form of other pathology.
3. Neither of the above
There are two reasons I would "take you to task." One is that you presume causality from correlation. The other is that unless you can offer a demographic cross sectional study you may be simply observing the conjugation heuristic.
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr. Burton S. Schuler of Panama City, FL
Maybe you should explain what you have written in your book in a short, scientific manner stating research that you have done to back up your ideas so those who have not read your book understand where you are comming from.
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dear Dr Schuler,
Quote:
I have been taken to task by some about my absolute feeling that the Dudley Mortons Toe (short 1st or hypermobile 1st) is the major cause of alot of foot problems.
I bet you have.
Quote:
I stand ready to start a spirted discussion to help you, help your patients learn about this.
This should be fun.
Just a heads up... you just might want to take a little squizz over some of these threads regarding "hypermobility" before Dr Kirby comes along...
The Toe Pad is a patented, proven medical treatment, that has withstood the test of time. It is not a work in progress. It is not an arch support or a special shoe that costs hundreds of dollars and will not work. It is a simple pad or insole that can be made for about $2.00 -$3.00. In Why You Really Hurt: It All Starts In The Foot, we show you how to make the Toe Pad.
Erm...I think we can work that one out Dr... and just how do you patent a piece of felt and 2 bits of tape??
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Oh Lor', I'd not seen the website.
Some gems.
Quote:
Look down at your feet. Socks off please! If your second toe seems longer, (and I mean even just a hair longer) than your first toe, you may have a short first metatarsal bone.
Quote:
It is very possible that because you have a Morton’s Toe, you have been suffering for years with an undiagnosed Myofascial Pain Syndrome or Fibromyalgia. This could be the real underlying cause of the aches and pains, all over your body, that no one, no medicine, or no thing, has been able to help. Millions of people suffer every day, with these torments and do not know why. I believe that in many cases Morton’s Toe is the explanation for this WHY, and the reason for aches and pains not only in their back, knee, and hip but also in a lot other places in their body.
Including the jaw. Shades of Rothbart indeed.
Quote:
Morton’s Toe causes fallen arches and flat feet.
Well thats that cleared up then.
Quote:
WHAT IS PRONATION?
“Pronation has long been recognized as a
cardinal sign of foot disorder”
Dr. Dudley J. Morton
Damn that pronation.
Oh very dear.
Does anyone else get the idea that more than a few of these things, (Rothbart, Glaser, this,) are just rehashes of old concepts which have since been superceeded? Its almost like somebody who has heard of cars, but never seen one, gets a good look at a model T Ford, gets excited at how much less poo it creates, and how much faster it is than his horse, then rushes out to tell all his mates (who are already driving in ford Mondeo's) how great this exciting new thing is!
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Enough of this cruel, unsupported barracking. Lets get down to specifics.
Dr Schuler.
You Said
Quote:
Over the years, the one constant that I have seen with patients who have bunions is a short first metatarsal bone and/or hypermobility of the first metatarsal bone, (Morton’s Toe) due to inheritance. We know that Morton’s Toe takes place at the first metatarsal bone, so it makes sense you will have a lot of abnormal stresses and strains at that area. Because of this, bunions can and do exist.
How would you suggest we reconcile this with research like this
Quote:
Length of the first metatarsal and hallux in hallux valgus in the initial stage.
Munuera PV, Polo J, Rebollo J.
Int Orthop. 2008 Aug;32(4):489-95.
Quote:
The aim of this study was to confirm whether the length of the first metatarsal and the length of the hallux are greater than normal in the initial phase of the hallux valgus deformity. In a sample of 152 radiographs (98 of normal feet and 54 of incipient hallux valgus feet), the length of the first metatarsal and the hallux was measured according to methods previously described. Comparisons were made between normal and hallux valgus feet, and between male and female feet. The results show significant differences between the two groups in the first metatarsal (P<0.0001) and hallux (P<0.001). In the male feet, these differences are more marked (when comparing the length of the hallux between the female hallux valgus feet and the female normal feet, P>0.05). This indicates that in men with hallux valgus, the excess in length of the first metatarso-digital segment is greater than in women that develop this deformity, at least in its initial phase. According to these results, the size of the first metatarso-digital segment could be involved in the development of the hallux valgus deformity.
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
You said:-
Quote:
In Vol. 1 of their book Myofascial Pain and Dysfunction: the Trigger Point Manual, Doctors Travell and Simons stated that because of Morton’s Toe, sometimes the muscles of the lower leg can work against the head and neck muscles, resulting in restrictions of the movement of the head and neck muscles. It is this problem that can cause Temporomandibular Joint Pain. Treating the Morton’s Toe can decrease this problem by as much as 30 percent.
How do the muscles of the lower leg "work against" the muscles of the head and neck?
How was the figure of 30% improvement arrived at? Or is it a guess?
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
You state that a 1st ray which is hypermobile, and therefore dorsiflexes under GRF, is a bad thing (in fact THE bad thing).
You further state
Quote:
the reason for the excessive motion is due to an abnormal laxity (looseness) of the plantar ligament that runs under the metatarsal bone. This laxity is either inherited or acquired in childhood.
Do you feel that this hypermobility can be aquired in adulthood or is Davis Law incorrect?
If we accept that davis Law (and Wolf's Law) IS correct and that bone and ligament will stretch / change according to forces acting upon do you see a problem in treating a condition caused by a hyperextendable 1st ray with a device which will increase dorsiflexion moments in that very structure?
In other words, if the problem with the first ray is that it is too dorsiflexed (or able to me too dorsiflexed), should we be seeking to dorsiflex it MORE?
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
You speak of plantar fascitis.
Will dorsiflexing the 1st metatarsal with a toe pad (as you advocate)
A: Increase, or
B: Decrease
The tension in the Plantar fascia (specifically the medial slip of the planter apeurneurosis) after the heel lifts and the windlass mechanism comes into force.
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
You advocate the use of the toe pad (to dorsiflex the 1st metatarsal) for a wide variety of pathology including 1st MPJ problems.
Do you feel that dorsiflexing the 1st toe will
A: Increase, or
B: Decrease
Internal planterflexion moments at the 1st MPJ during gait. And if A ; (a clue, Check out the work of a bloke called Howard) do you think this might increase interosseus trauma and predicate Function Hallux Limitus.
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
You said:-
Quote:
Morton’s Toe (Long Second Toe) , can be caused by one or both of two problems that can effect the first metatarsal bone
I'll admit to being confused here. I understand the concept that a hypermobile or short 1st metatarsal might reduce a substantial portion of Ground reaction force medial to the Sub talar axis. This might reduce supination moments across the STJ and the "abnormal pronation" you speak of might ensue.
However I don't understand how, if Mortons toe refers to a long SECOND toe Rather than a short FIRST toe, how this will be. How can a problem with a long second toe be defined entirely by the length / behaviour of the first?
In a nutshell, is Mortons toe (or mortons foot syndrome if you prefer) caused by a long second toe or a short / hypermobile first?
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
One chapter of your book is entitled:
Quote:
Why arch supports don’t work
Would you mind elaborating on that, with particular reference to the literature on orthotics which shows resolution rates around 65% and improvement rates over 80%?
Do you have any such literature to show that the toe pad DOES work?
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
You said
Quote:
Many reasons have been given in the past for why our heels hurt. I absolutely feel that having a Morton’s Toe is one of these reasons.
The plantar fascia is the large rubber-band type structure that helps support our whole foot. Because of that, it gets strained a great deal and is the major cause of heel pain.
I base this statement on the thousands of foot/heel x-rays I have taken over thirty years as a foot doctor. I absolutely feel that this fact has been overlooked by most foot doctors. I invite them to verify the truth of my observation. If they did look for a Morton’s Toe, I feel they would find one present the vast majority of time their patients appeared with heel or arch pain.
Would you say that mortons toe (by your definition of the second toe being longer than the first) exists in
A: A minority of feet
B: About half of feet
C: The majority of feet
D: The Vast majority of feet.
If you answer C or D, that mortons toe is present in the majority of feet, do you feel this might explain the fact that it appears in the majority of feet WITH HEEL SPURS.
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr schuler
You said
Quote:
There are big big bucks to be made in selling pre-made arch supports and insoles. It is an industry that makes hundreds of millions of dollars a year. They are sold everywhere from special chain stores that sell nothing but arch supports and insoles, to a guy selling them out of the trunk of his car. The one common denominator is that these “things” are sold based on false hopes and fraudulent claims. The people selling them have as much knowledge and training about the human foot and why you really hurt as the nice person who asked you if you want paper or plastic at the grocery checkout counter.
Given the research which shows that Pre fabricated orthotics can acheive real improvement in assorted foo pathology do you feel that these claims are truly fraudulent?
Do you feel your generalisation of people selling them is accurate?
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
You said
Quote:
Even if you feel wonderful with your supports or insoles, you are not treating the real reason for your foot/arch pain. The problem is not your arch but the ball of your feet and the metatarsal bones.
Do you feel it appropriate that you are telling the reader (ie anyone who has felt wonderful with insoles) that their problem is in fact, mortons toe? Do you now contend that 100% of foot pain is caused by this?
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Dr Schuler
You said
Quote:
However, Dr. Dudley J. Morton, the leading medical expert on the human foot for the first half of the 20th century, who taught at Yale and Columbia Medical Schools, and who wrote seven medical textbooks, might be wrong. And the nice person in the arch support store, who was selling double-wide mobile homes a week before you met, may be right. It really is a close call.
Is this a fair (nay ethical) statement or is it a tad misleading? Have their been other "experts in the human foot" who came AFTER Morton who thought that their might be something to this whole orthotics idea after all?
Re: Dudley Mortons Toe (and love of money) the root of all Evil
Robert:
A little too much caffeine this evening??
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Pathology of the 1st metartarsal bone
Re: Pathology of the 1st metartarsal bone
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Re: Dudley Mortons Toe (and love of money) the root of all Evil
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