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Met Adductus in Adults

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  #1  
Old 15th February 2005, 10:14 PM
clhanna clhanna is offline
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Default Met Adductus in Adults

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Hi there everyone,

I was just wondering if anyone had any thoughts on how to treat Met Adductus in people say above the age of 20. Orthoses, strapping, mobilisation/manipulation, surgery ......?


Cheers
Cam
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  #2  
Old 17th February 2005, 10:58 AM
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Originally Posted by clhanna
Hi there everyone,

I was just wondering if anyone had any thoughts on how to treat Met Adductus in people say above the age of 20. Orthoses, strapping, mobilisation/manipulation, surgery ......?


Cheers
Cam
Why would one want to even treat metatarsus adductus, unless it was causing symptoms or pathology? Metatarsus adductus can be quite beneficial mechanically for the foot since it improves the pronation-resisting nature of the foot and is actually present to some degree in most normally functioning feet. At what level of deformity do you propose treating metatarsus adductus if they are asymptomatic otherwise?
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Old 17th February 2005, 04:56 PM
clhanna clhanna is offline
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Sorry Kevin,
I should have given a better description of the symptoms that i have been presented with.

Pt complaining of pain associated with overloading the lateral rays during gait. There is also associated rearfoot varus and the x-rays showed a supinated rearfoot complex (talar declination angle, calc inc angle), so there is quite a cavous presentation. The pt has a very broad forefoot that we have fitted into some extra depth and width footwear. I'm wondering if there are any suggestions regarding style of orthotic device, the use of mobilisation/manipulation, strapping, comments on surgery for this condition.......?

Cheers
Cam
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Old 17th February 2005, 06:33 PM
clhanna clhanna is offline
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Kevin, I'm just going to pick your brain for a bit here, hope that is ok!

Regarding met adductus, what is your approach to treating asymptomatic children with this condition?

If anyone else has any thoughts feel free


Cam
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Old 17th February 2005, 10:15 PM
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Quote:
Originally Posted by clhanna
Kevin, I'm just going to pick your brain for a bit here, hope that is ok!

Regarding met adductus, what is your approach to treating asymptomatic children with this condition?

If anyone else has any thoughts feel free


Cam
I don't treat asymptomatic children with metatarsus adductus unless the child is quite young (less than 8 months old) and the deformity is quite significant. I do serial casting for those children.
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**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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Old 17th February 2005, 10:21 PM
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Quote:
Originally Posted by clhanna
Sorry Kevin,
I should have given a better description of the symptoms that i have been presented with.

Pt complaining of pain associated with overloading the lateral rays during gait. There is also associated rearfoot varus and the x-rays showed a supinated rearfoot complex (talar declination angle, calc inc angle), so there is quite a cavous presentation. The pt has a very broad forefoot that we have fitted into some extra depth and width footwear. I'm wondering if there are any suggestions regarding style of orthotic device, the use of mobilisation/manipulation, strapping, comments on surgery for this condition.......?

Cheers
Cam
Try an orthosis with a lateral heel skive and forefoot valgus correction and extra medial arch fill in the positive cast (to lower medial arch height of orthosis). The metatarsus adductus increases the subtalar joint supination moment since the metatarsal heads are all structurally positioned more medial relative to the STJ axis than would be present in a metatarsus rectus foot (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001). The overloading of the lateral metatarsal rays is a reflection of the increased magnitudes of STJ supination moments. I wouldn't also be surprised if the peroneus brevis and/or longus are also tonically active during relaxed bipedal stance.
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Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
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Old 21st February 2005, 04:26 PM
clhanna clhanna is offline
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Quote:
Originally Posted by Kevin Kirby
Try an orthosis with a lateral heel skive and forefoot valgus correction and extra medial arch fill in the positive cast (to lower medial arch height of orthosis). The metatarsus adductus increases the subtalar joint supination moment since the metatarsal heads are all structurally positioned more medial relative to the STJ axis than would be present in a metatarsus rectus foot (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001). The overloading of the lateral metatarsal rays is a reflection of the increased magnitudes of STJ supination moments. I wouldn't also be surprised if the peroneus brevis and/or longus are also tonically active during relaxed bipedal stance.
Thanks Kevin,
that was basically my exact prescription and you were spot on about PL and PB.

Regards
Cameron
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