Thursday, October 18, 2007

Foot issues, pronation -why?

Hallux valgus: etiology

The most common forefoot problem encountered by podiatric surgeons is the painful bunion joint. The variety of ways in which this deformity presents, together with the technical considerations and difficulty in its management, pose a significant clinical challenge.

When you think you turn the pedal over about 5,000 times per hour, you can start to see why this is a big deal.


There is no one specific cause that might explain the incidence of hallux abducto valgus. However, there are numerous papers detailing the various etiologies which include: pronation, long first metatarsal, muscle imbalance, hyper mobility syndromes, biomechanics and footgear. On the bike, we see a lot of the problems from the wrong pair of shoes, along with the biomechanics of the best pedal stroke for their bones.

Hallux abducto valgus is common within the inflammatory arthropathies that cause discomfort while on the bike. In these cases, the deformity is presumed to be directly due to muscle imbalance, but we find that the muscle imbalanc is due to the saddle being too low. The condition is also more common in women which suggests that the role of high heel footgear may exacerbate a predisposition to hallux abducto valgus (wishing to be taller). My 19 year old dauther came in yesterday wanting to show me how her new high heels made her legs look more tone?

If the underlying biomechanical etiology is not adequately addressed, the deformity will recur. Therefore, an appreciation of the pathomechanics (wear & tear) of hallux abducto valgus is vital. The problem is your heel is in space and you can't know its orbit around the bottom bracket. Keep this simple, its best, taking what parts you already have on the front of the car! We can't change the shape of your bones! You picked your mom & dad!

We are not in health care, but we are in the alignment business! We don't want you to wear your speed rated tires out because you don't have the front-end of the car holding the correct toe-in or toe-out, yaw, etc... Get it right or wear & tear will come.

When we introduced the laser to bike fitting, many fitters simply looked at it as a tool to make your knee follow the line. Is was even written by fitting services that was the best use of the laser. That is the worst think you can do when your bones are a certain shape. Think about the wear and tear on the surface of the bones by doing this. This is one of the problems of just using a line from your knee.

Many people can't use the newer shoes that think eveyrone needs a cant! Products will be found out with time!

Hallux valgus:

Classically, the medial eminence of the first metatarsal is prominent and rubs against the side of the shoe. There may also be a bursa over the joint which becomes periodically inflamed (the use of higher heels). In addition, the lateral deviation of the hallux may compress the second toe contributing to a hammer deformity at the PIP joint.

Some complain of pressure underneath the first MTP joint, which may be related to sesamoid position, whilst others are aware of lesser metatarsalgia with particular pressure under the second MTP joint associated with transfer metatarsalgia and capsulitis of the second MTP joint. Occasionally, there may be a coexisting neuroma in the second or third interspace with characteristic symptoms of forefoot burning. Frequently, there is pain across the dorsal joint line, particularly laterally where the articulating cartilage is eroding. The range of motion of the hallux may be diminished due to early osteoarthrosis and degenerative changes within the joint.

It is important to assess the both weightbearing and non-weightbearing. If it goes too far, surgical correction might be the only fix of a painful hallux abducto valgus, without assessment of the biomechanical cause, may lead to early recurrence of the deformity and further pain, particularly even if you are young.

Our CAD takes into account the many shapes of your body, that is why it works. Don't force your joints into angles they don't go! You will wear them out!

If you have buring feet most of the time, it might be too late, it might be time to go to a podiatric surgeon to see if they can fix the problem.

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