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Tuesday, February 15, 2011

Top 100 Biomechanical Guidelines #39: Root Balancing Crucial with Inverted Negative Cast (forefoot valgus/plantar flexed first ray deformities)

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     When I am dealing with patients with lateral foot and metatarsal problems, I love when I find forefoot valgus tilts in their biomechanics. The correction for this everted forefoot tilt allows for Maximum Lateral Column and Metatarsal Support at the same time. The cast of the right foot below shows the negative cast capturing this everted forefoot to rearfoot relationship. When the forefoot has an everted deformity, the negative cast will sit inverted.

Here the casts are brought back to a more stable heel vertical position in preparation for making the postive cast corrections, and eventually, the orthotic devices themselves.


After this cast is filled with solid plaster, it will be leveled to the stable heel vertical position.


See how the lateral arch demonstrated here is just as high as some medial arch supports giving great lateral column support.

See how this lateral arch support will translate into great overall metatarsal support.

Here a little taste of how the process goes at the lab. Once the heel inverted position is noted, a nail is used to bring the cast back to a heel vertical stable position.

 Then plaster is used to make what is called a platform with the end point where the orthotic device (plastic) will end just behind the weigth bearing surface.
 Hopefully, this representation of the foot after the platform is in place shows the potential of great metatarsal support.
 Here the positive cast is placed down with lateral arch in full view. This translates into a great lateral or outside arch.
Here is an orthotic device made off a similiar mold with a inside and outside arch so similiar that it is hard to tell what side is the normal arch. Also, easily demonstrated, is how much natural metatarsal arch is created.

So, here is the magnificence of a Root Balanced Orthotic Device. In the next posts, I will be discussing the pros and cons of the Root Balancing of forefoot varus or supinatus. But, for now, I will finish saying balancing Forefoot everted deformities is the true greatness of the Root Technique. What are some of the problems treated successfully with this technique? These include:
  1. Morton's Neuromas
  2. Metatarsalgia
  3. Tailor's Bunions
  4. Bunions
  5. Metatarsal Stress Fractures
  6. Sesamoiditis/Sesamoid Fractures
  7. Cuboid Syndrome
  8. Midfoot Sprain/Arthralgias
  9. Peroneal Strains
  10. Ankle Sprains

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.