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Wednesday, April 6, 2011

Top 100 Biomechanical Guidelines #43: Sagittal Plane Blockade may Occur with Everted not Inverted Heel Corrections (Forefoot Varus Correction could cause Blockade of Motion)

These are Forefoot Varus Casts. Uncorrected then lean inward and the arch would flatten and foot pronate. Correction of this foot has always been a dilemma for biomechanical experts. If you fully straighten this foot, the heel goes straight up and down, but the correction places too much support under the inside front of the foot (near the big toe). Drs Sheldon Langer, Justin Wernick, and Howard Dannenberg were the first podiatrists to discover and explore how potentially dangerous this support was. Too much pressure under the big toe area (first metatarsal) could block the normal motion of the foot from heel to toe and cause problems in the foot, ankle, knee, hip and back. They coined the phrase "Sagittal Plane Blockade" to describe this problem. When you walk with your orthotic devices, do you feel like you can easily move across them? This is a question I try to ask all my patients, and try to observe in gait evaluation. It is vital for normal foot function and to avoid symptoms.

     When I measure foot biomechanics, and I take a cast capturing over 5 degrees of forefoot varus, I know I will have issues for compromise to deal with. Fully correcting the total amount of forefoot varus would probably lead to problems related to Sagittal Plane Blockade. Correcting less than total could lead to the continuation of symptoms related to the pronation I was trying to treat in the first place. For the biomechanical experts out there, if you sacrifice some of the forefoot varus correction with a modified Root Balance Technique consider Kirby Skives, Inverted Pours, or BiAxial Wedging to get your pronation control without producing Sagittal Plane Blockade. You are basically transferring support from the front of the arch to the back of the arch.

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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.