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Friday, May 18, 2012

Biomechanics for the Podiatrist: Thou Shall Not Varus

  Blogging on Friday is Biomechanics for the Podiatrist    

The phase "Thou shall not Varus" is a bunionectomy phase for students and beginner surgeons to avoid over correction of a bunion. In this article, I would like to discuss a simple fix for patients who bring in shoes that over supinate them. This is also called under pronation, lateral instability or Varus Instability. After the foot is placed over 3-4 degrees of varus positioning, that foot can destabilize quickly and become laterally unstable. The YouTube video below describes this common problem most commonly observed as the patient walks away from you. 

     Lateral Instability or Excessive Varus Positioning can be helped in the office with simple shoe wedging at the time that the problem is noted. The following photos explain the process.

A scalpel is used to cut into the lateral side of the midsole normally from the heel to the metatarsal heads.

Then Barge Cement is used to glue the 2 sides of the opening and the 2 sides of the wedging material.
Here the 1/4 inch wedges, and they may be any thickness, are standing up with both sides glued and the glue is drying.
Here is a closer look at the wedge which is skived and the curved end to be placed into the distal end of the opening.
Once the glue has dried, the opening is forced wide, and the wedge is stuffed into the midsole as deep as possible.
Here is the side view of the wedge in place, the sides ground smooth, and super glue (or knock-off) used to seal any loose attachments.
Another view of this wedge from the back.

     One of my Golden Rules of Foot: Thou Shalt Not Varus. Over Supination has been blamed as a cause or aggravating factor in more than 17 injury pain syndromes, including peroneal tendinitis, ilio-tibial band syndrome, ankle sprains, stress fractures, knee and hip joint arthralgias, low back pain, etc. Patients who are too varus positioned as functionally unstable. Personally, I believe over pronation should get a little less press and over supination more. Definitely, this simple in office shoe wedging technique will help 1000s of your patients.

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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.