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The British Association of Prosthetists and Orthotists (BAPO) was established to encourage high standards of prosthetic and orthotic practice. It is committed to Continued Professional Development and education to enhance standards of prosthetic and orthotic care. BAPO is the only UK body that represents the interests of prosthetic and orthotic professionals and associate members to their employers, BAPO enjoys the support of a high majority of the profession as members.
Monday, 26 November 2012
BAPO Conference & Exhibition 2013 - Sponsorship Information
Thursday, 22 November 2012
The role of foot morphology on foot function in diabetic subjects with or without neuropathy
- Annamaria Guiottoa, 1,
, - Zimi Sawachaa, 2, ,
- Gabriella Guarnerib, 3, ,
- Giuseppe Cristoferib, 4, ,
- Angelo Avogarob, 5, ,
- Claudio Cobellia,
Abstract
The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P < 0.05), decreased contact surface on the hindfoot (P < 0.03).
While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions.
Highlights
► Simultaneous three-dimensional kinematics and pressure analysis of three foot's subsegments: hindfoot, midfoot, forefoot. ► Comparison between controls, diabetics non neuropathic and neuropathic subjects' foot biomechanics. ► Foot morphology contribution to altered biomechanics. ► Data were collected during gait on 60 subjects: 20 controls and 40 diabetics. ► Statistically significant alterations on neuropathic and diabetic subjects with different foot morphology and heel/hallux alignment.
Source: http://www.sciencedirect.com/science/article/pii/S0966636212003700
Tuesday, 20 November 2012
BAPO Conference & Exhibition 2013 Registration now open
BAPOnline NOW OPEN!
Register for Conference & Exhibition 2013 at www.bapo.com
For for the very latest info on our Clinical Programme, Competitions and Social Programme look no further than latest NewsJigs:
http://gallery.mailchimp.com/e99b59101e344f80e38400f12/files/Newsjigs_Nov_2012_FINAL_.pdf
Tuesday, 13 November 2012
Fwd: NHS CB welcomes mandate from the Government
PRESS RELEASE
13 November 2012
WE WILL PUT PATIENTS AT THE HEART OF A LIBERATED AND INNOVATIVE NHS, PLEDGE HEADS OF NEW NHS COMMISSIONING BOARD
The Chief Executive of the NHS Commissioning Board today (Tuesday) welcomed its mandate from the Government.
Sir David Nicholson described the mandate as "a major step on the road to the more liberated and innovative NHS that can be more responsive to its patients."
The NHS Commissioning Board (NHS CB), which is independent of government, is currently preparing to take on its full responsibilities from 1 April 2013.
Sir David said: "Our aim and our passion is to deliver a better NHS on behalf of patients and the public. We will do this by working side by side with local clinical leaders; by focussing relentlessly on the outcomes that the NHS delivers for people; and by freeing those on the frontline to transform services in line with the needs of local communities.
"The mandate enables us to do this. It marks a major step on the road to the more liberated and innovative NHS that can be more responsive to its patients.
"Make no mistake, the NHS will find this a challenging and stretching ask - and it comes against the most challenging financial environment the NHS has ever experienced. But I believe the goals are achievable.
"The mandate avoids the danger of excessively prescribing the actions of health professionals. We in the NHS Commissioning Board want to ensure power in the NHS sits with those who are closest to the patients. Our role will be to work closely with local clinical leaders and provide the support they need. Our role is not to tell them what to do."
Sir David concluded: "I am under no illusions about the scale of the task. There will be bumps in the road and we will have to learn from them.
"But I have been greatly impressed with the enthusiasm and commitment shown by our new clinical leaders and I look forward to us continuing to work in partnership to do what's best for patients in the coming years.
"We have a once in a lifetime opportunity to do things differently. We will succeed only by releasing the energy, ideas and commitment of front-line staff and organisations. The NHS Commissioning Board wholeheartedly embraces this challenge."
The Chair of the NHS Commissioning Board, Malcolm Grant, added: "The publication of the Government's mandate to the NHS Commissioning Board marks a vital milestone in the liberation of the NHS.
"It sets clear objectives for the NHS for the coming two years, couched in terms of outcomes for patients, and it recognises that the NHS CB and clinical commissioning groups (CCGs) must operate independently from day-to-day political control.
"The aim of the NHS CB is to secure greatest value to patients from the nation's investment in the NHS. We will oversee delivery against the mandate, and compliance with commissioners' broader legal duties.
"And we will ensure maximum freedom for CCGs, so that local clinical leaders may respond more effectively to the needs of their local population. They willneed to innovate and transform local health services to meet the needs and wishes of patients, while assuring the delivery of improved outcomes.
"This is an exceptionally challenging yet exciting time for the NHS, and through the mandate the Government has laid the foundation for a locally responsive, clinically-led NHS, focused on improving outcomes for the people of England."
Monday, 12 November 2012
Pressure Ulcers: Prevention and management in primary and secondary care Guideline
Do you work with Children? Do you have knowledge in treating pressure ulcers? Why not share this knowledge and join NICE on a consensus panel. BAPO is a registered stakeholder and you can help out as a BAPO member in offering help to support your professions treatment in this area.
The National Clinical Guideline Centre (NCGC) is now recruiting for members of a Delphi consensus panel to inform the areas regarding children in the guideline 'Pressure Ulcers: Prevention and management in primary and secondary care' guideline.
The NCGC is currently developing guidance for the prevention and management of pressure ulcers for all who access NHS service. However, it is acknowledged that there are few randomised controlled trials or high quality cohort studies available for children (including neonates, infants, children and young people). It is recognised that, in areas such as this where there is no high quality evidence available, the use of formal consensus methods is appropriate. Therefore, to inform the development of the guideline, the guideline development group will use a modified Delphi consensus technique to agree statements relating to the prevention and management of pressure ulcers in children and young people, which will subsequently be developed into recommendations for inclusion in the guideline.
Below is a link to the advertisement, which includes information on the roles required for the panel and all the necessary details on how to apply. The deadline for applications is 5pm, 21st November 2012.
Panel members will be expected to take part in two consensus surveys, via email. In addition, panel members will need to be able to deal in a timely manner with any relevant correspondence.
If you have any queries regarding these positions, please contact katie.jones@rcplondon.ac.uk.
Sunday, 11 November 2012
'Autism gene discovered' by researchers - Health News -
"Genetic mutation discovered in people with autism," The Daily Telegraph reports.
The newspaper goes on to say that this mutation "cuts communication between brain cells to about one-tenth of normal levels" and offers "a likely explanation" for the cognitive and behavioural difficulties experienced by people with autism.
This headline is loosely based on recent research into the impact of a previously discovered genetic mutation on the ability of brain cells to transmit signals. The Telegraph speculated that misfiring signals could cause the symptoms of autism.
The study was conducted using rat brain cells, and did not involve people with autism directly.
The researchers described the detailed molecular processes that occur between brain cells when the level of a specific protein is changed. Previous research had discovered that mutations to the gene that controls this protein occurred in people with some types of autism. The authors found that varying the level of this protein affected other proteins responsible for communication between the rats' brain cells.
The research did not, however, examine the impact of this disrupted communication in people with autism, and should not be interpreted as offering "a likely explanation for their cognitive and behavioural difficulties" as reported by the Telegraph.
In addition, many experts think that autism may arise as the result of a combination of factors – not just genetics. Viewing autism as a purely genetic disease may well be an over-simplification.
Wednesday, 7 November 2012
NHS Continuing Healthcare: Getting Ready for 2013
NHS continuing healthcare (NHS CHC), NHS funded nursing care and personal health budgets is an area of £2bn spend and covers health and social care needs for very vulnerable people.
CCGs will be legally responsible from 1 April 2013 for undertaking this assessment process which is prescribed by the Department of Health, underpinned by legislation and must be consistently applied throughout England.
NHS North of England has prepared a set of slides as part of an overall briefing pack for CCGs. The slides set out:
- An overview and why this is an issue for CCGs and CCG responsibilities
- An outline of the policy context
- An outline of what CCGs will inherit (individuals can ask for their cases to be looked at back to 2004)
- Whether there will be any policy changes after 2013
- Key performance issues (consistency in access is key to NHS CHC)
- What CCGs need to be able to deliver on NHS CHC from April2013
- Links to commissioning support, the NHS CB and local authorities
The work needed now to be legally compliant for April 2013
The pack also lists NHS CHC leads in each of the SHA areas.
Tuesday, 6 November 2012
Healthy Living and Social Care theme launched as part of Red Tape Challenge
The Healthy Living and Social Care theme of the Red Tape Challenge launches today.
The 6-week long initiative invites healthcare professionals and the public to comment on regulations covering a range of areas including quality of care, mental health, the NHS, public health and professional standards.
Since its launch in April 2011, the Red Tape Challenge has looked at regulations across government that have an impact on business, the voluntary sector or the public.
The Department for Business, Innovation and Skills is also launching its 'Focus on Enforcement' review, which is part of the government's commitment to regulate all businesses more efficiently.
Public Health Minister Anna Soubry said:
"This Challenge will give the public, healthcare workers and clinicians a vital opportunity to let us know how we can improve the way we regulate or how we can do things differently, whilst ensuring the public is protected.
"We will use the feedback they give us to plan how to get rid of requirements that are no longer needed, freeing up business from unnecessary red tape and giving health professionals more time to care for patients."
Monday, 5 November 2012
SERUM MELATONIN LEVELS IN ADOLESCENT IDIOPATHIC SCOLIOSIS PREDICTION AND PREVENTION FOR CURVE PROGRESSION PROSPECTIVE STUDY
M. Machida, J. Dubousset * , T. Yamada ** and J. Kimura **
Author Affiliations
Corresponding to: Masafumi MACHIDA, M.D., Department of Orthopaedic Surgery, National Hospital Oraganization, Murayama Medical Centre, 37-1, 2-chome, Gakuen, Musashimurayama-shi, Tokyo 208-0011, JAPAN., Fax: 81-42-564-2210, E-mail: masa85@oak.ocn.ne.jp.
Abstract
Objective: To clarify whether serum melatonin levels in adolescent idiopathic scoliosis correlate with curve progression, and whether the exogenous melatonin treatment is effective in patients with decreased levels of endogenous melatonin in adolescent idiopathic scoliosis.
Method: A total of 63 adolescents were studied; 38 with adolescent idiopathic scoliosis and 25 age matched control subjects. We divided the patients into stable (28 patients) and progressive (10 patients) groups based on the scoliotic curve measured radiographically at three to six month intervals. The level of melatonin was considered low if it fell below the mean – 2.0 standard deviation established in normal adolescents throughout the 24 hour period or nocturnal (0:00 –6:00 hour) integrated concentration. Oral melatonin replacement (3mg / before bedding) was administered in patients with decreased endogenous melatonin. The patients with low melatonin were treated with a brace, melatonin or both combined. During melatonin treatment, the level of melatonin was measured yearly for a period ranging from three to six years.
Results: In all subjects the melatonin levels showed diurnal variations; low during the day and high at night. Of 38 patients with adolescent idiopathic scoliosis, 22 patients had normal melatonin and 16 had low melatonin. Of 22 patients with a normal melatonin, 10 of 15 treated with brace and 6 of 7 untreated patients had stable scoliosis, and the remaining six had a progressive scoliosis. Of 16 patients with low melatonin, eight of nine treated only with melatonin, and four of seven treated with melatonin and brace had stable scoliosis. The remaining four had a progressive course. Of the 10 patients who had progressive scoliosis in normal and low levels of melatonin, nine had greater than 40 degrees of curve at the initial examination.
Conclusion: These findings suggest that transient melatonin deficiency may be associated with deterioration of scoliosis and that melatonin level may serve as a useful predictor for progression of spine curvature in patients with idiopathic scoliosis. Also, the results of this study suggest a possible role of melatonin supplement in the prevention of progressive scoliosis especially in mild cases showing less than a 40° curve.
http://www.bjjprocs.boneandjoint.org.uk/content/90-B/SUPP_III/430.4.abstract
Saturday, 3 November 2012
Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after 1 year of wear
Joaquin A. Barrios1,*, Robert J. Butler2, Jeremy R. Crenshaw3, Todd D. Royer4, Irene S. Davis5
Journal of Orthopaedic Research
Abstract
The use of lateral foot wedging in the management of medial knee osteoarthritis is under scrutiny. Interestingly, there have been minimal efforts to evaluate biomechanical effectiveness with long-term use. Therefore, we aimed to evaluate dynamic knee loading (assessed using the knee adduction moment) and other secondary gait parameters in patients with medial knee osteoarthritis wearing lateral foot wedging at a baseline visit and after 1 year of wear. Three-dimensional gait data were captured in an intervention group of 19 patients with symptomatic medial knee osteoarthritis wearing their prescribed laterally wedged foot orthoses at 0 and 12 months. Wedge amounts were prescribed based on symptom response to a step-down test. A control group of 19 patients wearing prescribed neutral orthoses were also captured at 0 and 12 months. The gait of the intervention group wearing neutral orthoses was additionally captured. Walking speed and shoes were controlled. Analyses of variance were conducted to examine for group-by-time (between the groups in their prescribed orthoses) and condition-by-time (within the intervention group) interactions, main effects, and simple effects. We observed increased knee adduction moments and frontal plane motion over time in the control group but not the intervention group. Further, within the intervention group, the mechanical effectiveness of the lateral wedging did not decrease. In patients with medial knee osteoarthritis, the effects of lateral foot wedging on pathomechanics associated with medial knee osteoarthritis were favorable and sustained over time. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
Friday, 2 November 2012
The Effects of Wedged Footwear on Lower Limb Frontal-Plane Biomechanics During Running
Lewinson, Ryan T. BSc; Fukuchi, Claudiane A. BSc, PT; Worobets, Jay T. PhD; Stefanyshyn, Darren J. PhD, PEng
Clinical Journal of Sport Medicine:
POST AUTHOR CORRECTIONS, 25 October 2012
doi: 10.1097/JSM.0b013e31826b7c83
Original Research: PDF Only
Objective: Patellofemoral pain syndrome (PFPS), the most common running injury, has been associated with increased internal knee abduction angular impulses (KAAI). Wedged footwear can reduce these impulses during walking, but their effects during running are not well understood. The purpose of this study was to identify the effects of wedged footwear on KAAIs and describe the mechanism by which wedged footwear alters KAAIs during running.
Design: Controlled Laboratory Study.
Setting: Motion analysis laboratory.
Participants: Nine healthy male subjects.
Interventions: Participants ran at a speed of 4 m/s with 7 different footwear conditions (3-, 6-, and 9-mm lateral wedges; 3-, 6-, and 9-mm medial wedges; neutral).
Main Outcome Measures: Knee abduction angular impulses and 8 predictor variables were measured and compared by 1-way repeated-measures analysis of variance ([alpha] = 0.05) with Bonferroni-adjusted 2-tailed paired t tests for post hoc analysis ([alpha] = 0.002). Correlation ([alpha] = 0.05) was used to determine the relationship between the mediolateral center-of-pressure to ankle joint center (COP-AJC) lever arm length and KAAIs.
Results: Laterally wedged conditions produced significantly lower KAAIs (P = 0.001) than medial wedge conditions. Peak knee abduction moments decreased (P = 0.001), whereas ankle inversion moments (P = 0.041) and the COP-AJC lever arms increased (P < 0.001) as wedges progressed from medial to lateral. KAAIs were negatively correlated with COP-AJC lever arm length (r = -0.50, P < 0.001).
Conclusions: KAAIs are reduced with laterally wedged footwear because of lateral shifts in the center-of-pressure beneath the foot, which then increases ankle inversion moments and decreases peak knee abduction moments. Laterally wedged footwear may therefore offer greater relief to runners with PFPS than medially wedged footwear by reducing KAAIs.
Thursday, 1 November 2012
Cheaper prosthetic finger prototype could be a blessing to many
10,000 miles will not stop Richard Van As of South Africa and Ivan Owen of Washington State from building an inexpensive prosthetic finger prototype that could one day help millions of amputees. Richard lost his arm last year in an accident. In spite of his condition, he did not lose hope and decided to search for prosthetics online that could help him. After a seemingly futile search, he eventually found one of Ivan's mechanical hand prop videos on YouTube.
Ivan, who has a keen interest in mechanical systems, started working on his prop as a personal project. Richard immediately sent Ivan an email and since then, both men have been trying to build a mechanical digit that could replace what finger amputees lost. Richard created a plastic replica of his hand for Ivan to use as a reference. Ivan went on to work on a prosthetic finger made up of a lever arm, a fingertip a set of pulleys, and a grip pad. The current prototype that Richard is now using acts like a glove and is held by a hand mount.
Unlike other high-tech prosthetic fingers in the market, Richard and Ivan claims that their prototype is cheaper and is easier to build. Richard and Ivan will be giving away the design for free so that other people will also benefit from their work. You can check out the project here. "My vision for the future will be to take this knowledge and carry it as far and as fast as possible. Get the design and parts out there to as many people as possible so that we can do as much as we can to help fill this need," said Ivan Owen.
Source: http://www.ubergizmo.com/2012/10/cheaper-prosthetic-finger-prototype-could-be-a-blessing-to-many/
Sunday, 28 October 2012
Consultation on ensuring fair and transparent pricing for NHS services
A consultation to help ensure fair and transparent pricing for NHS services is opened today by the Department of Health.
From April 2014, Monitor and the NHS Commissioning Board will take over responsibility for pricing NHS services from the Department. They will do this through the national tariff. These arrangements will place responsibility for pricing with the bodies best placed in the new system to undertake it.
This consultation seeks views on the Department of Health's proposals for:
- which providers can formally object to Monitor's way of calculating prices
- what level of objections from commissioners and/or providers would require Monitor to: reconsider how it calculates prices, or refer its way of calculating prices to the Competition Commission, who will then decide whether or not it is appropriate.
- Respond to the consultation online
- Read Fair and transparent pricing for NHS services – A consultation on proposals for objecting to proposed pricing methodology
- Download consultation response form
- Read answers to frequently asked questions for this consultation
The closing date for responses is 21 December 2012.
This consultation should be considered alongside current consultations on a new licensing regime for providers of NHS services and procurement regulations for NHS commissioners.
Saturday, 27 October 2012
Role of ankle foot orthoses in the outcome of clinical tests of balance, Disability and Rehabilitation: Assistive Technology, Informa Healthcare
Role of ankle foot orthoses in the outcome of clinical tests of balance, Disability and Rehabilitation: Assistive Technology, Informa Healthcare
Nilovana Panwalkar, Alexander S. Aruin
Source: http://informahealthcare.com/doi/abs/10.3109/17483107.2012.721158
Nilovana Panwalkar, Alexander S. Aruin
Purpose: The purpose of this study was to investigate the effect of ankle foot orthoses (AFOs) on the outcome of balance assessment. Methods: Ten healthy subjects participated in clinical tests of balance with and without bilateral ankle foot orthoses (AFOs). The following clinical tests were performed: the Modified Clinical Test of Sensory Interaction on Balance (MCTSIB), the Limits of Stability (LOS) and the Functional Reach test. Results: A statistically significant effect of AFOs was seen in the outcomes of the MCTSIB test (p = 0.042), LOS test (p = 0.021) and Reach test (p = 0.003). Conclusions: The results indicate that the use of AFOs may impede the performance of clinical tests of balance. This outcome should be taken into consideration while performing balance evaluations with patient populations in the clinic.
Implications for Rehabilitation
- Ankle foot orthoses (AFOs) are effective means of improving ambulation in patients.
- The use of AFOs may influence the outcome of clinical tests of balance.
- The role of AFOs should be taken into consideration while performing balance evaluations in the clinic.
Source: http://informahealthcare.com/doi/abs/10.3109/17483107.2012.721158
Clustering and classification of regional peak plantar pressures of diabetic feet
Abstract
High plantar pressures have been associated with foot ulceration in people with diabetes, who can experience loss of protective sensation due to peripheral neuropathy. Therefore, characterization of elevated plantar pressure distributions can provide a means of identifying diabetic patients at potential risk of foot ulceration. Plantar pressure distribution classification can also be used to determine suitable preventive interventions, such as the provision of an appropriately designed insole. In the past, emphasis has primarily been placed on the identification of individual focal areas of elevated pressure. The goal of this study was to utilize k-means clustering analysis to identify typical regional peak plantar pressure distributions in a group of 819 diabetic feet. The number of clusters was varied from 2 to 10 to examine the effect on the differentiation and classification of regional peak plantar pressure distributions. As the number of groups increased, so too did the specificity of their pressure distributions: starting with overall low or overall high peak pressure groups and extending to clusters exhibiting several focal peak pressures in different regions of the foot. However, as the number of clusters increased, the ability to accurately classify a given regional peak plantar pressure distribution decreased. The balance between these opposing constraints can be adjusted when assessing patients with feet that are potentially "at risk" or while prescribing footwear to reduce high regional pressures. This analysis provides an understanding of the variability of the regional peak plantar pressure distributions seen within the diabetic population and serves as a guide for the preemptive assessment and prevention of diabetic foot ulcers.
Source: http://www.jbiomech.com/article/S0021-9290(12)00521-0/abstract
Sunday, 21 October 2012
Effects of a knee–ankle–foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum
Abstract
Background
A knee–ankle–foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee–ankle–foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee–ankle–foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait.
Methods
Eleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee–ankle–foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle.
Findings
The knee–ankle–foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased.
Interpretation
Wearing a knee–ankle–foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle.
Keywords: Kinematic, Kinetic, Spatiotemporal, Hyperextension, Stance and swing phase
Source: http://www.clinbiomech.com/article/S0268-0033(12)00226-4/abstract
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Thursday, 18 October 2012
BAPOmag 2012 Issue 3
BAPOmag 2012 Issue 3 Now available and BAPO Members can download the latest issue from the Members section of our website.
Tuesday, 16 October 2012
Monday, 8 October 2012
Anatomical Origin of Forefoot Varus Malalignment
- Rebecca S. Lufler, PhD*,
- T. M. Hoagland, PhD†,
- Jingbo Niu, MD, DSc‡and
- K. Douglas Gross, PT, DSc‡
Abstract
Background: Forefoot varus malalignment is clinically defined as a nonweightbearing inversion of the metatarsal heads relative to a vertical bisection of the calcaneus in subtalar joint neutral. Although often targeted for treatment with foot orthoses, the etiology of forefoot varus malalignment has been debated and may involve an unalterable bony torsion of the talus.
Methods: Forty-nine feet from 25 cadavers underwent bilateral measurement of forefoot alignment using adapted clinical methods, followed by dissection and measurement of bony talar torsion. The relationship between forefoot alignment and talar torsion was determined using the Pearson correlation coefficient.
Results: Mean ± SD forefoot alignment was −0.9° ± 9.8° (valgus) and bony talar torsion was 32.8° ± 5.3° valgus. There was no association between forefoot alignment and talar torsion (r = 0.18; 95% confidence interval, −0.11 to 0.44; P = .22).
Conclusions: These findings may have implications for the treatment of forefoot varus since they suggest that the source of forefoot varus malalignment may be found in an alterable soft-tissue deformity rather than in an unalterable bony torsion of the talus. (J Am Podiatr Med Assoc 102(5): 390–395, 2012)
Source: http://www.japmaonline.org/content/102/5/390.short
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