Forefoot Valgus

Question 1

What is the definition of a forefoot valgus?

Answer 1

Forefoot valgus is a structural abnormality where the forefoot is everted in relation to the rearfoot when held in STJ neutral and MTJ locked. Two categories - total and functional.

Question 2

What is the aetiology of forefoot valgus?

Answer 2

Congenital deformity

• Excessive valgus torsion of the head and neck of talus
• PF 1st met

Question 3

Explain total forefoot valgus.

Answer 3

All mets are everted at STJ neutral.

Question 4

Explain functional forefoot valgus

Answer 4

Functional problem - e.g. PF 1st ray is functional forefoot valgus.

Question 5

Explain the pathomechanics of forefoot valgus.

Answer 5

Compensation for a forefoot valgus will occur at the MTJ first, then the STJ. It can be flexible or rigid.

Question 6

Explain flexible forefoot valgus.

Answer 6

Flexible forefoot valgus is when there is sufficient MTJ ROM to compensate for the valgus position.

Question 7

Explain rigid forefoot valgus.

Answer 7

Rigid forefoot valgus is when the MTJ has inadequate ROM to bring the forefoot to the ground, so STJ supination is required. The rear foot supinates to bring the forefoot to the ground, causing the calcaneus to invert and create rigid lever. These patients will tend to have a high arch and walk on the outside of their heels.

Question 8

What are the signs and symptoms of a flexible forefoot valgus?

Answer 8

M - Medium to high arch with lowering on WBing
I - Inflammation (Myositis of lateral compartment)
T - Tailor’s Bunion
C - Callus sub mets 1-3
H - Hallux Limitus/HAV

N - Neuromas

Question 9

Explain how a medium to high arch with slight lowering on WBing is a symptom of flexible forefoot valgus.

Answer 9

• foot unlocked due to pronation

Question 10

Explain how inflammation/myositis of the lateral compartment occurs with a flexible forefoot valgus.

Answer 10

• use all of MTJ ROM to bring forefoot to ground
• start to use STJ supination to bring forefoot to ground
• lower leg externally rotates, which is resisted by the peroneals eccentrically
• the peroneals are overworked as they attempt to pronate the STJ and invert the foot

Question 11

Explain how a Tailor’s bunion results from a flexible forefoot valgus.

Answer 11

• the forefoot is unstable/unlocked

- loading on the 5th ray when it is unstable

Question 12

Explain how callus sub mets 1-3 occurs with a flexible forefoot valgus.

Answer 12

• 1st ray DF at loading so it won’t accept load

- load moves over to 2nd/3rd mets and person rolls off 1st at propulsion

Question 13

Explain how HAV or hallux limitus results from a flexible forefoot valgus.

Answer 13

• unstable/unlocked forefoot

- add hallucis has the advantage

Question 14

Explain how neuromas occur in a flexible forefoot valgus.

Answer 14

• nerves are mashed together due to unstable forefoot

Question 15

What are the signs/symptoms of a rigid forefoot valgus?

Answer 15

H - Hammering/clawing of 4/5
A - Achilles tendonitis/Haglund’s deformity
T - Tenosynovitis of peroneus longus
S - Shock related symptoms

I - Irritation of nerve (neuroma)
T -
C - Callus sub 1/5
H - High arch in WBing and NWBing

Question 16

Explain how hammering/clawing of 4/5 occurs in a rigid forefoot valgus.

Answer 16

• PF ‘attitude’ of mets causes instability
• sagittal plane disruption causes a PF met
• phalanges are disrupted and insecure
• claw
• causes mets to PF even more

Question 17

Explain how achilles tendonitis/haglund’s deformity occurs with a rigid forefoot valgus.

Answer 17

• achilles tendon rubs on the superior lateral edge of calcaneus
• due to angulation of tendon (STJ is slightly supinated therefore calc is slightly inverted)

Question 18

Explain how tenosynovitis of peroneus longus occurs with a rigid forefoot valgus.

Answer 18

• the peroneals are attempting to pronate/evert the foot back to vertical/neutral
• prone to inversion sprains of the ankle

Question 19

Explain how shocked related symptoms occur with a rigid forefoot valgus.

Answer 19

• less shock absorption due to position of foot

- includes lower back pain, gluteus medium strain, knee and lateral ankle pain

Question 20

Explain how nerve irritation/neuromas occur with a rigid forefoot valgus.

Answer 20

• DF toe position applies mechanical stress to the nerve (due to stretching)

Question 21

Explain how callus sub 1/5 occurs with a rigid forefoot valgus.

Answer 21

• load onto 5th met and due to rigid foot position there is no smooth loading to 1st
• clunk onto 1st

Question 22

Explain how a high arch in WBing and NWBing occurs with a rigid forefoot valgus.

Answer 22

• foot is rigid due to supination

- calc is inverted