Treating FHL: Why It's Essential For Orthotic Success

“It is my opinion now that there are few conditions which would not benefit from a timely plantarflexion of the first metatarsal and resultant midtarsal joint stabilization,” says Dr. Ocker. Q: What has been your patients’ reaction to this treatment, particularly in those who have had a more standard approach to orthotic care? A: One of Dr. Williams’ patients is a professional basketball player who had several failures with traditional orthotic therapy. All his orthotics posted him into varus. “The problem was that in stance and during gait, he never, and I do mean never, put any weight under his first metatarsal head,” recalls Dr. Williams. “I use the F-scan system on certain patients for gait analysis. When I saw the pressure distribution for this patient, I was amazed. He had all of his weight lateral. He never put any weight under the first met.” When Dr. Williams made the basketball player a temporary orthotic and used a first ray cutout, the patient immediately walked better and he finally had pressure under the first metahead. He valgus posted the patient an extra four degrees and adjusted for his LLD. “He’s been playing great all year,” says Dr. Williams. Dr. Ocker says his patients are often “remarkably impressed” that one practitioner’s orthotics offer such a dramatic improvement over another’s orthotics. “This has proved most startling and informative,” says Curryer. “Patients who have had orthotics from myself or others based on ‘Rootian’ principals or just arch supports tend to notice and comment on a sensation that their feet feel ‘free.’ They do not feel confined and almost always feel a positive postural benefit.” A number of patients have come to Curryer’s office with foot orthoses from other providers that have not resolved their symptoms or have created other problems. Invariably, he has added an Fhl accommodation and a lateral forefoot wedge to the existing device. Six weeks later, these patients have shown marked improvement in symptoms and orthoses wear patterns, according to Curryer. Given these successes, Curryer has also changed non-responsive fifth MTPJ diabetic ulcer patients to this approach as opposed to using a conventional arch support, varus-posted device. These lesions, which historically were difficult to maintain, healed, resolved quickly and remained healed when Curryer applied SPF principles to their foot orthoses. Be Aware of These Post-Therapy Outcomes Generally, you may find that patients notice some initial strain in their hip flexors, possibly due to the orthoses requiring the leg to extend fully in gait. Patients often experience some lower back stiffness initially but it resolves well with physiotherapy and a few weeks time, points out Curryer. Dorsal first MTPJ pain is rare, but if it does occur, Curryer says you can resolve the problem via manipulation and, if necessary, a local steroid injection. On many occasions, Curryer’s patients with foot or leg symptoms will return to him, saying they have noticed a decrease in previous back, neck or other postural complaints that they did not mention upon their initial visits to him. He says he did not notice this consistent patient response when he utilized conventional biomechanical approaches. Q: What success have you found which surprised you the most and what outcomes most surprise your patients? A: “It is the broader postural benefits which have impressed me and my patients the most,” offers Curryer. He continues to have success with the usual foot-related symptoms but has also seen an increasing number of referrals for patients with chronic postural pain. Curryer treats them with the SPF model, in conjunction with physiotherapy and massage therapy, and usually resolves between 50 percent and 100 percent of these issues. Curryer says most of his patients have been getting physiotherapy and massage therapy and/or chiropractic care with no long-term resolution. He adds that most of them have been wearing conventionally-prescribed foot orthoses for many years. Simple application of SPF principles and slight changes to physiotherapy treatments to adjust asymmetries and other problems have proven themselves clinically time and time again, according to Curryer. Dr. Williams says both he and the basketball player were pleasantly surprised by what happened in his case. “He’s really pleased with his outcome and he has ordered two extra pair of orthotics,” notes Dr. Williams.

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