Forefoot-rearfoot relationship

Forefoot-rearfoot relationship
The biophysical criteria for normality states that the forefoot should be perpendicular to the bisection on the posterior aspect of the calcaneus when the subtalar joint is held in its defined neutral postion and the midtarsal joint is maximally pronated.

Technique:
• patient prone, posterior aspect of the calcaneus in the frontal plane
• patient instructed to remain relaxed and not assist (contraction of anterior tibial muscle will invert the forefoot and the rearfoot and cause a false finding of an inverted forefoot)
• lateral aspect of forefoot is held with one hand, while the other hand palpates the talus to place the foot in its defined subtalar joint neutral position. The lateral aspect of the forefoot is dorsiflexed to resistance to pronate the midtarsal joint while the subtalar joint is held in its neutral position
• the head is placed immediately above the calcaneus – the relationship between a plane representing the plantar aspect of the metatarsal heads and the bisection on the calcaneus is noted or measured

Reliability -
• determination of the forefoot to rearfoot relationship has poor reliability
Glascoe et al (Aust J Physio – need to add ref) apparatus to measure – measure relative to transverse plane and not bisection of calcaneus

Common mistakes:
• not comparing the plantar aspect of the forefoot to the bisection (it should not be compared to the transverse plane)
• not fully pronating midtarsal joint to resistance
• not placing foot in its defined subtalar joint neutral position
• incorrect bisection on the calcaneus
• attempting to determine relationship when patient is supine
• patient contracting the anterior tibial muscle (patients may need to practise relaxing)

Clinical use:
• observed as being perpendicular, inverted or everted
• if inverted  forefoot varus or forefoot supinatus
• if everted  forefoot valgus or plantar flexed first ray (acquired or congenital)
• if perpendicular  normal or a forefoot supinatus that has developed in what was originally a flexible forefoot valgus)
• measurement is not necessary (if orthoses is to be used, the forefoot to rearfoot relationship is captured in the cast, so the orthoses can be made to automatically account for this)

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