The Crispin Colloquy

Ed,

I am posting several illustrations from Golding on foot anatomy. This is bone structure only. And it won't answer all your questions but it's a beginning.

PS...anyone wanting to DL thiese illustrations and edit or annotate them is welcome to...Golding is public domain, AFAIK.



Tight Stitches
DWFII--Member HCC

Here's the lateral view...


Tight Stitches
DWFII--Member HCC

And here's the medial view...




Tight Stitches
DWFII--Member HCC

DW,

Thanks for the illustration now things are coming into play.

Fred,
Near as I can tell from your description of a pigeon wedge??? is you have it backwards. That would make a person internally rotate their foot... Maybe I just misread your words?

Now Fred, You brought up an excellent topic of a Morton's toe. Now we have picture to work from (thanks DW!) it should be easier to describe. A Morton's toe occurs with about 1/3 of the population so the shoe/bootmakers on this site should see this fairly often. In a Morton's toe the 1st Metatarsal is genetically short (or surgical short with bunion surgery) making the sencond toe look longer and increases the likelihood of plantar fascia strain.

My question to the boot and shoemakers out there is how do you take this into account when selecting a last or for that matter when using a plaster made last??? I've mulled this over and just don't get it! Do you select a medial heel to ball measurement the same as usual or do you cheat your measurement up a bit because the lesser metatarsal joints (treadline) will be in the wrong place if left at the medial ball( 1st met joint).

I know this probably belongs in the lasting section but since we have such a nice picture of the anatomy I figured I'd start it here for now...

Sean

Sean,
I thought you were talking about in-toing for children and a forefoot extension/stiffener under the lateral forefoot to externally rotate the foot and I was simply agreeing with you, I thought.

No, the pigeon toe wedge will cause the foot to toe out and a reverse thomas heel is utilized in conjunction, also encouraging the hip,knee and foot to externally rotate.I don`t think I said something backwards at all.Could you please explain?

Anyway the medial toe wedge,& medial thomas heel encourages the foot to toe in and supinate.

In regard to your question for last making and the Mortons Toe,these are my thoughts on that matter.

I think as the old addage goes "form follows function".Therefore whether casting the foot for custom footwear or developing a new last the medial heel to ball measurement is a given but I still question the Splay foot.That one is illusive to me,still.[I have the bizarre thought of "hog tied and gagged"].Anyway,the mortons toe extension will distribute forefoot pressure to the 1st met.head and hallux releiving the 2nd.mpj[metatarsal phalangeal joint].

Remember the tread line of the shoe follows from the foot,the 1st to the 5th met.heads and there is a distinct parabolic curve across the MPJ`s of the foot and not a straight line. Nothing is straight on our feet or on the shoe/boot lasts either.

So what would be the ideal angle of progression in walking and/or running? In walking 7 degrees angled externally is considered normal,15 degrees externally rotated is consequentially considered abnormal.Hopefully,if we increase cadence in running then the hip will internally rotate at heel strike,the knee will track straight ahead and the foot will appear slightly pigeon toed following the knee.Meanwhile from heel strike to toe off ,the foot propells off the ground,and the toes are pointed straight ahead,aligned like the headlights on the car.The knee does not bear weight but distributes the body weight to the foot.The foot follows the knee.Since the knee joint flexes on one plane I consider the knee as a weight transference joint and not a weight bearing joint.

I have watched too many people walking and running with an externally rotated foot strike and cringe when I see their body weight collapsing the medial knee cartlidge.

I personally feel that most of us have forgotten something we knew when we were born,that is basically standing,walking and what is good posture,for the foot and our body.

So,if 1/3 of the population has a mortons toe and all 5 metatarsals have to plantarflex at toe off in order for the toes to dorsiflex ,does 1/3rd the population require a mortons toe extension for walking and running in footwear?Should we go barefoot and maybe have stronger healtier feet or should we reconsider ourselves as moving forward in life,aligning our gait for efficiency or waddle like ducks or penguins with our feet externally rotated?

I chose to talk about running because of our body`s natural intelligence and awareness of itself in maintaining alignment integrity between the foot and the knee.In walking,running and standing at least there should be awareness of our lower bodies alignment,like the hip internally and externally rotated and derotating the femur, and those same forces affecting the knee ,tibia and foot,otherwise our entire lower body is dis-connected.

This is all about the kinetic chain.The spinal column is deeply connected to the Mortons Toe and its manifestations,so I think!

The pedograph, respective measurements, and lasts are our fundamental tools and bio-mechanics is where art and science meet with physical therapy and healing.And last making is like the holy grail....blah blah blah\Peace

Please take this discourse,as discussion with good intentions and food for thought.OK.
best regards,Fred

Thanks Fred,
We are on the same page with the forefoot stiffener/ extension, (nothing backwards.) It is easy to take a sentence two ways on this forum and I misinterpreted your words.

I don't think that everyone with a Morton's toe needs a Morton's extension or in fact orthotics. For some, a Morton's toe causes great grief and for others, there is no mechanical problem with it. I tend to be pretty conservative in how I deal with things... If it ain't broke don't fix it.

I'm going to move my last question over to the appropriate part of the forum. I think it will be viewed by more members there,

Cheers,
Sean

Rob,
I thought I`d move this discussion over here from 'the Last Questions'.

On the Orthotic Remedy for the Mortons Toe I will incorporate a Material called Quikform from American Plastics.This will be from heel cup to the metheads and under the 1st MPJ and Hallux.
It is flexible and firm.I also use Quikform for Heel counters.It is sticky and thermoforms with vacuum pressing, and for counters by hand using gloves.It is about 1.8mm in thickness.

I wouldn`t compromise the 1st MPJ from plantarflexing at the Heel lift phase in gait,so I am always sure the lesser metatarsals have sufficient balance with the 1stMPJ.
.
I have also used 1/8th" cork and 35-45 durometer EVA under the hallux{big Toe] allowing for plantarflexing of the 1st Met.,and slightly dorsiflecting of the hallux with forefoot valgus and dorsiflexed 1st metatarsal.

[For those readers unfamiliar with forefoot valgus,it is a deformity of the forefoot where the forefoot is everted against the rearfoot.Eversion is synominous with valgus or turning in medially.And it is one single plane of motion associated with Pronation,called the Frontal Plane].

Sean ,I have also addressed Turf Toe with a similar reinforcement extension under the 1st MPJ/Hallux with a more aggressive material 3,4 or 5mm SubOrtholen.Again supporting the lesser mets and toes.

best regards,Fred

Rob & Fred,

I'm lovin' reading all this when you guys are tech-talking--kinda like drinking water from, a fire hose.

Fred,

Does American Plastics have a web site or an address you could tell me?

Rick,
American Plastics,Tel.800/772-7401 and [url=http://www.americanoandp.com%2CArlington%2CTexas]www.americanoandp.com,Arlington,Texas[/url].
Fred

Thanks Fred.

I don't see QuickForm on their product page. Could it be SureForm?

Rick,
No, Sureform is a subortholen product / Quikform,the item # is QF-1000.Ok
Also,Euro International has a product called Moritz that is similar,also heat activated.It works great for heel counters and orthotic reinforcement.Talk to Candy or John.
Fred

Hi All
Well just delivered a pair of boots for a fellow who has an extreme supine foot. Works as a heavy equipment operator, didn't need a certified safety boot.
image{/Users/brendanbalon/Desktop/r.n1.jpg}
foot and casting
image{/Users/brendanbalon/Desktop/r.n7.jpg}
Dressed cast/last with orthotic insole
image{/Users/brendanbalon/Desktop/r.n8.jpg}
Finished product
I used a renoflex/quickform counter and extended it so I had to keep the lining and outter leather seperate. Stich down construction, soft toe toe stiffener, Vibram Sole and heel

He loved them, I have other pics if anyone is interested
Regards
Brendan in the Frozen North

Hi Brendan,

I'd like to see the pics but they're not showing up.

Greg, not quite as frozen, not quite as north but still cold

Greg et all
I'll try again HTML is not my fort EH (thats Canadain)
pic 1
pic 2
pic 3
hope this works
BB

Brendan,

Can you tell me what materials you used for your foot support bed build up and maybe a wee bit about the process?

Also can you comment on the condition of the client? The build ups seem to position the foot into "high heel" territory, yet the finished boots, which are beautiful, have a hiking boot quality. Can't imagine someone doing a lot of walking wanting their feet in that position. Or, are you compensating for some situational or congenital existing foot position, like one short leg/foot?

Thanks,
Georgene

Hi
Trying to answer but get kick off with loading a graphic
be patient i'll get it
BB

Next pic

Hi
I try again now the pics are up.
As you see the forefoot is dropped towards the 1st met head '
Fat pad necrosis and callousing under 1,3,5th met heads. Hell fat pad like a bag of lead pellets. Rhumatoid Arthritis sister has same feet suspect genetic neurological condition, no LLD.
Casted in prone, non weight bearing neutral subtaler. this fixes the heel height fore/rear foot alignment. Sit client up cast on, do a dorsal clam cast above the ankle at 90 to floor. mark 90 degree lines
When I dress a cast I use the "Total Contact" approach. note on second pic the marks for the pressure spots. These areas are built up to reduce pressure.
It looks high but the heel to forefoot is 7/8 diff a lot of Western boots have a heel this high and what about womens high heels!

Once the toe box et all is done cast dry and smooth I vacuem form a layer of 35 durometer EVA against the cast the next layers are 55+ durometer EVA. The insole is shaped to resemble a " Normal" treadline this incorporating a rocker shaped sole to reduce met head pressure and help accomodate rigid foot lack of motion. You must also make the cast insole funtion as a last so the upper does not bag, gap and the counter grabes the foot and insole with a nice line that will allow the heel to strike with out hitting early or late in the gait cycle.

I then use a mix of old idea new plastic technology to make a EVA steel shank, thermoplast sheet to make an insole to attach everything together as the orthotic is removable . This method makes for a real rigid, light weight and cleanable system.

Hope this helps any more questions just ask.

From the slightly warmer frozen north
Regards
Brendan

Thanks Brendan. Very interesting!

Thanks Brendan, a lot of painstaking steps went into those boots before the actual shoemaking. And now you've got the picture loading thing down too!

Regards
Georgene

Hi Brendan,

Great job. Thanks for the explanation on using the hanging lining. I was thinking that you may have used an envelope construction, putting the lining on the last, build up re-enforcement and heel elevations and than put an upper without lining over it all. It's a good technique if you need to add ankle re-enforcement and it allows to keep the buildup of the LLD less in the removable orthotic and more into the shoe, adds to the stability.

Did you take in the cone of the last at all to create a better lock on the foot? It's hard to judge from the picture if the customers ankle is enclosed when the shoe is on the foot.

Do you work regularly off a plaster last? Any problems with breakage and did you get it out of the shoe in 1 piece? Do you use reebar to re-enforce the mold or do you have any other tricks to keep the mold from breaking when lasting?
Did you add any padding under the ball of the foot additional to the 35 shore base layer? How thick do you make that layer? You have me curious what you used for an insole and how you made your shank. Did you put in a full length shank?

Again, great job and I would like to find out a little more about the techniques you used.

Rob

Hi Rob
Thanks for the kudo's, I am familiar with the envelope construction and this pair bordered on that technique.
I worked a bit of a cone in, it does cover his ankle but the counter still misses the mallioli. With such a wide rigid foot I tried to lock the foot but still give it some shape.
I use plaster all the time rareley do I break anything but it does happen. I don't use any reinforcing in the plaster just some tacks to define foot lenght and other anomilies so when I hit the tack I quit removing material. This one came out in one peice with some sweat and a few choice words, but i have had to make a cut in the mid foot and hold the last with packing tape. may
sound strange but it works.
As for the top layer of 35 it is 1/4 inch. As one of my old Prosthitc mentors said "never use cushioning to disguise poor fitting" When using the total contact approach you try to take the weight over a large area so you should not need localized padding. For this gent's met heads you don't want to make him have no contact just reduce it.
And the insole my trade secret! but in the spirit of the HCC I will share, 1st layer EVA 60+ durometer split to about 1/8 inch and thermoformed over the orthotic. Rough up after cool cement a steel shank in place then heat quickform and again press it on the insole. Trim insole as usual for cement construction. This traps the shank and depending on how rigid I want the ball determines how far I run the quickform it past the ball and how thin i taper the leading edge. I rareley use a full shank. The reasoning, if I shape the cast and then the rocker worked into the orthotic this should off load the mets during the swing phase. Also with the shank in place, once to pull your counter and upper over the heel less leveling material is used. This makes a very strong and torsionally stiff shank/ heel area and light weight .
Hope this helps
Brendan