Looking at pictures
of feet is limiting from a pedorthic standpoint. You don't have the
entire three dimensional foot in front of you. You can't rotate the
picture or check range of motion, however images have their
usefulness. On the dorsal aspect of the feet pictured are slightly
reddened areas. It was fairly obvious on the right foot, less noticable
on the left, but still present. When I spoke to the owner of the feet
this person denied having any bony prominences at the base of the first
ray. When I asked the person on the phone to trace their finger up from
their great toe, they discovered that they had a small prominence on
each foot in the area where the red marks were visible.
Bony prominences are important landmarks wherever they appear because
they give practitioners information about what is happening below the
surface. In the case of this particular picture, I suspected a hyper
mobile first ray. In order for propulsion to take place the first ray
needs to become a rigid lever. Some degree of movement is normal, but
excessive movement should be noted as it indicates laxity in the
connective tissue. Many times this is inherited, either one or both of
your parents had loose connective tissue which is why you have it. Hyper
mobility can also be the result of injury, such as a sprain, or
diseases that affect the connective tissue.
During
a clinical examination, bony prominences can be observed and felt.
Lacking the physical foot, localized skin irritation at the first
metatarso cuneiform joint indicates that something is pressing on that
area hard enough for the skin to become discolored. Red across more of
the joints may have indicated shoes that were laced too tightly.
Patients with a hyper mobile first ray typically have bony prominences
on the dorsal aspect of their feet from the pinch that occurs when the
joint is stressed abnormally. Calcium deposits are a way for the body to
protect itself. Deposits occur only when the body calls for them, the
skin around the joint was normal, therefore a hyper mobile first ray is
suspected and could be confirmed with a physical foot examination.
Periodically people will ask practitioners what they think about
certain footwear items. Without knowing what type of a foot someone has,
it's difficult for anyone to recommend a certain brand or type of shoe.
This is also why you should be wary of well intentioned people you know
touting their footwear since they may have a completely different foot
shape or arch type than you do. Not long ago someone asked me what I
thought of
a
particular boot. Goodyear welt construction is a desirable trait in
footwear since it means the sole has been sewn to the uppers instead of
glued. Caterpillar in general is known for quality items, the boots
looked nice online, but another thing I noticed about the feet in the
picture is the reddened areas on the third,
fourth, and fifth toes which is a greater immediate cause for concern.
Will StuartO))) be able to keep his beloved Caterpillar work boots
or will further discussions lead him into RedWing territory? Stay tuned
for the next exciting installment of E2Pedorthics featuring: Footbeds!