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!

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