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Rothbarts Foot (Primus Metatarsus Supinatus)
In 2002, a paper was published in the Journal of Bodywork and Movement Therapies describing a previously unreported embryological foot structure, the Primus Metatarsus Supinatus foot (now known as Rothbarts Foot), which I linked to the incomplete torsional development of the talus. Clinically this results in an elevated first metatarsal and hallux (big toe) (See Photo below).
The presence of a Rothbarts Foot structure is suggested by a:
Rothbarts Foot is the result of an incomplete torsional development of the talar head (see red arrow)
- lateral ankle instability, less frequent with senescence (See Figure Below)
- deep first web space (See Figure 1 Below)
- positive Knee Bend Test
However, a definitive diagnosis for Rothbarts Foot is based on Primus Metatarsus Supinatus values (PMSv). PMSv between 11mm and 29mm (approximately ½ to 1 inch) are pathognomonic for Rothbarts Foot (PMSv between 30mm and 59mm are pathognomonic for the PreClinical Clubfoot Deformity, See Measuring PMSv below).
Measuring PMSv. Procedure: Place weight bearing foot in its anatomical neutral position (articular margins of the subtalar joint are congruous). Slide microwedge underneath the first metatarsal head. The distance between the ground and the 1st metatarsal is the PMSv.
Reliability of the PMSv measurement:
A double blind randomized trial was conducted by George Cummings and Elizabeth Higbie at Georgia State University, School of Health Sciences (1996) to determine the accuracy and reliability of the PMs values. They concluded that the BioVector Measurement Test (referred to in their paper as the weight bearing method of measurement), when used to determine PMs values, is accurate and reliable.
Discussion: Orthosis prescription for forefoot posting is commonly based upon measures of the forefoot performed on a non-weight bearing foot. However, the relationship of measures of the unloaded foot to determine orthosis prescription for compensatory forefoot function during gait is still in question. Another approach [originally introduced by Dr Brian A Rothbart] to determine orthosis prescription is to, [using microwedges], measure the height of forefoot posting necessary to prevent excessive pronation of the subtalar joint during weight bearing.
Purpose: The purpose of this study was to determine the intrarater, interrater and day-to-day reliability of forefoot measures during an active, weight bearing movement. Methodology:
Study: Thirty-two volunteers, 18 females (mean age 38.9 ± 15.3 yr) and 18 males (mean age 44.8 ± 20.6 yr) participated in the study. Four examiners performed repeated forefoot measures on both feet using the weight bearing technique during two test sessions separated by a week. Intrarater and interrater reliability (ICC (3,1)) ranged from 0.90 to 0.95 and 0.87 to 0.94, respectively. Day-to-day reliability (ICC (1,1)) ranged from 0.84 to 0.88 for all measures.
Conclusion: The weight bearing method used in this study to determine forefoot posting is reliable. The acceptable reliability of this method justifies the need for future investigations of the validity and the clinical efficacy of this technique for orthosis prescription.
The Cummings study was an, independent, double blind study. It established the accuracy and inter/intra-rater reliability of the PMSv measurements. This same measuring technique is used today in the differential diagnosis for the differential diagnosis of Rothbarts Foot.
Reference
Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
Cummings GS, Higbie, EJ 1997 A weight bearing method for determining forefoot posting for orthotic fabrication. Physiotherapy Research International, Vol 2(1):42-50. [This study was funded by a grant from the College of Health Sciences at Georgia State University]
Rothbart BA 2009. Morton's Foot vs Rothbart's Foot. Are They the Same? Podiatry Review, Vol 66(3):6-9.
Rothbart BA 2009. Rothbarts Foot Linked to Talar Supinatus. Rothbarts Research Blog, April 30th.
Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot Structure and the PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Inventor and Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain
Cummings GS, Higbie, EJ 1997 A weight bearing method for determining forefoot posting for orthotic fabrication. Physiotherapy Research International, Vol 2(1):42-50. [This study was funded by a grant from the College of Health Sciences at Georgia State University]
Rothbart BA 2009. Morton's Foot vs Rothbart's Foot. Are They the Same? Podiatry Review, Vol 66(3):6-9.
Rothbart BA 2009. Rothbarts Foot Linked to Talar Supinatus. Rothbarts Research Blog, April 30th.
Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot Structure and the PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Inventor and Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain
