Forefoot varus is something that is getting some renewed attention recently (The Potentailly Injurious Effects of Forefoot Varus Posting; Effects of Forefoot Varus Posting). Forefoot varus is defined as an inverted position of the forefoot relative to the rearfoot when the subtalar joint is in its neutral position and the midtarsal joint is maximally pronated. It is thought to be an osseous problem with the neck of the talus. The reason for the increased attention is the confusion between forefoot varus and forefoot supinatus. A forefoot supinatus looks the same but is a soft tissue contracture. Forefoot varus is actually quite rare (probably 1-2% of foot types) and a forefoot supinatus is much more common. The problem is that the management of the two are very different and getting it wrong has the potential to be injurious. A number of research project have been published in recent years have had ‘forefoot varus’ as their inclusion criteria. If the subjects in included in the study had a combination of forefoot varus and forefoot supinatus, then the results will be very different if they were all truly a forefoot varus. Researchers using an inclusion criteria of ‘forefoot varus’ really need to make it clear that they understand the difference between forefoot varus and forefoot supinatus.
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