Forefoot Supinatus and Foot Orthotics

Forefoot supinatus is not a diagnosis, it is a pathomechanical entity as a consequence of abnormal foot function. Forefoot supinatus is a theoretical construct in which the forefoot in inverted relative to the rearfoot when the subtalar joint is held in it neutral position and the lateral forefoot is loaded. It is a forefoot supinatus as it is in that position because of a soft tissue contraction that develops over time due to the rearfoot being everted post subtalar joint neutral. The forefoot supinatus is in contrast to the definition and theoretical construct of forefoot varus which is an osseous or bony inverted position of the forefoot. In reality the distinction between the two is not always totally clear and there is a continuum between the osseous forefoot varus and the soft tissue forefoot supinatus, with elements of both in cases of a patient with an inverted forefoot.

While there is some dispute around these theoretical constructs there are clinical entities that have these features that do need to be addressed in clinical practice when foot orthoses are considered.

There are a number considerations in the foot orthotics when indicated in someone who has a forefoot supinatus:

  1. If possible the foot orthotics must deal with whatever it is that is making the calcaneus evert past vertical.
  2. The forefoot supinatus needs to be corrected during the negative modelling of the foot otherwise the foot orthotic will just hold the forefoot in its supinated position. If it can not be done, then the manufacturing laboratory needs to add a forefoot supinatus correction to account for that.
  3. Mobilization and manipulations may be needed to somewhat correct the foot at the time the patient gets the foot orthotics. There are some forefoot supinatus exercises that could also be prescribed.

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