Dear Editor

Abstract

The article entitled “The Critical Analysis of Dudley Morton’s Concept of Disordered Foot Function” was of interest. The discussion regarding pressures under the ball of the foot was verification that a short and hypermobile first ray tends to increase pressure under the second metatarsal, a finding a surgeon quickly understands. The discussion, unfortunately, minimized the importance of the windlass mechanism as described by Hicks to fully appreciate the stability of the first ray. Without a windlass which produces stability of the foot structure in propulsion, the first ray will be unstable against weight-bearing forces, particularly as the heel everts and puts more pressure on the medial column of the foot. One can quickly see this in practice by maximally dorsiflexing the hallux and then only partially dorsiflexing the hallux. The resulting first ray instability of the latter maneuver can be readily appreciated. Once the windlass mechanism is looked at in more detail, I think this whole issue will become a lot more clear. Since this variable has been largely ignored by previous research, the picture certainly does not clarify easily. If we truly see a person walking with maximal dorsiflexion of the first MTP joint (a clinical rarity in private practice) we seldom see foot pathology. A great majority of my patients never walk with that kind of stability of the foot structure. Once the windlass mechanism is allowed to function normally, the weight-bearing patterns along the ball of the foot change dramatically as the first ray plantarflexes though propulsion. This not only changes the pressure pattern on the ball of the foot but has a significant impact on the trajectory of force. I think future research considering how the windlass mechanism is functioning in conjunction with plantar pressure assessment will help to clarify this issue quite a bit. Thanks to the authors for trying to clarify a very important concept. Sincerely, A Critical Analysis of Dudley Morton’s Concept of Disordered Foot FunctionThe Journal of Foot and Ankle SurgeryVol. 45Issue 3PreviewThe name Morton is associated with a foot structure characterized by a short first metatarsal in comparison with the adjacent second metatarsal. Dudley Morton is credited with recognizing a short first metatarsal as being a primary defect of the foot. Morton, an anatomist, approached his observation from an evolutionary perspective. His theory of disordered foot function was based on the premise that human alignment centered on an “axis of leverage” and around an “axis of balance.” Morton concluded that the presence of a short first metatarsal was compounded when the first metatarsal segment was hypermobile. Full-Text PDF