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02/20/2013    Dennis Shavelson, DPM

Etiology of Hallux Varus (Barry Mullen, DPM)

Dr. Mullen seems mired in 30 year old
biomechanics. Modern evidence is proving STJ
neutral biomechanics unacceptable at a
professional level. The reality is my claims are
unproven right or wrong, yet there is proof
rejecting Barry’s.

The omission in Barry’s biomechanical foundation
seems to be Wolff’s and Davis’ Laws. Maybe
that’s because rigid fixation eliminates
remodeling and adaptation from occurring at
osteotomy sites. A foot maintained in a more
optimal position than flat in a shoe will
generate moments and forces in the direction of
correction, right Dr. Wolff?

Discussing a re-alignment of the hindfoot in the
same breath as hallux valgus and varus reveals
an American podiatry fixation that is crying for
change. Why fix the kitchen when the problem is
in the living room. PostopThotics for bunions
are forefoot-focused.

“Subtalar joint dominance” doesn’t fly once one
understands the forefoot dominance in a flexible
forefoot functional foot type and bunion

I’m pleased that Dr. Mullen shared that
he “under appreciate(s) major structural mal-
alignment” or that post-op, he gets “resultant
functional weakness in a given foot type” and
that “this may lead to a poor orthotic choice.”
Perhaps a visit with modern FLEB would reduce
these shortcomings in his biomechanics.

When it comes to fractures, the initial 4-6 week
post-op period is most critical since soft
tissue fixation is occurring, macrophages are
mobilizing, and the template for eventual bony
positioning is being established whether
osteotomies are internally fixated, pinned, or
left free to “float.” This is a biomechanical
debate of architecture, forces and moments,
postop, not fixation.

Dr. Mullen’s 1977 position is capable of being
upgraded as proven by both logic and the
available evidence. “Root works very well” but
we can and eventually will do better.

I suggest that he dispenses PostopThotics for
his next few cases (I’ll absorb the costs) and
consider revisiting biomechanics in a new and
fresh manner before seeming to know so much
about their usefulness.

Dennis Shavelson, DPM, NY, NY,

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