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First Ray Insufficiencies: Myths & Misconceptions

October 12 - October 23

First Ray Insufficiencies: Myths & Misconceptions

“The most debated concept about foot and ankle pathology may be the role of instability of the first ray…”
Corinne Van Beek, MD and Justin Greisberg, MD Mobility of the First Ray:Review Article Foot & Ankle International/Vol. 32, No. 9/September 2011

How does instability of the first ray contribute to the pathomechanics of hallux abductovalgus, hallux rigidus, functional hallux limitus and metatarsalgia?

How much of your current knowledge about the first ray is based upon
accepted dogma rather than good science?

Many myths and misconceptions regarding the mechanics of the first ray exist today and often lead the practitioner to implement treatments that ultimately fail.

Here are common myths about the first ray which will be discussed in this webinar:

  1. Hypermobility of the first ray is a theoretical condition of excessive dorsiflexion motion of the first metatarsal during dynamic gait
  2. Clinical measures of hypermobility of the first ray are commonly performed in a static off-weight bearing condition which will not engage multiple forces which occur during dynamic gait
  3. Static measures of first ray mobility do not predict first ray hypermobility during gait
  4. Stability of the first ray is dependent upon specific anatomic structures located at the first metatarsophalangeal joint (1st MTPJ), providing static or dynamic restraint of motion, or both.
  5. Hallux abductovalgus (HAV) deformity is the only pathology of the human foot which demonstrates excessive dorsal mobility of the first ray with static exam, and this hypermobility reduces or vanishes when the first metatarsal is re-aligned over the sesamoids.
  6. Metatarsus primus elevatus (MPE) is a static radiographic measure which does not predict load bearing capacity of the first metatarsal during gait
  7. Patients with evidence of MPE do not show excessive mobility of the first ray with static exam.
  8. Metatarsus primus elevatus is the result of progressive degenerative arthritis and progressive plantar flexion contracture of the hallux seen in hallux rigidus
  9. Most people demonstrate greater range of motion of dorsiflexion of the 1st MTPJ off weight bearing compared to range of motion weight bearing and during dynamic gait.
  10. Studies of patients with evidence of functional hallux limitus with static examination will show normal extension of the 1st MTPJ during dynamic gait

In this presentation, Dr Doug Richie will uncover these myths and reveal the sound science which can change current strategies to treat common pathologies in the human foot.


Douglas Ritchie, DPM

Douglas Richie received his Doctorate of Podiatric Medicine from the California College of Podiatric Medicine.   He completed a post-graduate Podiatric Surgical Residency Program at Western Medical Center in Orange County, California. Richie is certified by the American Board of Foot and Ankle Surgery and is a Fellow of the American College of Foot and Ankle Surgeons.

Richie is also a Fellow and Past President of the American Academy of  Podiatric Sports Medicine.    His research interests have included studying prevention and treatment of the ankle sprain as well as the pathomechanics of flatfoot deformity. Richie is a two-time recipient of the American Podiatric Medical Association Research Award and has also received  the Richard Schuster Biomechanics award from the American Podiatric Medical Association.

Richie holds five US patents on technologies regarding manufacture of footwear, ankle brace design and foot orthotic design.    He recently retired from  38 years of clinical practice located in Seal Beach, California.

With faculty appointments at the California School of Podiatric Medicine and at Western University School of Podiatric Medicine, Dr. Richie devotes his time to teaching, original research and writing.  His recently completed book “The Pathomechanics of Common Foot Disorders” will be published in Fall, 2020 by Springer Nature.


Member Price: $100 + tax
Non-Member Price: $150.00 + tax

*If a member registers for all three OEE’s individually, please contact Victoria Peers for a $50 discount on your November registration.


Début :
October 12
Fin :
October 23
Catégorie d’évènement:
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