This is part 18 of a series that should be read in order.
Key Points:
- Introduction into the concepts behind the H orthosis
- What is a BH device?
Like my Inverted Orthosis, which has one owner, the Sagittal Plane Orthosis belongs to Dr. Howard Dananberg. He has dedicated 40 plus years of his life to it. The theory is called “The Sagittal Plane Facilitation” theory. It revolves around the ability, or lack of ability, of our foot to easily move in the sagittal plane from heel contact to toe-off. Small braking forces caused by some limitation in this forward progression done over and over and over again leads to repetitive stress that is predictable. He places his emphasis in the world of orthotic therapy on designing a device that helps with first metatarsal plantarflexion in propulsion. Dr. Dananberg has documented the successful improvement in low back pain with his device, along with big toe joint pain. The applications for this H (H is for Hallux and the elimination of functional hallux limitus) type device are much more than these though.
I have broken down these Sagittal Plane (H) devices into: BH, H1, H2, and H3. These are my versions as with all the other types I have described. These are how I achieve more and more Sagittal Plane Facilitation advancing from BH to H1 to H2 and to H3 based on the theories of Dr. Howard Dananberg. This is how I take his theory and make orthotic devices around and from its principles. Therefore, these are my representations of his work, but may not be how Dr. Dananberg would present them. What are some of the components of this orthosis that we will use in the various versions? These include:
- First Ray Cut-outs of more and more angulation within the plastic (freeing up plantar pressure moments which would dorsiflex the first metatarsal, in order to allow perhaps more plantarflexion)
- Narrowing the design on the plastic width (also less plantar medial pressure caused by the orthosis)
- Increasing the medial arch to increase first metatarsal plantar declination
- Adding a version of the patented Kinetic Wedge (™) forefoot modifications, like a biveled hallux support (typically 1/8 inch thickness). This is a patented structure by Langer Biomechanics Group. It is called a “Dynamic Wedge” in the KevinRoot modifications section.
- Rearfoot post for better heel alignment
- Varus intrinsic heel alignment (you have to control the pronation, especially dealing with heel valgus which can be the cause of functional hallux limitus. This may require that your balancing will be a B or P orthosis in my classification.
- Dancer’s Padding (aka Reverse Morton’s Extension)
- Heel lift to shift weight forward aiding in propulsion and subtalar joint supination
BH is your typical B orthosis with two or three of the above 8 modifications. You typically want to see the elimination of any functional hallux limitus that is present.
Prescription for BH:
- Balanced cast to Heel Vertical (only in B1)
- Lab discretion balancing B2
- May be very appropriate that the frame is a P device
- 5/32 polypropylene (unless weight demands 3/16 or 1/8 )
- Slightly Higher Medial Arch (1.5 mm less arch fill)
- Bevelled sub Hallux 1/8 inch wedge (called dynamic wedge-see above)
- Dancer’s Padding
- 18 mm Heel Cup Heights
- Standard Width on Form
- Zero degree Extrinsic Rearfoot Post (when pronation correction needed)
- 1/8 inch Spenco full length (to attach the dynamic wedge and dancer’s padding)
Next week I will continue this discussion on Dr. Dananberg. But, what is apparent to me, or at least one of my general rules for this, is that I do not have to think of absolutely perfect pronation correction for this device to work due to the emphasis on what is being done around the first metatarsal and hallux. For this reason, it achieves results with only some medial column support and direct modifications to free up the first metatarsal-phalangeal joint.
Review of all the Orthotic Types Being Presented
Corrective Orthotic Devices
↓
- Balancing (B): (B1 and B2)
- Pronators (P): BP, P1, P2, P3, P4, P5, and P6
- Supinators (S): BS, S1, S2, S3
- M/L Instability (M): BML, ML1, ML2, ML3, ML4, ML5, and ML6
- Shock Absorption (C): BC, C1/C2, C3/C4/C5, C6, and C7
- Sagittal Plane (H): BH, H1, H2, and H3
