Rothbarts Foot, PreClinical Clubfoot Deformity and Morton’s Foot (Morton’s Toe)

Rev 10.20.2016
The differences between Rothbarts Foot, PreClinical Clubfoot Deformity and Morton’s Foot
(also known as Morton’s Toe and Greek Foot) are as follows:

Structure

Plantargrade (Normal) Foot – The plantargrade foot is structurally stable. The calcaneus and
talus bones have completed their ontogenetic torsional development during the eighth and ninth
week of fetal development. These bones do not maintain an abnormal torsion (twist).

Morton’s Foot - The name Morton’s Foot derives from American orthopedic surgeon, Dudley
Joy Morton (1884-1960), who originally described it as a triad of findings: a congenital short
first metatarsal bone, a hyper mobile first metatarsal segment and posteriorly located sesamoid
bones.

Rothbarts Foot – The Rothbarts Foot is an unstable, abnormal foot structure present at birth. It
is the result of an incomplete torsional development of the talus (the bone that sits on top of the
heel bone) that occurs between the eighth and ninth week of pregnancy.

PreClinical Clubfoot Deformity – The PreClinical Clubfoot Deformity has a more pronounced
structural deformity compared to the Rothbarts Foot. Specifically; the Preclinical Clubfoot
Deformity is the result of an incomplete torsional development of both the calcaneal (heel) and
talar bones.
Function

Plantargrade Foot – A functionally stable foot in which the big toe and first metatarsal rest on
the ground when the rearfoot is placed into its anatomical neutral position … And so, when you
stand or walk, the bottom of your foot makes contact with the ground without having to rotate
inwardly and downwardly (abnormally pronate). The mechanical receptors on the bottom of your
feet are stimulated in specific quantities and locations and the specific signal that they send to the
brain tells the brain to maintain good posture.
Morton’s Foot - In all normal foot structures, the first metatarsal head bears the majority of a
person's body weight in preparation for pushing off the big toe when you walk. But because, in a
Morton's Foot, the first metatarsal is shorter than the second metatarsal, the body's weight is
automatically transferred to the longer second metatarsal head.

Rothbarts Foot - The result of the incomplete development of the talus is that when the rear foot
is placed in its anatomically neutral (correct) position, the big toe and its adjoining metatarsal are
both elevated and twisted inwards relative to the ground.
As your body’s weight is shifted from the heel to the front part of your foot (while standing or
walking), gravity forces your elevated big toe and its adjoining metatarsal to roll inward, forward
and downward until they rest on the ground. (foot twist/abnormal pronation).
PreClinical Clubfoot Deformity - People with a Preclinical Clubfoot Deformity have a more
severe foot twist (when they stand and walk) compared with those who have a Rothbarts Foot.
The result of the incomplete ontogenetic development of the calcaneus and talus is that when the
rear foot is placed in its anatomically neutral (correct) position, both the inside bottom surface of
the heel bone and the big toe and its adjoining metatarsal are both elevated and twisted inwards
relative to the ground.

As the body’s weight lands on the heel, gravity forces the heel bone to twist inward and
downward until the entire heel bone rests on the ground. This motion collapses the arch of the
foot. As the body’s weight is transferred to the front of the foot, gravity forces the elevated big
toe and adjoining metatarsal to roll inward, forward and downward until they also rest on the
ground.

Note – Because the Rothbarts Foot and PreClinical Clubfoot Deformity can functionally look
very similar, it’s only through running specific computer and video analyses that the differential
diagnosis (determining which of the two structures you actually have) can be made.

Appearance
Plantargrade Foot – There is no elevation of the big toe. That is, when the foot is placed in its
anatomical neutral position, the big toe and adjoining metatarsal rest on the ground. Walking,
there is no visual foot twist as the weight of the body is transferred from the heel bone, across the
midfoot to the forefoot.
Morton’s Foot – The big toe is more than 2mm shorter than the second toe.

Rothbarts Foot – It is not easy to see the Rothbarts Foot just by looking at your feet. The
elevated and inwardly twisted big toe and first metatarsal that characterizes the Rothbarts
Foot can only be seen when the rearfoot (subtalar joint) is placed in its anatomically neutral
position.*
*
The subtalar joint is in its anatomical neutral position when its joint spaces from front to back
and side to side are uniform and even. That is, there is no deviation or variance in the thickness
of the joint space from side to side and front to back.
The only way to 100% determine that you have a Rothbarts Foot is by looking at the bones
inside your feet. Theoretically, a radiographic profile of the talar head and a protocol for
measuring the talar head would provide a definitive diagnosis, but no such test has yet been
developed.
However, there are indicators that the Rothbarts Foot is present, such as the questions asked in
the Rothbarts Foot Questionnaire as well as in my patient profile (done during your Initial Phone
Consultation). The BioVector Measurement test shows the presence of the elevated big toe and
first metatarsal when your foot has been placed in its anatomical neutral position. My
computerized gait analysis rules in (or out) whether you walk in a predefined way (consistent
with the walking motion of a person with a Rothbarts Foot).
PreClinical Clubfoot Deformity – It is not easy to see the PreClinical Clubfoot Deformity just
by looking at your feet. The inwardly twisted and elevated calcaneus, first metatarsal and hallux
(big toe) that characterizes the PreClinical Clubfoot Deformity can only be seen when the
rearfoot (subtalar joint) is placed in its anatomically neutral position.*
The only way to 100% determine that you have a PreClinical Clubfoot Deformity is by looking
at the bones inside your feet. Theoretically, a radiographic profile of the posterior aspect of the
calcaneus and talar head would provide a definitive diagnosis, but no such test has yet been
developed.
However, there are indicators that the PreClinical Clubfoot Deformity is present, such as the
questions asked in the Rothbarts Foot Questionnaire as well as in my patient profile (done during
your Initial Phone Consultation). The BioVector Measurement test shows the presence of the
elevated big toe and first metatarsal when your foot has been placed in its anatomical neutral
position. My computerized gait analysis rules in (or out) whether you walk in a predefined way
(consistent with the walking motion of a person with a PreClinical Clubfoot Deformity).
Note – Because the Rothbarts Foot and PreClinical Clubfoot Deformity can visually look very
similar, it’s only through running specific computer and video analyses that the differential
diagnosis (determining which of the two structures you actually have) can be made.
Symptoms

Plantargrade Foot – The plantargrade foot does not cause chronic muscle and joint pain.
Optimal health resulting from good posture.

Morton’s Foot – The Morton’s Foot causes foot pain (frequently under the second metatarsal
head) but is rarely the cause of chronic musculoskeletal pain in the rest of the body.

Due to its smaller size, the second metatarsal head is not meant to support the majority of the
body's weight. So when this happens, the body protects the (smaller and more fragile) second
metatarsal head by building up callus tissue. This callus tissue acts like a pebble imbedded in the
skin, which produces pain when you walk.

My research concurs with Dudley Morton's findings; that this foot structure mainly produces
painful symptoms in the feet. But, recently, much has been written on the internet about the
Morton's Foot, citing Janet Travel’s earlier work, which suggests that Morton's Foot is a
common perpetuator of chronic musculoskeletal pain throughout the body. It needs to be
clarified that, in Travel’s later years; what she thought to be Morton's Foot, might very well be,
in fact, a Rothbarts Foot. This is because (in a Rothbart Foot) in which the first metatarsal is
elevated and twisted; it can appear shorter than the second metatarsal – when in actuality it is
not.
Rothbarts Foot - The Rothbarts Foot causes chronic muscle and joint pain throughout the body.

PreClinical Clubfoot Deformity – The PreClinical Clubfoot Deformity (currently not known or
understood by many physicians) is often the cause of the most severe disabling and debilitating
chronic muscle and joint pain.

Since the severity of ‘foot twist’ determines the severity of the postural deformity and resulting
chronic pain, the Preclinical Clubfoot Deformity produces more debilitating symptoms than the
Rothbarts Foot.

Prevalence:
Morton’s Foot – The Morton’s Foot is relatively uncommon foot structure. Although Morton's
Foot is considered a disorder, many healthcare providers simply consider it to be a normal
variant of foot shape, affecting 30-50% of the population (depending on the author). However,
in my experience, it is not a common variant of foot shape, but an uncommon foot abnormality;
affecting approximately 10% of the world population (it's more common in some parts of the
world than others).

Rothbarts Foot - The Rothbarts Foot is a relatively common foot structure. According to my
findings based on 45 years of research and clinical experience, it affects approximately 15 – 20%
of the world population.

PreClinical Clubfoot Deformity – The PreClinical Clubfoot Deformity is a very common foot
structure. According to my findings based on 45 years of research and clinical experience, it
affects at least 70% of the world population.

Treatment
Morton’s Foot - The Morton’s Foot is effectively treated by using an extension pad extending
from the 1st metatarsal head, past the big toe.

Rothbarts Foot -The Rothbarts Foot can only be effectively treated by using Rothbart
Proprioceptive Therapy.
PreClinical Clubfoot Deformity- The PreClinical Clubfoot Deformity can only be effectively
treated by using Rothbart Proprioceptive Therapy.