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Role of the spring ligament

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, May 6, 2008.

  1. I don't like having words put into my mouth. I never said that people with tibial varum all run faster than people than straight legs. What I did say was that many better runners have tibial varum likely due to their ability to avoid chronic overuse injuries to the knee with increased training mileage. Please pay better attention when you attend one of my other international lectures.

    By the way, Paul, my eyes are open, but I am not gullible.
     
    Last edited: May 16, 2008
  2. Mr. Miller:

    Just returning the favor from a posting you made to me about a year ago on JISC mailbase. By the way, you may want to invest in a spell checker before you do that doctoral thesis.:rolleyes:

     
  3. kevin miller

    kevin miller Active Member

    Mr Kirby,

    You are quite welcome, and the point is made. I really can't believe you kept that post this long. It was a good one, hey? It did need a spell check, though. Are we even yet? I would much rather trade knowledge than insults, but I'll keep this up as long as they let us.....which shouldn't be too much longer if I were the moderators. As for the spell checker, I usee it abot evry 2d or 3rd timr, which is better than most. In any case, I tire of this, so let's either get back to something useful or quit. Agreed?

    Kevin
     
  4. Agreed. Please let's talk about something other than tensegrity and/or biotensegrity. I'm sure that there are plenty of other subjects that both of us would rather discuss with each other and with the others following along.

    Have a nice weekend.:drinks
     
  5. David Smith

    David Smith Well-Known Member

    Paul

    This diagram is open chain eg in ipsilateral swing thru, most people dorsiflex their toes during swing thru. But the same diagram (+GRF vectors) could apply to the example you gave of standing on the hard bathroom or kitchen floor with toes dorsiflexed.

    When standing in RCSP it is usual but not necessary to have tension in both the Plantar fascia and achilles tendon at the same time. The lesser toes do not need to dorsiflex or contact the ground for there to be tension the plantar fascia in resting stance.

    Are you messin with my head or have one of us lost lost the plot?:confused:

    Regards Dave
     
  6. David Smith

    David Smith Well-Known Member

    Kevin M

    You wrote
    ,

    I often have people who have been to many other specialists and get better after one consultaion and intervention from me.

    Today a lady who I had not see for about a year came in for some 4mm heel lifts.
    She came in a year ago with hip and back pain as a secondary complaint to her chiropody treatment. Mentioning her long standing hip and back pain I noticed that she had an apparent l.l.d. and fitted her a 4mm heel lift. Today, as I said, she came in for some more and commented that she had not had a minute of pain since I fitted the heel lift. She had spent five years previous to this in pain and seeking treatment from hospital specialists and GP to no avail. "I come here and you fix me in five minutes it's incredible" she said.

    This is a fairly common occurence but, since nobody ever comes back not to buy heel lifts because they were crap, it in fact proves nothing to anyone except me of course and I think it proves that I am a wonderful faith healer.:dizzy: I have actually been told this by several customers "Are you a spiritual healer dear I can sense your healing aura"

    Things happen and I take from it what I need but proving that things happen in the way I percieve them to be, is another whole long and labourious ball game.

    All the best Dave
     
  7. Mart

    Mart Well-Known Member

    Fabulous post Dave - more on the other thread when (if) I find time to articulate something approaching this level of reason.


    :good: :good: :good:

    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  8. David Smith

    David Smith Well-Known Member

    Mart

    Thanks, I also have thoroughly enjoyed your intelligent contributions to Podiatry Arena .

    Group Hug:rolleyes:

    :drinks Cheers Dave
     
  9. musmed

    musmed Active Member

    Dear Kevin

    I suppose I and other will have to have their ears washed out!

    I reiterate this is not what you said. You may have thought that, but what you said certainly did not come out in these terms.

    Please pay better attention.... maybe you should pay attention to what you say and then my attention will not need comment.
    I will be happy to attend a local lecture if that makes what you say any better... I doubt it.

    mate don't take Aussie for a joke. We ALL heard what you said and what you said was gospel according to you.

    I will leave it at that.
    Regards to all
    Paul Conneely
    www.musmed.com.au
     
  10. musmed

    musmed Active Member

    Dave

    May I be so bold as to ask how you "notice an apparent leg lenght difference" and what does this mean?

    Thanks in advance

    Paul Conneely
    www.musmed.com.au
     
  11. Stanley

    Stanley Well-Known Member

    Dave,

    I’m glad to find out that you are finding some of my techniques useful. We should compare notes, as to what works and when. :drinks

    Dave, I think I told you that I rub the fascia near the knee for recurring cranial faults (after testing it), and that the cranial faults can cause weak foot muscles, equinus, etc. So what I am saying is that is may seem that the process goes distally, but it only does that after a few steps. :cool:


    It is a quantum leap to say that the tone of ligaments, fascia and muscle communicate tonus information and synergistically adjust accordingly. :drinks
    I agree that this does not prove biotensegrity. To prove whether it exists of not, we would need to know how much cartilage compresses with a certain unit of pressure, then see if this is the same number as in vivo. I don’t have access to this information. I was hoping you did, so we could put this discussion to bed.
    By the way, I am leaning that there is biotensegrity. For it to occur, the bones would have to hang in the fascia. I am pretty sure this is what is happening. Failure of the fascia is what would increase the loading of the joints. Some of the anatomical signs seem to be ignored. In your work on the plantar fascia, I didn’t see the contribution of the attachment of the plantar fascia into the skin. :confused:
    According to Gray’s (http://www.usmleweb.com/reference/gray/sub131.html):
    The central portion, the thickest, is narrow behind and attached to the medial process of the tuberosity of the calcaneus, posterior to the origin of the Flexor digitorum brevis; and becoming broader and thinner in front, divides near the heads of the metatarsal bones into five processes, one for each of the toes. Each of these processes divides opposite the metatarsophalangeal articulation into two strata, superficial and deep. The superficial stratum is inserted into the skin of the transverse sulcus which separates the toes from the sole.

    I wonder why it attaches to the skin if not for tensegrity. :confused:

    Regards,

    Stanley
     
  12. kevin miller

    kevin miller Active Member

     
  13. kevin miller

    kevin miller Active Member

    OK, We'll give it a try, though I don't think Tensegrity is going to fade away as easy as we might like. This is good, though. Debate is a very good thing. At least some thik there is something to debate. I think we have finally gotten past the rigid definitions laid out by the engineers and moved to a more biologcal set that we can eork from.

    Anyway, Kevin, here is your question. It is no trick. Several different people have a different answer, but I have never heard one from your camp...
    What is the foot for? (Besides the obvious)

    Cheers,
    Kevin M
     
  14. David Smith

    David Smith Well-Known Member

    Paul

    Anything I want it to!:boxing:

    But to elaborate, no more than seeing a stance and foot shape that indicates a short leg (whether functional or structural or a combination of both) and using a trial heel lift get the results I have stated (for that patient).


    Stanley

    This is a limitation of the modeling technique I used. As you see I used a simple manual technique (augmented by MS Excell for the thousands of repetitive calculations) however I think it gave some useful data that could be evaluated and reasonable conclusions made within the limits of the experiment and my shaky mathematical skill and the constraints of the paper.

    Ok it was too difficult so I left it out :sinking:

    Cheers Dave
     
  15. Stanley

    Stanley Well-Known Member

    Dave, So you put the heel lift under the side with equinus?

    In no way did I want to cast dispersions on your excellent paper. :drinksThere were some important points made by it (ie the importance of the lesser digits-so I now consider adding toe crests to my orthoses for patients that have plantar fasciitis). I just wanted to make the point that looking and seeing are two different things. If we don't see the structures of tensegrity, it doesn't mean it may not be there. (My favorite example of looking but not seeing is the surgeons who are looking when they perform their calcaneal spur surgery but don't see that the plantar fascia is not attached to the spur).

    If you find it too difficult, then there is no hope for me.:bash:

    Regards,

    Stanley
     
  16. musmed

    musmed Active Member

    Dear All

    I was listening to Howard D in Sydney on Sunday and he said a very prodound thing.
    He said we walk to tighten our fascia so the whole body supports us when we walk.
    He said the windlass mechanism tightens the fascia from the toes to the skull.

    This fascial attachment to the skin now make so much sense

    Worth more than a thought especially those who see those Massai boots...
    Regards all from the sunny south coast where the weather has been magnificant.

    Paul Conneely
    www.musmed.com.au
     
  17. kevin miller

    kevin miller Active Member

    Ah..paul, what Howard said only makes sense if you buy into what we have been talking aobut here for a week. This stated with the spring ligament and has progressed to the entire fascial plane, yet we are still talking about the same thing in a sense because it is all interconnected. Even in the feet te fascial compartments that hold the intrinsic muscles act as force transfer agents between the PF and Mets because the form a semi-rigid attachement between the two that becomes rigid as soon as the msucles tighten up. Kev
     
  18. Stanley

    Stanley Well-Known Member

    This makes anatomical sense.

    Here is a site we should all explore:

    http://www.anatomytrains.com/explore/dissection

    Click on: Superficial Back line and you will see how the plantar fascia is connected to the top of the skull right above the brow.

    Regards,

    Stanley
     
  19. Sicknote

    Sicknote Active Member

    Hi guys, I was just wandering, is there a potential for the spring ligament to be strengthened through an exercise/moving the foot through a particular plane/ROM or some type of training?. Is there a muscle(s) which directly relate to the spring ligament?.

    Any replies would be appreciated.
     
  20. How do you strengthen a ligament? Rather than just keep walloping out the posts into every thread that fits vaguely with your ambition, why don't you actually spend some time thinking about what you are asking us, for yourself?

    You suggested in a response to Kevin that you are a student doing research for an essay. you are a student of what? Where? What is the title of your essay you have been asked to complete?
     
  21. Sicknote

    Sicknote Active Member

    I have. Just looking for other opinions.

    My understanding of the situation is that resistance training improves the strength of not just muscle, but also the supporting infrastructure - tendons, ligaments, and bones. The function of tibialis posterior in maintaining the medial arch of the foot is supported by the spring ligament, so the tibialis posterior muscle-tendon complex is certainly important.

    Tendons and ligaments--an overview.


    Original link: http://www.ncbi.nlm.nih.gov/pubmed/9302572?dopt=Abstract


    "...Consideration is also given to the structure and function of tendon sheaths and to the dramatic effects of exercise and deprivation on tendons and ligaments-exercise strengthens, but even relatively short periods of immobilisation can dramatically weaken tendons and ligaments..."
     
  22. Stanley

    Stanley Well-Known Member

    Hi,

    Great question. I don't know the answer, but I can lead you in the right direction.
    First of all, all structures can be strengthened by progressively increasing stress to it (Davis' law and Wolf's law).
    The old time strongmen used to do exercises particularly to strengthen ligaments. They felt you had to protect the joints in order to get strong. Look into the books of George Jowett. This is anecdotal, so I leave it to you to find out if there were some studies to prove it, or to do the research.
    As far as muscles, they are there to protect ligaments. When the muscles fail, the ligament takes up the force. Look at the flexor digitorum brevis in addition to the other muscles in the area.
    Also, there are muscle fibers in ligaments. You can look into what changes the tone of these muscle fibers.
    You might also look into prolotherapy to strengthen the ligament.

    I hope you find the answer, as I would find it very helpful.

    Regards,

    Stanley
     
  23. How do you strengthen the spring ligament?

    What are you a student of , where are you studying and what is the title of your essay?
     
  24. Ian Linane

    Ian Linane Well-Known Member

    The only way I have heard of ligaments being "strengthened", if that is the correct term anyway, is by them being repeatedly stressed, in a controlled way, so as to generate increase in collagen lay down.

    For example, the Deltoid in footballers that can be thicker on the kicking foot. I'm not sure this is making them "stronger", possibly implying a contractile element by use of the term, so much as making their tolerance under load greater when at their extreme end range, by virtue of increased fibre lay down.
     
  25. Sicknote

    Sicknote Active Member

    Through progressive resistance/overload.


    Original link: http://www.ncbi.nlm.nih.gov/pubmed/9302572?dopt=Abstract


    "...Consideration is also given to the structure and function of tendon sheaths and to the dramatic effects of exercise and deprivation on tendons and ligaments-exercise strengthens, but even relatively short periods of immobilisation can dramatically weaken tendons and ligaments..."
     
  26. User7

    User7 Active Member

    If progressive resistance/overload can lead to "strengthening" of ligaments, and inactivity lead to the opposite, what happens when orthoses are used to reduce the load on these structures?

    It's commonly reported and/or presumed that long-term orthotic therapy can result in adaptive shortening of lax ligaments, such as the springs, but that the ligaments will deform and lengthen quickly if the orthoses are subsequently abandoned. Why? If the orthoses reduced the loads on the spring ligament, we could presume that any shortening would be accompanied also by "weakening" (reduced tensile strength?). Without the load-reducing orthoses in place, the short, but weak, spring ligament might then plastically deform due to sudden overload.

    Could a serial approach avoid this? Start with a highly controlling device and progressively replace with less controlling devices, or less stiff materials? Controlled exercises designed to load the spring ligaments just short of plastic deformation during the orthotic therapy, perhaps combined with prolotherapy, would help, presumably.
     
  27. Here's something better to think about for a while: how does rupture of the spring ligament occur in association with posterior tibial dysfunction? As the posterior tibial muscle/ tendon unit becomes progressively incapable of resisting external pronation moment by providing internal supination moment, progressively more loading is added to the spring ligament. This is a slow process happening over many months if not years if not decades. Why then doesn't the spring ligament increase in strength via it's resistance to the pronation moments? Why does overload result in plastic deformation and ultimately rupture? Surely over time the ligament should have got stronger and stronger and stronger? Yet, spring ligament rupture is not too uncommon. Indeed, via the reasoning you give, what we actually want to do to strengthen the spring ligament is to progressively increase the external pronation moment, (which is what the pathological process leading to spring ligament rupture does) The question then becomes, what role does external pronation moment play in pathology...?


    Please don't say that it's because the spring ligament is exposed to too much force too soon without adequate conditioning or I'll kill you. Seriously.

    Which comes back to my point, how do you strengthen the spring ligament? Theoretically, you do this by increasing the external pronation moment acting on the foot, if you can do this without creating pathology elsewhere, that'd be good. No such thing as a free lunch. I played around with these kind of ideas about 15 years ago, and soon stopped.

    Furthermore, lets take a closer look at the research which says inactivity leads to decreased tensile strength of ligaments- show me one of those studies which were a) performed in humans and moreover, b) didn't use complete immobilisation via fixation (plaster cast etc)? Do foot orthoses immobilise the foot? Do they even change the kinematics?
     
  28. Phil Wells

    Phil Wells Active Member

    Simon

    Good questions. Not totally sure of the mechanics of the elastic deformation but could neurological feedback be part of the process. I vaguely remember from Uni that blood pressure baroreceptors reset to a new normal when high'low pressure is present for long enough.
    Could the same mechanism be happening with gradual non-pathological over load not being 'noticed' by the neuro system and the potential for self correction (If such a thing can happen) not occurring.
    What is the threshold for the strengthening of a ligament and would it ever occur if the above mechanism is hiding the overload?

    Got me thinking!

    Phil
     
  29. The significant thing about the spring ligament complex and posterior tibial tendon dysfunction is that the PT tendon directly supports the spring ligament complex so that a failure or weakness in the PT muscle-tendon will increase the tensile stress on the spring ligament complex. In addition, there is an incredible difference in the mechanical characteristics of the spring ligament complex from one individual to another. See the attached reference.
     

    Attached Files:

  30. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    An Attachment-Based Description of the Medial Collateral and Spring Ligament Complexes.
    Cromeens BP, Kirchhoff CA, Patterson RM, Motley T, Stewart D, Fisher C, Reeves RE
    Foot Ankle Int. 2015 Feb 23.
     
  31. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The spring ligament complex: Illustrated normal anatomy and spectrum of pathologies on 3T MR imaging
    Hythem Omar, MD, Vikram Saini, MD, Vibhor Wadhwa, MD, George Liu, DPM, Avneesh Chhabra, MD
    European Jnl of Radiology; Article in Press
     
  32. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Anatomic study of the medial side of the ankle base on the joint capsule: an alternative description of the deltoid and spring ligament
    Kentaro AmahaAkimoto NimuraReiko YamaguchiNatnicha KampanAtsushi TasakiKumiko YamaguchiRyuichi KatoKeiichi Akita
    Journal of Experimental Orthopaedics December 2019, 6:2
     
  33. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Functional assessment of the spring ligament using ultrasonography in the Japanese population.
    Tanaka K, Kudo S
    Foot (Edinb). 2020 Jan 28
     
  34. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of each bundle of the spring ligament complex between the standing and supine positions: A multiposture magnetic resonance imaging study
    TomoHamada et al
    Foot and Ankle Surgery 6 July 2021
     
  35. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Anatomical variants of the medioplantar oblique ligament and inferoplantar longitudinal ligament: an MRI study
    Paweł Szaro et al
    Surg Radiol Anat. 2021 Nov 20.
     
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