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"Orthotics (shoe inserts) do not correct the CAUSE of problems of the foot & leg, they only support them. At the F&LC we identify the true cause and fix it by X-ray analysis, joint mobilisation and corrective exercises."

But Ted,
I pulled the above quote from your website. Isn't this saying the same thing, kind of?

Also, and I don't want to misquote your business here, but I think you are saying that bodyweight and the forces associated with ambulation are responsible, in the main, for the problems you deal with?

Now that's kind of interesting too . Because I (and one or two others) happen to believe that the unnatural (for us since we have not evolved for a life on a hard, flat surface) surfaces we walk on, coupled with our "go anywhere - do anything" adaptable feet, are the main reason we see problems.

Phil, I agree with you BTW, that footwear causes problems too.

No problems with manipulations here - I do them myself. But orthoses (little more than an interface between the ground and the patient) are an important part of overall care.

Cheers,
davidh

It would seem the thread has moved to an orthoses therapy vs. manual therapy contest. This is not the point of using manual therapy. There is no argument that a normal foot with no positional, anatomical or mechanical deficit will respond well to manual therapy without foot othoses. As foot care professionals we seldom see those in our office. It is my contention that using joint mobilizations will enhance the effect of orthotic therapy and produce better outcomes which is why patients come to see us in the first place!

I think that there are few cases that we see where only one form of therapy cures all that ails. As mentioned in an earlier post, it is the combination of therapies that will produce the best outcomes.

Woodman

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Woodman

Hi David,

The specific 'cause' we focus on is subluxation of joint(s) in the foot and leg. We have found that orthotic therapy can be very effective in supporting subluxation, but it does not correct subluxation (much like reading glasses assist in eye sight disorders, so they only work while you are wearing them).

Subluxation occurs when a joint is exposed to more force than it can withstand. So forces from body weight, ambulation may contribute and events such as ankle sprains, injuries, poor posture, work related positions, strenuous actions can also contribute to subluxation.

If patients are experiencing musculoskeletal dysfunction due to compensation caused by other biomechanical factors such as femoral or tibial torsion, ligamentous laxity, plastic deformation of connective tissues then orthotic therapy is indicated. Our assessment process is designed to assess for the primary etiological factor and treat that accordingly. We use orthotic therapy where indicated and offer options for those patients who ask '...isn't there something else I can do to help myself?'

Hopefully you clicked on to the links from which you quoted to see how we determine the treatment options most suitable and help people determine if our services will suit them?

Bob, I agree with your observation that manual therapies can enhance orthotic therapy efficacy. So few podiatrists in Australia actually do this though.

Cheers,
TedJed

Dear Moderator and Members:

I came across this thread today, and will chime in on this since I do a lot of extremity joint manipulation. First, I want to say that some of the discussion regarding chiropractic is nauseating. Granted, chiropractic has suffered with its share of charletans, and it continues to harbor a contingent hung on dogmatic tennets. However, the majority of good, modern chiropractic doctors deserve some respect and professional consideration.

On the topic of manipulation of the foot and ankle, there is nothing mystical about it. It is what it is: joint manipulation. How it is applied, which joints are targeted, and how skilled the practitioner is makes the difference in a patient feeling better or not. Most foot and ankle pain issues that will respond to manipulation will likely do so in short order, not in weeks or months as someone highlighted in previous posts. It also is not a replacement for foot orthotics, is not a means to create a longitudinal arch, and is not a substitute for differential diagnosis or medical treatment. Duh!

Regarding manipulation for ankle sprain, it can safely be done to grade-2 inversion sprains, and combined with soft tissue mobilization and some light taping, either kinesiotaping or other proprioceptive taping, it is very effective in reducing pain and promoting immediate improvement in function. I am particularly interested in the common sequelae to inversion ankle sprain: functional instability. I have my ideas about how functional instability may be considered an acute dysfunction of the ankle that causes reflex inhibition to leg muscles (e.g. everters), and I'd be happy to chat about that. The inhibitory reflexes are well understood at other joints, particularly the knee. Regardless, high velocity manipulation is safe and effective for ankle sprains – those with and without obvious disruption of ligaments. The manipulation may be a way to eliminate the joint dysfunction and reduce the potential for sudden arthrogenic inhibition to the ankle muscles. Below are some references to consider.

'Regards,

Scott Gillman, DC, DACBSP
www.drgillman.com

1. Safran, M.R., et al., Lateral ankle sprains: a comprehensive review: part 1: etiology, pathoanatomy, histopathogenesis, and diagnosis. Med Sci Sports Exerc, 1999. 31(7 Suppl): p. S429-37.
2. Hertel, J., et al., Talocrural and subtalar joint instability after lateral ankle sprain. Med Sci Sports Exerc, 1999. 31(11): p. 1501-8.
3. Palmieri, R.M., et al., Arthrogenic muscle response to a simulated ankle joint effusion. Br J Sports Med, 2004. 38(1): p. 26-30.
4. Shakespeare, D.T., et al., Reflex inhibition of the quadriceps after meniscectomy: lack of association with pain. Clin Physiol, 1985. 5(2): p. 137-44.
5. Dananberg, H.J., Manipulation of the ankle as a method of treatment for ankle and foot pain. J Am Podiatr Med Assoc, 2004. 94(4): p. 395-9.
6. Gillman, S., The Impact of Chiropractic Manipulative Therapy on Chronic Recurrent Lateral Ankle Sprain Syndrome in Two Young Athletes. Journal of Chiropractic Medicine, 2004. 4(3): p. 153-158.
7. Eisenhart, A.W., T.J. Gaeta, and D.P. Yens, Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc, 2003. 103(9): p. 417-21.
8. Pellow, J.E. and J.W. Brantingham, The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. J Manipulative Physiol Ther, 2001. 24(1): p. 17-24.

Foot Mobilisation Techniques (FMT) Courses will be conducted in England in April 2010.
Further information available at www.footmobilisation.com

Scott,

Welcome to the board.

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"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright

David G. Wedemeyer, D.C., C.Ped.

Phill,
With dinner attire: "As the limits of passive joint movement are approached, additional resistance is encountered as the joint's elastic limits are challenged. Movement into this space, the end play zone (EPZ), may be induced by forced muscular effort by the patient or by additional overpressure (end play) applied by the examiner. If the forces applied at this point are removed, the joint springs back from its elastic limits. Movements into this region are valuable in assessing the elastic properties of the joint capsule and its periarticular soft tissues.
Movement beyond the EPZ is possible, but usually only after the fluid tension between the synovial surfaces has been overcome. This process is typically associated with an articular crack (cavitation). Sandoz has labeled this as the zone of paraphysiologic movement and identified its boundaries as the elastic and anatomic barriers." ~ from Chiropractic Technique: Peterson and Bergmann, 2nd ed.

Note the order: from active ROM>Passive ROM> Physiologic barrier>EPZ>Elastic Zone>Paraphysiologic Space>Anatomic Limit>Joint trauma or pathology

In a t-shirt explanation of paraphysiologic space: extend your index finger (active), then bend it back a little further with your palm (passive), feel it creak to a stop (physiologic barrier), slightly spring a little further back and feel the play (End Play zone). Now give it a quick, controlled spring and if you hear/feel it cavitate, congratulations - you have passed the elastic zone and made it to the Paraphysiologic space. I believe this is called "Cracking One's Knuckles" in jeans and flip-flops. "Jamming Your Finger Playing Basketball" is passing the anatomic limit and reaching joint trauma. Don't do that to yourself ~ a chiropractor would not, either.

Cheers!

Very nicely done Rabbit. Well articulated and described.
Ted

Was interested in reading this thread, as I attended a course run by Ted at his clinic in Adelaide earlier this year. I admit I was very sceptical but am always keen to learn more rather than discard something.
During the 2-day workshop I learnt, practiced, and underwent the mobilisation and manipulation techniques that were taught.
I have since being using these techniques in conjunction with other modailities and finding the results very pleasing, and agree with Dr Gillman's time reference. It still requires accurate diagnosis of the problem, and therefore the appropriate treatment modalities available. (another excample could be massage vs dry needling - I utilise both depending on varying factors including pt consent). I can not imagine ever using mobilisation as my only modality as I like Shane's analogy of the quiver...

TedJed,

I just explained it as my professor did to us on one of the first days of class - we were equally astounded at the simplicity;-)