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Foot orthoses outcomes and kinematic changes

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  #31  
Old 24th January 2005, 05:14 PM
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Originally Posted by Atlas
My guess would have been > 10-20%.

But beyond the windless effect (which I presume does not relate to lesser rays), low-dye taping surely influences all rays, all FHB slips, and hence, I again assume, the total tensile stress through the plantar fascia.

Typo. I meant FDB....not FHB.
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  #32  
Old 24th January 2005, 05:24 PM
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My guess would have been > 10-20%.
It reduced it by 80-90%, down to 10-20% of the original force - sorry for the confusion.
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  #33  
Old 24th January 2005, 08:59 PM
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Quote:
Originally Posted by Atlas
Plantar fasciitis/fasciosis, in my clinical experience is invariably assisted (at least short-term) by low-dye taping. What does low-dye taping do to rear-foot kinematics? Other than restrict the range closer to neutral position, probably very little.

What low-dye taping does do, and this perhaps supports Phil's theory, is that is has more of an influence on the mid and forefoot. I envisage that low-dye taping unquestionably removes tension from the plantar fascia structure, without the direct pressure exerted by a device without groove.

Low-dye taping, I envisage also pulls the 1st ray into plantar-flexion; and I assume the other rays...hence reducing tensile stress on FHB.
As Craig noted in his research, the Low-Dye strapping reduced the tension in the plantar fascia by 80-90% when measuring the force to establish the Windlass Effect of Hicks. This makes sense when you model the foot as I have previously explaining the biomechanical etiology of functional hallux limitus (Kirby, KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002, pp. 139-152).

Low-Dye strapping causes a anteriorly directed force on the plantar calcaneus and a posteriorly directed force on the anterior forefoot. These two forces will cause a rearfoot dorsiflexion moment and a forefoot plantarflexion moment, especially when the strapping is exerting a large tensile force on the skin of the foot (such as when the foot is in the late midstance phase of gait).

Since the plantar fascia, like the Low-Dye strapping, also causes an anteriorly directed force on the plantar calcaneus and a posteriorly directed force on the anterior forefoot, it likewise creates a rearfoot dorsiflexion moment and a forefoot plantarflexion moment. Therefore, the Low-Dye strapping will reduce the tensile force on the plantar fascia since the Low-Dye strapping, basically, performs the same mechanical function as the plantar fascia.

This is the beauty of understanding the joints of the foot and lower extremity by using the concept of moments and rotational equilibriium: many therapeutic modalities may be explained mechanically much more precisely than would be possibe without their use.
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Old 24th January 2005, 10:44 PM
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Quote:
Originally Posted by Kevin Kirby

Low-Dye strapping causes a anteriorly directed force on the plantar calcaneus and a posteriorly directed force on the anterior forefoot. These two forces will cause a rearfoot dorsiflexion moment and a forefoot plantarflexion moment, especially when the strapping is exerting a large tensile force on the skin of the foot (such as when the foot is in the late midstance phase of gait).

Since the plantar fascia, like the Low-Dye strapping, also causes an anteriorly directed force on the plantar calcaneus and a posteriorly directed force on the anterior forefoot, it likewise creates a rearfoot dorsiflexion moment and a forefoot plantarflexion moment. Therefore, the Low-Dye strapping will reduce the tensile force on the plantar fascia since the Low-Dye strapping, basically, performs the same mechanical function as the plantar fascia.
The forefoot plantarflexion moment made sense to me, but you have opened my eyes to the rearfoot dorsiflexion moment provided by taping.


My original rearfoot mindset regarding the efficacy of low-dye taping of plantar fasciitis conditions centred around reducing the excursion of the medial tubercle. The plane of excursion would of course depend on the horizontal/vertical position of the STJ axis. My original rearfoot mindset was low-dye taping reduced the total excursion of the origin, hence the therapeutic influence on the rearfoot.

But I have ignored and/or not come across the rearfoot dorsiflexion effect of L.D.taping; perhaps at my peril.


I had almost come up with a 'rule' that suggested if L.D.taping is therapeutic, perhaps a root +/- modified device would suffice.

Now that you have got me on a rearfoot dorsi-flexion wavelength, I might have to dilute the rule as other devices and modifications dorsi-flex the rearfoot more potently.
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  #35  
Old 25th January 2005, 09:42 AM
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Default Mechanical Effects of Low-Dye Strapping

Quote:
Originally Posted by Atlas
The forefoot plantarflexion moment made sense to me, but you have opened my eyes to the rearfoot dorsiflexion moment provided by taping.

My original rearfoot mindset regarding the efficacy of low-dye taping of plantar fasciitis conditions centred around reducing the excursion of the medial tubercle. The plane of excursion would of course depend on the horizontal/vertical position of the STJ axis. My original rearfoot mindset was low-dye taping reduced the total excursion of the origin, hence the therapeutic influence on the rearfoot.

But I have ignored and/or not come across the rearfoot dorsiflexion effect of L.D.taping; perhaps at my peril.

I had almost come up with a 'rule' that suggested if L.D.taping is therapeutic, perhaps a root +/- modified device would suffice.

Now that you have got me on a rearfoot dorsi-flexion wavelength, I might have to dilute the rule as other devices and modifications dorsi-flex the rearfoot more potently.
Low-Dye strapping will also cause a mechanical effect on the subtalar joint (STJ), however this effect is weaker than its effect on the midtarsal joint (MTJ). If the strapping can prevent flattening of the medial longitudinal arch (MLA), then the increased ground reaction force that occurs plantar to the medial metatarsal rays will cause increased STJ supination moment (or decreased STJ pronation moment).

Certainly the rearfoot dorsiflexion moment produced by Low-Dye strapping is very important along with its ability to produce a forefoot plantarflexion moment. The magnitude of rearfoot dorsiflexion moment and forefoot plantarflexion moment produced by the strapping (and the plantar fascia, for that matter) will be dependent on the height of the longitudinal arch of the foot. The higher the arch, the greater the moments. In a very flat arched foot, virtually no rearfoot dorsiflexion moment or forefoot plantarflexion moment will be produced by the strapping (and again, the same goes for the plantar fascia).

I think many clinicians make the mistake to assume that if Low-Dye strapping works, then foot orthoses should work just as well. Foot orthoses work by modifying the ground reaction forces on the plantar foot (all compression forces) whereas Low-Dye strapping works by adding tensile forces to the skin of the foot to cause its mechanical effect. It is for this reason that Low-Dye strapping generally is sometimes more effective for symptoms caused by excessive arch flattening moments, such as plantar fasciitis, than foot orthoses are.
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  #36  
Old 23rd February 2005, 10:23 AM
Paul Harradine Paul Harradine is offline
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Default Low dye taping and rearfoot motion

Sorry, bit late on this!

Harradine PD, Herrington L, Wright R. The effect of low dye taping upon rearfoot motion before and after exercise. The Foot. 11(2):2001. p57-61

We found during the initial 60% of stance phase rearfoot motion (pronation angle, max pronation and velocity of pronation) was not significantly altered by Low dye taping. Intial RCSP was more inverted, but this was lost after a brief duration of treadmill walking.

I've been using the F-Scan in-shoe for a while now and find low-dye taping increases 1st MPJ loading and makes force time curves much more 'm' shape in the symptomatic cases I see. Interesting how the windlass can appear to work more effectively without apparently changing rearfoot position or motion.

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  #37  
Old 24th February 2005, 09:34 AM
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Quote:
Originally Posted by Paul Harradine
Sorry, bit late on this!

Harradine PD, Herrington L, Wright R. The effect of low dye taping upon rearfoot motion before and after exercise. The Foot. 11(2):2001. p57-61

We found during the initial 60% of stance phase rearfoot motion (pronation angle, max pronation and velocity of pronation) was not significantly altered by Low dye taping. Intial RCSP was more inverted, but this was lost after a brief duration of treadmill walking.

I've been using the F-Scan in-shoe for a while now and find low-dye taping increases 1st MPJ loading and makes force time curves much more 'm' shape in the symptomatic cases I see. Interesting how the windlass can appear to work more effectively without apparently changing rearfoot position or motion.

Paul Harradine MSc BSc(Hons) CertEd
Podiatrist / Director
The Podiatry and Chiropody Centre
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Paul:

If the primary effect of the low-Dye taping is to cause a forefoot plantarflexion moment (with probably more effect on the medial column than lateral column) then your F-scan results make sense. The low-Dye taping crosses the midtarsal joint (MTJ), and does not cross the subtalar joint (STJ). Because of this, it will have much more mechanical impact on the MTJ than on the STJ. That is not to say that it will not have an effect on the STJ, but it will likely be much less visible.

A good example of how the windlass can be changed without an apparent change in rearfoot position or motion is to take a foot that is maximally pronated at the STJ in relaxed bipedal stance, and then add some extra STJ pronation moment to it by having, for example, the foot stand on a 10 degree valgus wedge.

Has the rearfoot position changed? No.

Has the rearfoot moved? No.

However, now try a Hubscher maneuver on both feet and which foot condition do you think will require more force to dorsiflex the hallux? The one with the valgus wedge. The supination resistance test will also likely require more force (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992).

It is the kinetics of the foot that will alter the kinematics. However, the kinetics can change without an alteration of the kinematics. Thinking in terms of rotational equilibrium and kinetics greatly helps in understanding these findings.
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  #38  
Old 25th February 2005, 01:42 AM
Paul Harradine Paul Harradine is offline
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Default Foot orthoses outcomes and kinematic changes

Hi Kevin

I completely agree with your reply. Infact, we demonstrated your valgus posting example to some extent in:

Harradine PD & Bevan LJ : The effect of rearfoot eversion upon maximum hallux dorsiflexion. Journal of the American Podiatric Medicine Association 9(90);2000

When fitting orthoses though, do you still like to see an 'improvement' in rearfoot position and motion? Or do you look for static test improvements such as Hubscher standing on the appliances etc?

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  #39  
Old 25th February 2005, 01:46 AM
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do you still like to see an 'improvement' in rearfoot position and motion?
Thats what started this thread....we have found NO correlation to dynamic changes in rearfoot position/motion and clinical outcomes (ie symptom improvement)
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Old 25th February 2005, 03:15 AM
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Default foot orthoses outcomes and kinematic changes

Hi Craig, thanks for the reminder on how the thread started.

It isn't however the question I asked Kevin. I was interested if a podiatrist with the wealth of clinical experience such a Kevin still 'likes to see an 'improvement' in rearfoot position and motion'. I then asked about static tests on orthoses (unshod!) such as the Hubscher.

Sorry for any confusion

Paul
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Old 25th February 2005, 03:21 AM
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I then asked about static tests on orthoses (unshod!) such as the Hubscher.
A reduction in the force to do that test when standing on orthoses (static test) appears to be more predictive of clincial outcomes than changes in the pattern of rearfoot motion (a dynamic test) ---- we starting the RCT to further test and refine this next week.

(Sorry about short sharp answers ---- too many deadlines, too many confernece abstracts due, too many grants to write .... and the students due back Monday

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  #42  
Old 25th February 2005, 03:25 AM
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Default Dynamic Rearfoot position

I would have to agree that in walking most orthotics dont influence rearfoot position hugely or consistently so. Changes one may see are often related to the MTJ not STJ, if one can draw an artificial anatomical line between them.

Less bulging of the midfoot medially under the malleolus, less abductory twist, less knee rotation, longer stride etc are the things you do see and are related to MTJ position. Through altering MTJ position can one alter moments in the STJ? Yes. Does altering the MTJ postion change the ability of the 1st MTP to dorsiflex? Yes. I find although orthotics may not change heel eversion one iota it is unsual to have a successful one that does not alter MTJ pronation and this then facilitates the 1st MTP.
Using the f-Scan when trying to deal with FnHL or windlassy problems very rarely does just using say a 3mm pad under the 2-5 MTPs make any difference but use somthing moulded to the foot that supported the arch and suddenly its all TONS easier. Hang on a minute am I saying ..."lock the MTJ".... ????!!!! Hmmm whats that a stump? you look familiar, I feel the urge to go around you.....

Running however I find "clinically" or empirically that heel eversion is tied to symptoms and is useful to use as a marker for orthotic effect. My theory is that the MTJ pathology is still occuring but because of running limb varus and increased lateral to medial and posterior to anterior directed force the heel everts much more significantly with it.


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Old 25th February 2005, 04:33 AM
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Default foot orthoses outcomes and kinematic changes

Craig - It would be great if there were static markers/tests that could determine (to some extent) the success or otherwise of foot orthoses. I've been using the Hubscher for a while now, and then F-scanning, and find that a substantial improvement in Hubscher does correlate with improved in-shoe gait parameters. I await your results!

I'm in the process number crunching some research on the reliability of the Hubscher, Max pronation and supination resistance tests. Good sample size, inter and intra groups. Just getting my head around the stats, but initial results show poor to moderate on most tests, max pronation being the least reliable.

Lawrence - great points, but reduce the coffee intake maybe? 'locking' the MTJ, whatever next? I've lost the key to that one.

I think our main issue is the fact that I certainly was taught 'Rootian' theory, very much joint position and motion and supplying orthotics to change rearfoot motion / position. However, when qualified I prescribed these orthotics and people got better. The same year we read the 'normal foot' does not 'work in neutral' and now orthotics may not even change rearfoot motion / position. However (and this is where the thread came from...i know craig!) rootian orthotics can work for many people, but were they putting the foot in STJN (probably not then)?, reducing moments across the STJ reducing symptom related moments?, or reducing tension in the medial band of the plantar fascia and reducing 1st ray dorsiflexory moments allowing windlass etc?. I think I'll go for all three, cover my bases and join Lawrence in podiatry area 51.

regards to all.

Paul
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Old 25th February 2005, 04:53 AM
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Default Mtj

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Old 25th February 2005, 05:55 AM
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I think it's available at the 'axes obliquity' store. I have looked there myself a while ago but could not find it
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Old 25th February 2005, 08:06 AM
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Originally Posted by Paul Harradine
Hi Craig, thanks for the reminder on how the thread started.

It isn't however the question I asked Kevin. I was interested if a podiatrist with the wealth of clinical experience such a Kevin still 'likes to see an 'improvement' in rearfoot position and motion'. I then asked about static tests on orthoses (unshod!) such as the Hubscher.

Sorry for any confusion

Paul
Paul and Craig:

I am not that interested in changes in changes in rearfoot position in relaxed bipedal stance, since they don't often change. However, I am very interested in changes in gait function and symptom improvement. Very often the changes with foot orthoses are seen to occur at the midtarsal joint level, which rearfoot measurements won't necessarily show. However, foot orthoses often do change rearfoot motion in gait.

The treatment goal for my patients receiving foot orthoses are as follows:

1. Reduce pathological loading forces on injured structural components.

2. Optimize gait function.

3. Not cause other pathologies or symptoms in accomplishing goals #1 and #2.

Nice discussion, Paul.
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Old 25th February 2005, 10:29 AM
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Thanks Kevin

Quote:
Originally Posted by Kevin Kirby
Paul and Craig:

Very often the changes with foot orthoses are seen to occur at the midtarsal joint level, which rearfoot measurements won't necessarily show. However, foot orthoses often do change rearfoot motion in gait.
I'm glad you said that. I often see alterations in rearfoot motion with foot orthoses. Worried it was just me and Lawrence seeing this! Of course it may be the caseloads we are seeing. With your three step treatment goals , would you expect to see a change in rearfoot motion more in a running orthoses prescrition (for example, designed for the type of runner who is maximally pronating but still maintaining an arch, with post tibial tendonitis?).

Have a good weekend

Paul

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Old 25th February 2005, 02:32 PM
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We do see rearfoot motion changes in some patients, we don't see them in others ---- what I am saying is that we have shown that there is no prospective correlation with changes in rearfoot motion and symptom changes.
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Old 25th February 2005, 06:53 PM
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I don't read much research, I just skim the take-home-message...if I am lucky.


If we are to believe that rearfoot changes don't always occur despite aggressive rearfoot 'correcting' devices, is this measured by getting the subject to stand on the orthotic? Without the heel counter of a shoe holding the heel on the orthotic? Or is the orthotic strapped to the foot?

Has some research been done with subjects in plastic tranparent shoes?
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Old 25th February 2005, 07:44 PM
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If we are to believe that rearfoot changes don't always occur despite aggressive rearfoot 'correcting' devices, is this measured by getting the subject to stand on the orthotic?
We did it by measuring frontal plane translation of malleoli relative to a reference point on shoe with and without othoses (within subject design - used digital video frames at several ponts in the stance phase) - ie if the horizontal distance between the reference point and lateral malleolus increases and the horizontal distance between the reference point and medial malleolus decreases --> more inverted rearfoot (and vice versa)

Irene McClay's group that showed some people pronate more in inverted orthoses, used a cluster marker design attached to the calc via small hole in heel counter (she did tell me how much it weakened te heel counter, but can't recall - it was not much)

Our current work is using running sandals, so we can attach a comprehensive marker set to the bony landmarks -- but that suffers as there is no heel counter... its all about trade offs in this business.
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Old 25th February 2005, 09:44 PM
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Originally Posted by Paul Harradine
Thanks Kevin



I'm glad you said that. I often see alterations in rearfoot motion with foot orthoses. Worried it was just me and Lawrence seeing this! Of course it may be the caseloads we are seeing. With your three step treatment goals , would you expect to see a change in rearfoot motion more in a running orthoses prescrition (for example, designed for the type of runner who is maximally pronating but still maintaining an arch, with post tibial tendonitis?).

Have a good weekend

Paul
Paul, I like your questions. Keep them coming.

Rearfoot motion is often difficult to observe clinically since the changes that occur are hidden by the heel counter of the shoe. However, orthoses commonly affect transverse plane knee position, stride length, relative percentage of stance phase that is propulsion, and midtarsal joint motion.

The more inverted the orthosis, with the more medial heel skive, then the more likely rearfoot changes will occur. I use this type of orthosis prescription for runners with pathology cause by excessive subtalar joint (STJ) pronation moments (e.g. medial tibial stress syndrome) or walkers with pathology caused by excessive STJ pronation moments (e.g. posterior tibial dyfunction). These orthoses very definitely alter the kinematics of the rearfoot and lower extremity during both walking and running.

However, the orthoses that I make for patients with a condition that may be caused by excessive rearfoot plantarflexion and forefoot dorsiflexion moments (e.g. plantar fasciitis) will often show little change in rearfoot kinematics since I don't necessarily invert or add a medial heel skive to these orthoses.
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Old 25th February 2005, 09:59 PM
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Quote:
Originally Posted by Lawrence Bevan
Using the f-Scan when trying to deal with FnHL or windlassy problems very rarely does just using say a 3mm pad under the 2-5 MTPs make any difference but use somthing moulded to the foot that supported the arch and suddenly its all TONS easier.

Lawrence Bevan
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Lawrence:

Excellent observations. Addition of a 3 mm pad under the 2nd-5th metatarsal heads adds a subtalar joint (STJ) pronation moment which will tend to cause the foot to often have more late midstance pronation. However, if you use the same forefoot pad with a medial heel varus wedge and a medial longitudinal arch pad, the foot shows dramatic increases in stride length, gait stability and foot comfort. But why??

The medial heel varus wedge and medial longitudinal arch pad add a STJ supination moment in early stance phase to help decelerate STJ pronation which then, during the latter half of stance phase, works with the 2-5 pad ( that causes a STJ pronation moment) to stabilize the rearfoot. Counteropposing moments on the STJ is one of the keys of this type of "padding" therapy which I have been using in my lecture demonstrations for the past 20 years.

This idea of counteropposing moments has been used by structural engineers for years in stabilizing tall antennaes by placing cables under tension on opposite ends of the antenne, attached to the ground, to create counteropposing moments to create structural stability of the antenna. A rearfoot varus wedge and forefoot valgus wedge accomplish this same mechanical effect on many feet by applying counteropposing moments across the STJ axis.
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Old 1st March 2005, 03:05 AM
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Default foot orthoses outcomes and kinematic changes

Hi Kevin, thanks again for the reply

This is the problem I have with the idea that first ray dysfunction / windlass dysfunction is resonsible for all foot related ills ( i know criag may not have been saying this, but sometimes it seemed that way!). I understand that a FnHL can theoretically 'cause pronation'. And sometimes maybe it does....but in cases when there is a 10 degree tibial varum? Would the large degrees (and velocity) of STJ pronation seen in these patients at contact phase be due to a FnHL? In these cases would we expect, and prescribe, to 'improve' rearfoot kinematics? If this patient was a runner, and had MTSS, would we only expect good results if we did improve this rearfoot motion? Although this tibial varum may result in increased tension in the medial band of the plantar fascia etc, could it possible be the initial pronation velocity / tibial loading responsible for symptoms?

Cheers again

Paul
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Old 1st March 2005, 03:20 AM
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The way I explain it to students is like this:

Imagine a foot that has pronated to end range of motion at the STJ with a huge amount of force. There will be bone on bone contact, that will hurt due to the compressive forces. The post tib will have to work hard (--> maybe MTSS, post tib dysfunction).

You then put an orthotic under the foot and watch them walk --- imagine there is no difference in the way they walk (ie the kinematics have not changed) - they come back 2 weeks later and the symptoms are gone.

The question then, is why did they get better even when there is no improvement in the pattern of rearfoot motion (ie kinematics) (which is what our research showed)

What has happened is this - the STJ has still gone to end range of motion and there is bone on bone contact, but the joint surfaces are only just touching each other and there are not the huge compressive forces that were previously hurting ... ie the foot orthoses have altered the kinetics (ie forces). The post tib will not have to work as hard (symptoms their reduce), as the kinetics have changed.

To get symptom relief, the kinetics (forces, work) have to be altered --- it does not seem to matter if the kinematics (motion, position) are altered or not.

Motion and position do not damage tissues (..yet the profession is very hung up on this). Forces damage tissues.

The force to establish the windlass being lowered with foot orthoses is just one measure of what is happening to the forces. Our research has shown that this lowering of that force is probably related to outcomes.
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Old 1st March 2005, 03:36 PM
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Quote:
Originally Posted by Paul Harradine
Hi Kevin, thanks again for the reply

This is the problem I have with the idea that first ray dysfunction / windlass dysfunction is resonsible for all foot related ills ( i know criag may not have been saying this, but sometimes it seemed that way!). I understand that a FnHL can theoretically 'cause pronation'. And sometimes maybe it does....but in cases when there is a 10 degree tibial varum? Would the large degrees (and velocity) of STJ pronation seen in these patients at contact phase be due to a FnHL? In these cases would we expect, and prescribe, to 'improve' rearfoot kinematics? If this patient was a runner, and had MTSS, would we only expect good results if we did improve this rearfoot motion? Although this tibial varum may result in increased tension in the medial band of the plantar fascia etc, could it possible be the initial pronation velocity / tibial loading responsible for symptoms?

Cheers again

Paul
Paul:

I really don't believe that functional hallux limitus (FnHL) is a cause of pronation, but is a result of a multitude of factors, with excessive subtalar joint (STJ) pronation moments being one of them. Other causes of FnHL can include a long first metatarsal, decreased medial longitudinal arch (MLA) height, a short hallux proximal phalanx and a larger radius of curvature of the first metatarsal head in the sagittal plane. By using a wooden model in a couple of demonstrations I performed at the PFOLA meeting in Boston a few months ago, I was able to show just how changes in MLA height can cause FnHL. Pronation and MLA collapse comes first, FnHL comes second, in my opinion.

Eric Fuller made a good case for the plantar fascia being one of the structures that can resist STJ pronation moments which, in turn, can be used to suggest how STJ pronation moments affect FnHL (Fuller, Eric A: Center of pressure and its theoretical relationship to foot pathology. JAPMA, 89 (6):278-291, 1999; Fuller, Eric A: The windlass mechanism of the foot: A mechanical model to explain pathology. JAPMA, 90:35-46, 2000).

In Craig Payne's excellent reply, he discusses how he teaches the concept of interosseous compression forces within the sinus tarsi as a method to help in understanding how the posterior tibial may be affected by STJ pronation moments. I very much like Craig's approach. I introduced this concept of interosseous compression forces within the sinus tarsi and how it may affect posterior tibial contractile activity to cause STJ supination in my first paper on STJ rotational equilbrium (Kirby, KA.: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989).

Tibial varum does not cause a particularly strong STJ pronation moment since large degrees of tibial varum may cause a STJ supination moment. I can think of many other types of structural deformities that will cause more STJ pronation moment than increased tibial varum.
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Old 1st March 2005, 03:47 PM
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Tibial varum does not cause a particularly strong STJ pronation moment since large degrees of tibial varum may cause a STJ supination moment.
I think a lot of people miss that last point. Also a tibial valgum and/or genu valgum provide a supinatory moment to the STJ. How often do you read in the podiatric literature about them pronating the foot.
Quote:
tibial varum
If someone has a tibial varum, yes the foot has to pronate to get flat on the ground, but since when has the "motion" of pronation or the "position" of pronated been pathologic - it never has (hence my comment above about the profession being hung up on motion and position. If a foot pronates excessively, it is still winthin the "range of motion" of the posterior tibial tendon - so how does pronation damage the posterior tibial tendon? It will only damage the post tib of the FORCES are high, so the muscle has to work harder. If the forces pronating in a foot in those with tibial varum are low, whats the problem?

I gotta go - off now to give the 2nd years their first biomech lecture for the semester - its the "half of what we teach you this semseter is wrong, but we don't know which half it is" lecture...
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Old 1st March 2005, 06:09 PM
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Originally Posted by Craig Payne
I think a lot of people miss that last point. Also a tibial valgum and/or genu valgum provide a supinatory moment to the STJ. How often do you read in the podiatric literature about them pronating the foot.
In a paper soon to be published in JAPMA, Bart Van Gheluwe, Friso Hagman and I studied the effects of simulated genu valgum and genu varum on a group of normal subjects walking over a force plate and pressure mat with some very interesting results. We calculated that genu valgum does indeed cause a STJ supination moment in late midstance.

Quote:
If someone has a tibial varum, yes the foot has to pronate to get flat on the ground, but since when has the "motion" of pronation or the "position" of pronated been pathologic - it never has (hence my comment above about the profession being hung up on motion and position.
Until podiatry students and podiatrists fully understand the concepts of moments, rotational equilibrium and external and internal forces acting on the foot and lower extremity, motion and position will still be regarded as being the cause of injuries by the podiatry profession. It has been and it will be a long, hard intellectual battle, but we have made significant progress in this regard within the past 15 years. These efforts to keep us more in line with the thought processes and work from the international biomechanics community will allow podiatric biomechanics stay at the forefront of mechanical and surgical treatment of foot and lower extremity mechanically-based pathologies.

Personally, I'm very optimistic and glad that we aren't still languishing under the influence of vertically balanced foot orthoses, compensations for forefoot deformities, subtalar joint neutral theory and the two-axis model of the midtarsal joint, even though I am sure that many "podiatric biomechanics experts" still teach these concepts. Thanks, Craig, for your research efforts in this regard.
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Old 2nd March 2005, 06:55 AM
Paul Harradine Paul Harradine is offline
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Hi Craig and Kevin

I've lost the thread here I think, I've just read back over previous messages. I don't think we are disagreeing. I was saying that in certain cases i like to see an improvement in rearfoot motion. In cases of a maximally pronated runner, maintaining and arch, with post-tib tendonits, these patients only significantly seem to get better if I see such an improvement. This obviously links in to forces.

I've quoted it in some of my papers: 'its not pronation that hurts, but the structures stopping the pronation'.....

Regards

Paul


To put my point more concisely, STJ pronation (motion) lowers the arch and increases tension in the medial band of the plantar fascia (force?). This, is itself, can cause problems related to an FnHL. Due to the nature of tissue loading etc, I often see cases where I would expect to see
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Old 2nd March 2005, 06:57 AM
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sorry about the junk after my name on the last bit. Meant to be to another thread!
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Old 2nd March 2005, 03:10 PM
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'its not pronation that hurts, but the structures stopping the pronation'
Jumping from a tall building (motion) does not kill you. Hitting the ground (forces) does.
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