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Does mobilisation of the foot and ankle change foot pressures?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by musmed, Nov 19, 2009.

  1. musmed

    musmed Active Member


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    Dear Team
    2 years ago (ownership now settled) I had 8 elite Sydney sprinters walk and jog over an RS scan force plate. The testing was done by the Australian representative for RS scan, Mr. Corcoran. I was assisted by podiatrist Ms. R. Rice, radiology was performed by Mr. Petsoglou a CT and MRI expert.

    After them walking and jogging over the force plate, completwe mobilisation to their feet was performed.
    This included: mobilisation of the hind foot, mid foot and 1st MET joint, ie all joints of the foot and ankle were addressed for dysfunction.

    After this they then walked and jogged over the force plates in exactly the same manner as prior to the mobilisations.

    Specialised CT's of the feet were also preformed. These are not included in this thread.

    The results are for the left foot only.
    There are 9 sets of resluts. 1 to 8 are for each athlete while the 9th is an averaging of the forces per measurement sector.

    As you will see there are many profound changes of force to the foot, heel and toes

    Regards
    musmed
     

    Attached Files:

  2. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other threads tagged with manipulation
     
  3. TedJed

    TedJed Active Member

    Hi Paul,

    Forgive my ignorance but can you please explain what the results mean? I can't interpret the differences between pre and post mobs because I don't know what I'm looking at/for.

    Thanks,
    Ted.
     
  4. musmed

    musmed Active Member

    Dear Ted

    You are thee first to email me despite 140 have had a look at the posting while on 40 have had a look at the photos. funny eh?

    Ted the images show the pressures under various parts of the foot and toes measured in newtons.
    each athlete walked and then jogged across a RS scan force plate several times with the average measuerment placed into the graph.
    Each athlete was given a colour which has been kept for each image. This is indicated on each graph. The wavy line is the average force supplied at each point by the athlete.

    After collecting this data we then mobilised their feet and repeated the whole process.

    A truck load of data was collected and then collated into a meaningful graph.

    As you can see there are great pressure changes when walking and pressures pre and post mobilisations are compared.

    Example:
    If you take athlete 5, called series 5

    Pre mobe walking post mobes walking
    M1= 175N M1= 135N
    HM = 220N HM = 195N
    where M1 is the pressure under MET head 1
    where HM is the pressure under the medial heel

    Pre mobe jogging Post mobe jogging
    M1= 135 M1= 400N
    HM= 150 HM= 175

    One can see that this means big differences in sprinting time.
    In 2002 the winner of the Stallwall Gift (this is probably the best professional sprint race in the world with a first prize of over 50,000 dollars), stated that by mobilisng his feet he lost 1 second in the 120 metre handicapped race. Without the mobilisation he would not have won the race.

    Hope this helps.
    Regards
    Paul Conneely
    musmed.com.au
     
  5. TedJed

    TedJed Active Member

    So if I'm reading this right, athlete 5 had a decrease in pressures with walking (post mobes) but an increase in pressures with jogging, massively under M1 (135 to 400). The changes are clear but is an increase in pressures following mobes a beneficial result? Or are you not claiming that an increase or decrease is better or worse? Rather, there is a change in pressures; lower in walking and higher in jogging.

    Thanks,
    Ted.
     
  6. musmed

    musmed Active Member

    Dear Ted
    The changes in walking show a better dispersion of forces across the whole foot. The benefit here is that all bones and joints are taking their fair share of the force that one applies to ones feet in walking. Peaks and troughs of force are less.

    In jogging there is a definite need to get the forces to the great toe to power off in a straight line and thus increase ones efficiency in jogging and I am certain these forces will be far higher in running, after all they are elite sprinters at the 100 and 2oo metre events.
    Unfortunatley we did not have the space to get them up to running speed.

    Hope that this helps.
    Regards

    Paul Conneely
    musmed.com.au
     
  7. Mart

    Mart Well-Known Member

    Hi Paul

    Are the regional pressures (which BTW are quoted in N which is not a measure of pressure) peak pressures, mean pressures or what?

    Interesting idea but you need to provide more info than this to be able to come close to persuading us about your conclusion.

    For example a basic issue might be velocity. Peak pressures might be lowered by slower velocity or higher cadence and shorter stride length. Did you compare contact duration variance for trials? It is quite plausible that the values could have been lowered post "mob" by creating a peturbation in strength, discomfort or any number of other things to slow velocity. What about the total stance phase force, contact durations for each trial and similarly the total surface area values? This would give a bit of insight into queston of if you are really seeing the changes you claim. Did you capture synchonised kinematic data, likewise allowing a better judgement of strength of evidence.

    It would be cool to take another look at with these data to get a better handle on things in terms of interpretation.


    cheers

    Martin
     
  8. musmed

    musmed Active Member

    Dear All and Martin

    Oh to live in a perfect world. I did these tests on a sunday in a radiology centre at an incredible cost.
    I agree all fancy data repeating everything several times (3 times was all the time we had) would be great. There is no university set up here, just a couple of people with some ideas.

    The scanner used is a RS scanner. If you have access to one of these I will send you privately the data on all of these souls. There is a truckload of data collected by the excellent system.

    I have enclosed a PDF file. You can print it out so it makes it easier to compare results. Unfortunately you cannot insert an excel file. From the data I have enclosed I think you will be satisfied that there are many changes.

    Eventually I will put on the web the 'angles of Paulex' changes which is done via CT. EAch set of imges take abou 3-4 hours to measure (no interruptions)
    These show many changes.
    to get a handle on these angles visit my website www.musmed.com.au, go to workshops, and then interesting things. You will find them there.

    Let me know what you think, this goes for all viewers.
    Regards from a nice day in sydney
    Paul Conneely
     

    Attached Files:

  9. Mart

    Mart Well-Known Member

    I have started a sub thread @

    http://www.podiatry-arena.com/podiatry-forum/showthread.php?p=122931#post122931

    The idea is to look at nitty gritty of using observational video gait examination and cheap/fast/dirty clinical kinetic data for evidence of foot behaviour. Also to consider limitations, value and justification for doing this. It should eventually include discussion of force/time curves and their interpretation.

    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
     
  10. musmed

    musmed Active Member

    Dear Martin
    Hi, was not my information detailed enough or what?

    I have looked at the photos and all I saw was skin. I do not know how you can say what the joints are doing epecially the subtalar joint.

    I have examined well over 100,000 feet and I can tell you that less that a few percent have any motion at the subtalar joint. I am certain that the several hundred whom I have taught will agree with me.
    The main motion occurs between the calcaneum and the fat pad and the fat pad and the skin and the skin and whatever it comes into contact with. These three 'joints' are never thought about let alone discussed.

    I presume this lady does not have symmetrical arm swing. Anyone who does not have upper limb pathology and non symmetrical swing has a foot problen. The great Howard D. pointed this out to me several years ago.

    As regards to Fl.Hall longus problem, the patient must have an inhibited popliteus muscle. If this is not addressed the whole foot issue will never resolve. This basically applies to all foot problems (outside of active joint diseases themselves alone).

    Once the Popliteus is restored to function, using a Travell and Simons spray and stretch technique, the problem usually is solved in a few minutes irrespective of how long it has been there.

    Regards
    Paul C
     
  11. Mart

    Mart Well-Known Member

    Hi Paul

    I had a quick look at the data which was 2 single comparative trials for a single foot/subject. I did not attempt to quantify the differences because as you will see in the thread I started the differences could be likely explained by the normal variance of inter step difference rather than the effect of the manipulation.

    Lets wait and see what my example shows with respect to that before jumping to conclusions regarding your data,

    I have no axe to grind regarding your experiment per se simply concern of interpretation which needs to be carefully considered otherwise it has no value.


    you said

    "I have looked at the photos and all I saw was skin. I do not know how you can say what the joints are doing epecially the subtalar joint."


    good question - why not get this on the the other thread which is what it is all about; interpretation, and keep your thread on track for its original intent.

    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
     
  12. lol :D:D:D
     
  13. Paul:

    Whatever you and your students are smoking must be verrrrrrrryyyyy good........:eek::cool:
     
  14. musmed

    musmed Active Member

    Dear Kevin and Spooner

    I do not know your sign language and thus do not understand your ideas

    I have documented every foot I have examined since 1991. Most findings are in a huge data base.

    I have no doubt in what i say because I have the data.

    How about some constructive comments on my mobilisation data not something to big note yourselves and belittle others

    Regards
    Paul
    musmed.com.au
     
  15. Really, Paul. When you make a statement such as "I have examined well over 100,000 feet and I can tell you that less that a few percent have any motion at the subtalar joint", whereas all existing anatomy or foot biomechanics medical textbooks say that the subtalar joint normally has rotational and/or translational motion of the talus relative to the calcaneus..........what kind of response would you expect??!!

    Imagine someone saying something like, "I have lived on Earth for well over 400,000 hours and I have no doubt that the Earth is flat. I can tell you that the Earth is flat because I have the data. I am certain that the several hundred whom I have taught will agree with me." What kind of response, Paul, would a scientist have to such a statement?
     
  16. musmed

    musmed Active Member

    Kevin
    I will rephrase my comment. less than a few percent have 'normal; motion when the joint is examined.

    The motion I look for in a supine foot resting on the bed is:
    1. it moves to a high and lateral position
    2. to a forward and downward motion
    3. eversion is greater than inversion in its neutral position.

    I agree that there is some motion as you describe.
    Once you cut up anyone motion is possible.

    In real life it is a different story.

    A reasonable question here: why is subtalar joint osteoarthritis so rare when one excludes a calcaneal fracture that involved the joint line?

    Could one good reason be that if it does not move, it cannot hurt itself. No different to a plaster on the leg for a broken ankle.
    Regards
    Paul Conneely

    I will never post information of the action of the talus in relationship to shoulder abduction scapulo hmeral motion patterns or the role of the talus in space/time continuum.
     
  17. Paul

    The differnce between no motion
    and not ´normal`motion
    is very different.

    Ive put a link to a study done with bone pins in real humans which you may or maynot have read it clearly shows the talus and calc. moving during the stance phase in slow running. Have a read.

    Your point about skin and fat pad movement in intersting and may have some play, but that can not be the point of main movement due to the huge shearing stresses which would occur it would just be too painful to walk let alone run.

     
  18. musmed

    musmed Active Member

    Dear All
    Heel stike is the only motion that requies NO neurological input at all. Worth thinking about.
    This will put my three 'joints' into perspective.

    Yes I have read this study. It goes to show that the results do not show any linerality between the weight of the individuals and outcomes. Why?

    May I be so bold as to suggest that if their joints were made as eaual as possible, that is mobilised, counter-strained, manipulated, muscles sprayed and stretched etc. so as to obtain a level playing field many results would have been different, so kappa scores, p values etc may have made more sense, as they should have.

    I did not see any allowance for what bones do best, ie torsion ,in these studies.

    just finished dinner, barramundi, the world's best fish.

    Regards
    Paul Conneely
     
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