Indwelling, sub fascial, orthotic

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I am not suggesting that an indwelling, sub fascial ,orthotic is a good idea or a treatment for anything at all but am presenting the idea merely as a hypothetical .

So what would happen if a small inflatable balloon of a fairly rigid ,generally inelastic material ,were surgically placed in the media aspect of the foot deep to the plantar fascia but superficial to the abductor hallucis and flexor digitorum brevis muscles and then inflated to form a non compressible but longitudinally flexible orthotic device .

For the purposes of argument lets say the device lies largely superficial to the principal vessels of the plantar venous plexus and is roughly the same size and shape as half a bar of Fry's chocolate cream . Lets also assume it is fixed in place via sutures to the central and medial aspects of the plantar fascia .

With such a device in place would the foot tend to pronate less than before during walking and would there be pressure fluctuations within the device as it is compressed between the muscles and the fascia ?

Could any other mechanical changes in foot function be expected ?

Gerry

 

First of all Gerry, let me say that your hypothesis is not as novel as you (and others) may think.
Back in the late 70's someone, and I have to confess I forget who, suggested quite seriously that a medial wedge could be surgically inserted into the heel to control sub-talar joint motion.

Back to your current hypothesis - the result would be different for every subject I suspect, and for every supporting surface the subject was asked to walk on (the foot behaving differently on different surfaces).

 

And then there is of course Hyprocure

 

Hi David
Narrowing the parameters ,let say the person is unshod and walking on a wooden floor . The implant is deep to the skin and fascia of the medial arch of the foot in an area where the skin does not contact the ground during normal walking .

The question is , during walking , are there pressure fluctuations in the orthotic device as it is compressed between the tightening plantar fascia and the eccentrically contracting muscles deep to the device .

Hi Mike
Interesting wee device

 

Hi David
What I am angling at is that perhaps the relatively small abductor hallucis muscle and under lying flexor hallucis brevis act ,during early stance or in static balance situations , in the manner of a hydraulic jack and act more conventionally during later stance . The idea looks to the laws both of Pascal and Laplace with regard to how a muscle may function under compression .

By way of explanation perhaps the following might be useful . I have no way of telling what sort of shape muscles are in but lets say you have kept yourself in good shape ! Find yourself a wooden stool and sit up straight on said stool . Now lift your feet off the floor so that your full weight is on your derriere . For want of a better phrase now clench your left glute . You should find that your torso tilts to the right .
The surface of the chair represents the medial aspect of the plantar fascia ,the glutes the intrinsics and the lower aspect of the pelvis the bony arch of the foot .

I would be interested to know what you think of the above .

Regards

Gerry

.

 

And then again there is Hyprocure ...

 

Hi Dieter
As I understand it Hypocure is an actual solution to a problem . The example of an indwelling orthotic given in the first post is not . It was meant only to draw attention to the area between the bony arch of the foot ,the plantar fascia , the tissues between them on the medial aspect of the foot and the functional interaction between these aspects . More of a literary device than an actual device .

Regards
Gerry

 

Gerry,

I appreciate the distinction. If there is any consideration to an implantable correction it will be better to address the problem at the source. Propping up the structure of the foot, in the way suggested, is a poor solution to the problem.

 

"Propping up the structure of the foot, in the way suggested, is a poor solution to the problem."

Hi Dieter
With regard to the quote above ,a poor solution to which problem ? I have mentioned neither a problem nor a solution .

Regards

Gerry

 

Gerry,

So what are you hoping to accomplish.

 

If I may offer my assistance... I believe what Gerry is attempting to present here is a "thought experiment" in order to glean an understanding of the role of pressure from intrinsic foot muscle contraction on venous return. I believe my friend and mentor Professor Kirby addressed this in another thread, yet Gerry's inquisitive mind has decided to follow his train of thought with this thread. He has also posted in another thread in an attempt to engage others in his struggle to understand this contemplation. That said, the original post here which stated: "With such a device in place would the foot tend to pronate less than before during walking" and "could any other mechanical changes in foot function be expected ?" were probably unnecessary and has only served to confuse issues here. Rather, the real interest from the original poster appears to be: "would there be pressure fluctuations within the device as it is compressed between the muscles and the fascia ?" In other words, does pressure from muscles in the arch and GRF aid in venous return as he obviously believes it does? Moreover, does this provide a significant influence in the venous return mechanism? In other words, does the compression from the contraction of the intrinsic muscles along with the compression from GRF in the medial longitudinal arch have a significant influence on venous return from the foot to the lower limb and back to the pumping station? Just paraphrasing... and trying to avoid other pointless posts in non-related threads, hope it helps. Gerry?

BTW, in my opinion- as I intimated in the other thread, read Bojsen-Mollers paper in which he describes how the orientation of the vessels beneath the heel may be related to venous return, since GRF under the heel offers far greater compression forces on the blood vessels than either muscle contraction in the arch and GRF in this location, Gerry.... For the record, I have no interest in debating this and won't offer any more on the topic, just getting bored of the same thing coming up over and over in multiple threads.

For those struggling: "does the compression from the contraction of the intrinsic muscles along with the compression from GRF on the veins within the medial longitudinal arch have a significant influence on venous return from the foot to the lower limb... yes or no? You decide...

However, if: "With such a device in place would the foot tend to pronate less than before during walking" and "could any other mechanical changes in foot function be expected ?" were actually the point of the OP... then, actually, just why?

To be honest I'm more concerned about the USA vote for president tonight- wouldn't trust either of them... Can't we just have the Obama family for another term?

 

Simon,

Thanks for this detailed and comprehensive explanation. I will bow out at this point except to say if this was in fact attempted a patient would very likely be intolerant to such an implant.

As for the election. The UK audience participation of events is almost definitely subjected to the unprecedented media bias working for the criminal Clinton machinery. In US history of election proceedings there was never such a corrupt candidate in play as Clinton. The Clinton's have a corruption record dating back three decades. And without any question, Clinton, who remains under FBI investigation ought not to be allowed to run for president of her high school library, much less the US. HC is linked to cheating, murders, corruption, bribes, pay-to-play, has extremely poor judgment, and is unlikable. Her thirty year record of 'public' service is distinguished only by her incompetence.

As for Obama ... history will reveal him to be the most ineffective and harmful President ever; again for many reasons.

I just voted Trump for many solid good reasons.

 

Nice work fella. I try to obtain my media bias on a world wide basis rather than rely upon Her Majesty's. As such, I wouldn't trust either of the candidates to sit the right way around on a toilet seat, let alone run a big (in-)continent like the US of A. Sleep tight. "ineffective" I'll give you because of the congress system, "harmful"- lets wait and see if what you voted for comes to power... my and many others only hope tonight is based on the congress system... which probably tells my American friends everything they need to know.

 

Simon,

Unfortunately the world wide media doesn't fare much better, unless you can have access the Fox News or OAN .... I have followed Trump in every speech and debate for the last 1+ year (there have been very many). He will do just fine ... for America. This is America's BREXIT and denouncement of globalism, lobbyists, and the stench of a swamp that is Washington. Trump stands for national security, sovereignty, jobs & the economy. His job will be a tough one; Obama has systematically destroyed America in the last 8 years.

I pray to God that Trump wins .... sleep well!

 

So the only global media that counts is FOX or OAN? You missed capitalism and xenophobia off of your list...

 

Simon,

Unfortunately the answer here is a resounding YES. None of the other media offerings bother even to pretend anymore to offer unbiased reporting. And instead provide only pro-Clinton propaganda. That Trump is a xenophobe, racist, bla bla - all hogwash and misreporting. Sad but true. I am of course only making reference here to US based communications. I don't see any point watching foreign based accounts of US events that I am observing first hand.

 

Thanks for your unbiased report. You've clearly been in the good ol' `uS of a" too long. P.S. As an immigrant, will Trump have you shipped out back to Poland? And yes, I am taking the piss because you see this big old Universe out there.... The USA isn't the centre of it. Time to think a little bit bigger... let's start with a global picture... no, we got to think of ourselves first.... Grow up planet Earth. But what about Trump and Pence... yeah, what about them? Two more fucking idiots who haven't provided a cure for cancer... Move along, move along...

 

Hi Dieter
With regard to Simons post -
"thought experiment" correct .

"For those struggling: "does the compression from the contraction of the intrinsic muscles along with the compression from GRF on the veins within the medial longitudinal arch have a significant influence on venous return from the foot to the lower limb... yes or no? You decide... " largely correct but I would prefer "eccentrically contracting muscles " .

"Bojsen-Mollers paper ....." the majority of the PVP is distal to the heel .



"Gerry.... For the record, I have no interest in debating this and won't offer any more on the topic, just getting bored of the same thing coming up over and over in multiple threads." not my problem unless Craig thinks I'm wasting his storage space .

So Dieter as surgeon and podiatry expert do you have a view as to how the PVP functions ? .
If like Simon you have become bored with this then no need to reply .

Regards

Gerry

 

Hi Simon,

Your misgivings are yours' to own. Since TRUMP is the 45th elected President of the US, your rant is irrelevant. Trump will hopefully deport ALL illegal immigrants who saw fit to break the law of the land. I will not be deported, since I am a LEGAL US citizen.

The USA , under Trump, doesn't want to be the center of the Universe, only put the US first again, within its borders. That said, under Trump it may well become again the center of the universe.

F***k globalism. Like many UK commentators reveal, on US television, the Europeans watching events from across the pond, cannot reasonably hope to understand what has happened in the US, and why Trump & Pence prevailed magnificently.

If your measure of success is cure for cancer, well, my friend, we better all crawl in our coffins for lack of worthiness.

I raise my glass to our President: Donald J Trump.

 

In case you hadn't noticed Dieter you just voted in someone who advocates the violation of women as your president.... Never mind. Not just my misgivings, the rest of the world seem to have grave concerns regarding this man and his abilities. As I type this, one African president is live on TV expressing her concerns regarding Trump.

Gerry, I think this is probably what you are looking for: http://www.phlebolymphology.org/the-plantar-venous-pump-anatomy-and-physiological-hypotheses/

 

Hi Simon
Thanks for taking a look .
I have seen this before and although it is anatomically very informative I feel the author is offering multiple explanations when it comes to the mechanics of the pump mechanism without ever quite nailing it .

Without going into to much detail -

"The lateral (or external) plantar pedicle is longer (12 cm), curved, and larger because it is located between the two muscle layers of the sole of the foot, and thus is compressed during contraction ."
( NOTE ; if adjacent muscles are lengthening and eccentrically contracting during early stance then the muscle bellies will not exert more pressure on each other and any interposed vessels but less )

AND
"and contact of the foot on the ground produces direct compression of the reservoir in the sole of the foot between weight-bearing areas." This would leave the medial aspect of the PVP unemptied and ,in my opinion ,is really an attempt to cover all the possible bases .

Compression of the PVP btwn muscles which are themselves being compressed between the bony arch and the plantar fascia makes perfect sense to me .And ticks alL the boxes .

If nothing else I have convinced myself .

Regards

Gerry

 

"If nothing else I have convinced myself ." Good, can we move on now....

 

I wouldn't call winning a presidential election with fewer votes than your opponent "prevailing magnificently".Can you all imagine what Trump would have been saying now if he had lost the Electoral College but got more popular votes?? Do the words "rigged election" sound like something he might be saying right now? It certainly wouldn't have been as gracious as Clinton's concession speech to Trump to try and bring this country together again.

For the good of my country of nearly six decades, and for the good of the country that my father and uncles fought for in World War II, I just hope that Trump can do half of what he said he can do for us Americans. First of all, however, he will need to get through his pending trial on Nov. 28 to defend himself against allegations of fraud in a federal civil trial over the Trump University real estate seminar program.

Welcome to the presidency, Mr. Trump. Now let's see what you are really made of, truth or lies....

 

Lucky for Trump the 13 th of December has opened up

The trail for rape of a 13 year old has been stopped/dropped

seems there was1 too many death threats to the accuser and family for them to want to continue

 

Simon: Violation of women, that's hilarious - and very typical of the Democrats failed diversionary tactics. America didn't buy the hyperbole, thankfully. So, Trump is President, the Democrats can suck it up - and yes, indeed, please move on. I agree with Kevin, now it's up to Trump to live up to the pre-election promises. Of course, we have to hold him to a higher standard than Obama, who failed America so magnificently, and still manages a ridiculously high popularity vote. And, Kevin , Hilary Clinton would have been tied up (and likely will still be) in legal issues for her crimes and corruption she will need all the time she now has to keep herself out of prison. No, wait - Obama will likely provide her with a Presidential pardon even though he himself should be impeached. Oh well.... there's something to be proud of.

 

Gerry,

My apologies for hijacking your thread with politics.

 

There is really no point in continuing this discussion. The die has been cast. But some of the things being said here on this thread will be remembered for many years by individuals like myself. People don't gain more respect by disparaging others who have different political beliefs...they lose respect.

 

Agreed Kevin .... that swings both ways. Sour grapes though. Democrats are having a very hard time accepting the outcome. Mark Cuban, billionaire and self proclaimed anti-Trump spokesperson widely predicted a market crash should Trump be elected. This morning the market is opening on a near record high. Watch America grow and prosper under Trump and in years to come your children will be thankful that Clinton failed. The End.

 

"You know I'm automatically attracted to beautiful- I just start kissing them. When you're a star, they let you do it. You can do anything. Grab them by the pussy. You can do anything." Donald J Trump

 

There are alternative universes here. The Clintons were investigated incessantly and Bill was impeached over debatable perjury charge that the majority of the country didn't think should be prosecuted. One view is that the liberals control the government and prevented any prosecution of the Clinton's wrong doings. Another view is that the > 10 committees investigating Benghazi were all political based attacks and they found nothing worth prosecuting. Either there was nothing there or the Republicans were too bungling to find anything that was good enough for a real court.

Obama was dealing with a congress that wasn't going to let him do anything. A foreign policy of not doing stupid things was a good one. Obamacare is Romneycare is the Republican version of universal health care. I'm waiting to see what they will replace it with. Or was that just an empty promise?

Did you see Trump's latest tweet? "Just had a very open and successful presidential election," Trump tweeted. "Now professional protesters, incited by the media, are protesting. Very unfair!"
What's unfair is that someone who lost the popular vote won the election. People should be upset about that in a democracy.

Yes, Hilary was flawed. But paid protesters? Seriously? It's amazing how similar Trump and that foot typing guy were in just making stuff up.

 

Eric, there is everything there but one's interpretation of events surrounding Benghazi will always be subject to partisan bias. The men on the ground killed and the soldiers affected have their own story to tell. HC is not simply 'flawed' but a criminal who belongs behind bars. She was never fit to run for office, much less be elected.

Soros absolutely sponsored, and continues to sponsor organized and violent opposition. If you don't understand this, your head is buried in the sand.

Obamacare is not the Republican version of healthcare. America is not a democracy but a constitutional republic. There is a reason why the electoral college was created by the founding fathers, and a reason why a President is elected in this way, and not the popular vote. Clinton has the popular vote - but only barely and the count is not over.

Democrats: the election is over, you lost. Trump will be inaugurated the 45th President of the USA.

 

Just because it was repeated so often in the Republican echo chamber does not mean she is a criminal. What crimes should she have been charged with and why weren't there charges? More people though she was more fit than Trump to be elected.

 

Latest news is Obamacare is staying with a few Trump tweaks .

Who knows what the final health care will be but it seems the we will bin Obamacare pledge may have lasted 24 hours if true

 

Eric: what crimes, really? The illegal private server used for government business, the bleaching of 33,000+ e-mails AFTER Congress issued a subpoena, her corrupt Clinton Foundation and pay-to-play for which the FBI will continue in their investigations etc etc.

The FBI refusing to indict but stating Clinton was 'extremely careless'. Hundreds of thousands of Wikileaks expose. Many legal experts agree she ought to have been indicted. Anyone researching this can arrive at only one conclusion: the Clinton's are a crime family. The Democratic Party is finally realizing it will have to cut its' ties from the Clinton's. The New York Times has issued an apology to its' readers for their shameful biased reporting against Trump. etc etc etc. I don't even care if Trump doesn't achieve 10% of what is promised. I am just hugely relieved that HC isn't in charge.

Eric, I will leave this as my final comment. Kevin has already declared a lifetime grudge. Democrats turn nasty quickly with anyone not willing to sing along to their songs.

 

Dieter:

You wrote: "Kevin has already declared a lifetime grudge."

You need to take a deep breath, Dieter. I never said I have a "lifetime grudge" against you. I respect you for your opinions and we have a good history together in many other things regarding podiatry.

However, I suppose I expected that someone of your training and education would make less inflammatory postings regarding your personal political beliefs in a public manner here on Podiatry Arena. Remember, we are not all Republicans here and we are not all Democrats here on this academic website for medical professionals. However, we all are professionals dedicated to improving the lives of our patients.

Unlike what you probably think, I don't hate Donald Trump and think he may actually do some good for our country. I'm willing to let him have a chance. We will need to just give him some time to see what he can do and also to see if his many promises were true, or if he just made those statements to get himself elected.

I'm hoping for the best for our country...that is all.

 

Colin Powel, secratary of state under W. also had a private server. So what law was broken? No point in repeating the NY Times explanation of why the deletions happened and why they would be not be considered illegal. Bernie, when he was running against Clinton in the primaries, said there was nothing to the e-mails.

Nasty???? Have you been reading right wing websites that lie about what Democrats think and say. Where did you get the idea that Democrats turn nasty?

 

Yes Simon, thanks for the replay. This was circulated ad nausea by the biased media for weeks on end. This was captured on a hot-mike; horse play from 12-14 years ago. Ever said anything you regretted after the fact? Ya, I bet ... be glad there's nobody around to record your every word. I assume you saw the video recordings of the democratic party planting violent, paid 'protesters' in Trump rally's - that's a strategy that is still being played out even now, amid the college kids cry babies to cause disruption and vandalism in the cities in the name of 'protest'. White males are assaulted in the street (4 black guys beating on one white guy they assumed to be a Trump voter) and a pregnant woman was pulled out of her car and getting beaten up. There's a trail of dead bodies following the Clinton's - dig deeper. Business people in important position 'tweeting' they will assassinate Donald Trump -watch the News. The FBI are on the cases.

In any case, America ignored this nonsense and voted against crooked Hillary. Democracy works......

 

Kevin: I concur but will add, this was a hugely important election for the country. HC, under no circumstances, was fit for office. You don't have to assume, from this that I am Republican. It took one non-politician to risk his personal fortunes to oust her with a conviction for the same beliefs. This isn't inflammatory, it's just fact. She's not even done yet, trying to destroy this country - Soros and the Clinton's are plotting as of right now. And in the event anyone doesn't understand the Soros connection, please do some research. He's one nasty SOB.

 

Kevin: and yes, you are right. Podiatry Arena isn't the forum for this discussion. This will end my discourse on the topic. Perhaps everyone else can now also follow suite, and end this exchange. Thanks.

 

May not be the thread for it but this election is very important to the rest of the world as well. 1st of if DJTrump does anything to up set the Chinese the world will look down the barrel of another recession.

Also where I live I personally would like a strong united NATO rather than a US president influenced by Russia.

Seems like reports are coming out already that the Coal mines don't look like being opened another big promise ( which is a good thing imho )

Steve Brannon certainly looks a nasty piece of work.

About the only things anyone seems to agree on is the US is now more divided than ever. Trumps camp is very much not ready for Jan 21st (at this stage) and no one knows where policy is headed.