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Speech

Discussion in 'Teaching and Learning' started by Dikfeld, Aug 16, 2010.

  1. Dikfeld

    Dikfeld Member


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    Hi Everybody,

    New to the forums, I'm a Podiatry student.

    Just wondering I have a speech coming up and my topic is Pathomechanics of the Pronated foot type. Now I'm wondering what this actually means I should be talking about? Would this mean talking about Signs and symptoms of the pronated foot type? like rear foot and forefoot deformities and then going on to talk about the mechanical deformities that may occur in the bones?

    If anyone can point me in some directions of some good sources for information it would be much appreciated.

    Cheers

    D
     
  2. The pronated foot type :bang:

    After some deep calming breaths and remembering that this title was probably foisted on you, I think you need to think first about what constitutes a pronated foot type. Or perhaps what your tutors think constitutes a pronated foot type.

    You could do an interesting piece on how if the foot type is derived using a static exam (like the FPI) then actually relatively little can be presumed about the pathomechanics in dynamic function. I think its only the SNA / nav height which is actually predictive of dynamic function (could be wrong).

    The presumption is that a "pronated foot" :bang::butcher: (more deep cleansing breaths) is pathological. Which it ain't. Most Afrocarribeans have "pronated feet" (grrraaagghh) and they make the best sprinters. SO maybe it should be "pathomechanics of the NON pronated foot type"

    Oh B*****X to it. pronated feet probably = medially deviated axial position within the bundle, increased mechanical advantage to GRF lateral to axis causing amplified pronatory moment and thus a greater demand for supination moment and likely high residual supinatory moment which is likely to exceed the tissue stress threshold of the structures providing supination moment and thus, hurt. Thats probably what they want to hear.

    Pronated foot type, grumble grumble snarl. I suppose one should be grateful they ddn't want "pathomechanics of the overpronated foot"
     
  3. Griff

    Griff Moderator

    Rob - stressed out so early on in the week? Doesn't bode well...

    McPoil & Cornwall also showed the longitudinal arch angle (LAA) to be 'highly predictive' of dynamic midfoot posture in JAPMA back in 2005 if memory serves (very similar to SNA), but as you suggest - we are far from a situation where all static measurements translate to dynamic function. Think these might be the only 2?

    Dikfeld,

    Rob is actually making some great points (in between his grumbles ;))

    A nice structure to your upcoming presentation may be as follows:

    (1) What is a 'pronated foot type?' - define this with respect to some the measurement systems used (foot posture index, navicular drift/drop etc etc). You may even want to start with what a 'normal' foot is - start with Chris Nesters bone pin study published in JFAR in 2009.

    (2) Then talk about how/if these classifications correlate to function (i.e. do they predict what the foot will actually do when the individual is walking/running)

    (3) Then, getting to the crux of the issue here, discuss the literature on the relationships between 'pronated feet' and injury. You may be surprised what you find during your search
     
  4. Pathomechanics of the pronated foot type? Probably something along the lines of rearfoot pronation causes unlocking of the midtarsal joint leading to hypermobility of the first ray............

    First define "pathomechanics"
    Next define "pronated foot type"
     
  5. Griff

    Griff Moderator

    Overpronation causes shin splints. Done.
     
  6. Seriously though, lets try and help this padawan out here guys. Dikfeld, which School of Podiatry are you attending? Which year of study are you in? What texts are on your recommended reading list for the module?
     
  7. maybe Dikfeld you could change to talk title around to something like...

    The motion of Pronation will lead to changes in forces applied on the foot, in certain foot types this may lead to Pathology.

    and then go on to discuss changes in STJ axis deviated - (medial ) and the effect this will have on lever arms of the Post. Tibial and tib anterior muscles ( look at kevin Kirbys papers ). , also discussion tension in the plantarfascia and then use Eric Fullers paper. ie look at mechancial models. as an example

    The Windlass Mechanism of the Foot
    A Mechanical Model to Explain Pathology
    ERIC A. FULLER, DPM*
    . (J Am Podiatr Med Assoc 90(1):
    35-46, 2000)
     
  8. Believe it!

    They were the only two of which I was aware.

    Yez baas.

    The pathomechanics of the pronated Foot type.​
    This title makes several presumptions.

    1. That there is such a thing as a "pronated foot type".
    2. That such a foot type must lead to "pathomechanics".


    The typing of feet is a difficult business. A "pronated foot" implies a static situation, suggesting that the observation is made in static weight bearing. However there is little evidence that many of the observations made in static weight bearing can be extrapolated into dynamic function. Also the question presupposes that a "pronated foot" is a pathological situation... which it may not be.

    If we make some presumptions and extrapolate that we are talking about a foot with a pathological function (one which has caused, or is likely to cause) tissue stress excessive to the threshold of one or more structure within the foot due to pronation, one must examine more than simply the peak measurement of pronation as measured by arch height (the only NWB measurement predictive of dynamic function). One must consider also:-

    a. Timing. Is the foot pronated too soon? Does it hit the ground already pronated?

    b. Degree. Does the foot pronate at the appropriate time but to a degree at which the axis deviates so far medial that excessive supination moment is required of structures like the sinus tarsi?

    c. Duration. Does the windlass and other supination structures bring the foot back to a more neutral position at the end of the gait cycle or does the foot remain maximally pronated throughout.

    d. Velocity. Is the shock absorbtion function of pronation met by the velocity of the pronation? Is there sufficient stiffness in the joint to allow a smooth loading of the pronation end range structures or does the foot whip straight into maximal pronation directly load is placed on it.

    e. Origin of the pronatory moments. What is the CAUSE of the "pronated" position? Is it a deficiency in the structures providing supination moment or an excess of pronation moment (for example from a severe equinus causing "escape pronation")


    f. Probably others

    Each one of these may present as a "pronated foot" but are distinct mechanisms, different "pathomechanical" explantions if you will.

    Ian, you wanna take a definition / discussion of pathomechanics?
     
  9. Graham

    Graham RIP

    Title:

    Pronation: The Root of all evil!

    Then go with Robert et als suggestions!
     
  10. For some reason I can't edit the last. The rest of the sentance was:-

    but does the gross kinematic position of the foot predict which of the pathomachanical patterns I described (or any others).
     
  11. Griff

    Griff Moderator

    Yep, the Hunt et al paper (http://www.ncbi.nlm.nih.gov/pubmed/11676785) actually showed that their measurements were limited in their ability to predict dynamic function.

    The Chuter JFAR paper (http://www.jfootankleres.com/content/3/1/9) may suggest that the FPI has strong predictive ability for dynamic function at the rearfoot, but in their research Nielsen et al (Gait & Posture 2010) concluded that despite this, 'individual predictions remain questionable'.

    It all comes back to the biggy - what predicts (or increases risk of) pathology? Are there lots and lots of prospective studies which show that a pronated foot type does this??... No. And just to confuse the issue, are there papers which have suggested that supinated foot types are more at risk of injury??... Yes.
     
  12. Dikfeld

    Dikfeld Member

    Thanks for your help guys! Has really helped so far. Is definitely going to take me some time to research and set out a really good presentation but you have all definitely given me some ideas and put me in the right direction.

    As for me I'm only new to this I'm a first year Pod student (Second Semester) at UWA (University of Western Australia). The Recommended Readings for the Pod Med unit are

    - Merriman's Assessment of the Lower Limb
    - Foot Orthoses and other Forms of Conservative Foot Care (Michaud)
    - Clinical Skills in Treating the Foot (Turner, Merriman)
    - Clinical Biomechanics of the Lower Extremities (Valmassy)

    I actually don't have any of the books yet I only get them out of the Library when needed. Does anyone recommend I should buy any of these books?
     
  13. You might start by reading chapter 2 in Valmassy and chapter 3 in Michaud. I wouldn't necessarily buy them, go to the library.
     
  14. Dikfeld:

    Here is a chapter on the biomechanics and treatment of flexible flatfoot deformity in children that I coauthored from 18 years ago that may answer many of your questions (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). Good luck on your presentation.
     

    Attached Files:

  15. Dikfeld

    Dikfeld Member

    Thanks Kevin that is awesome! It is very much appreciated!

    Cheers,

    Dick
     
  16. Dikfeld

    Dikfeld Member

    Hi Ian i'm looking for this Article but can't seem to find it... What journal is JFAR ie What does JFAR stand for?

    Cheers,

    Dick
     
  17. twirly

    twirly Well-Known Member

    Attached Files:

  18. Dikfeld

    Dikfeld Member

    Ah Excellent! Thanks for that!
     
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