Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Foot orthosis for patient maximally pronated in NCSP

Discussion in 'Biomechanics, Sports and Foot orthoses' started by spike2260, May 18, 2008.

  1. spike2260

    spike2260 Member


    Members do not see these Ads. Sign Up.
    Hi there,

    i do hope someone can help me, i am a second year student, and recently i came across a case i found interesting but was unsure on the treatment. The patient was found to be maximally pronated in RCSP, i want to know is it safe or even apropriate to then post them to neutral? and my other question is if a patient is maximally pronated upon examination in NCSP what would be the approiate form of treatment? Will it matter if the foot is flexible? or rigid? and if it is rigid how does this effect the treatment plan?

    And my final question is when is it not considered safe to prescribe orthotics for problems of this nature?

    i apprecaite any feedback on the matter, thank you
     
  2. perrypod

    perrypod Active Member

    Re: Foot orthosis

    Best advice I can give you is go through the case with a lecturer. This will be far more beneficial in your learning process. Also better for the patient. Hope all goes well
     
  3. Adrian Misseri

    Adrian Misseri Active Member

    G'day,

    Ahh the joys of undergraduate biomechanics when everything is exciting an new! Really we need a little more information on the mechanics of the foot. Generally speaking though, it seems that subtalar joint is maximally pronating in resting, and this will be putting massive strain on tibialis anterior, tibialis posterior, the sprng ligamnet, as well as the plantar fascia and other intrinsic foot muslces, which may or may not hurt, and which may be putting strain on other structures more promimally as well. That being said, this may be an asymptomatic flat foot that although 'pathological' by our traditional biomchanical theories, might actually be not pathological for the patient. What I'm trying to suggest is that you need to look atthe foot mechanics and gait mechanics as a whole, not just as a maximally pronated rear foot in static bipedal stance. As perrypod suggested, this woudl be a good one to discuss and work through with your lecturer in the first instance, but feel free to post up some further patient information and get a few opinions on hee.
    Cheers and good luck!
     
  4. ClintonAbel

    ClintonAbel Active Member

    ....my other question is if a patient is maximally pronated upon examination in NCSP what would be the approiate form of treatment? Will it matter if the foot is flexible? or rigid? and if it is rigid how does this effect the treatment plan?

    And my final question is when is it not considered safe to prescribe orthotics for problems of this nature?

    ----

    When you describe the foot in NCSP as being maximally pronated, are you referring to all motions within the definition of pronation, or just rear foot angulation?

    You could be looking at a true calcaneal valgus angle, at which point it was always my understanding that orthoses managment is futile.
     
  5. Adrian Misseri

    Adrian Misseri Active Member

    I've always thought bring the ground up to the calcaneus with an extrinsic reardoot post and get the rest of the foot to do what it needs to, to control whatever other biomechanical abnormalities ned to be addressed?
     
    Last edited by a moderator: May 20, 2008
  6. ClintonAbel

    ClintonAbel Active Member

    Adrian,

    I think this is where the holes show in the initial patient presentation. Knowing what the longitudinal arch is doing, the FPI and what pathology has been demonstrated is important.

    If the original post author is using just a rearfoot marker to asses his maximally pronated foot in NCSP, we could be trying to fix something that doesn't require fixing.

    Also, if the rearfoot calcaneal bisection is in valgus and the STJ (by talar head palpation) is neutral, trying to force varus angle out of this calc position could result in long term degredation of the STJ.

    I have only seen one patient like this, as a student.

    Clinton
     
  7. Adrian Misseri

    Adrian Misseri Active Member

    I agree... as I said earlier, we need a bigger overall picture. Great to see a student putting it out there in an effort to understand biomechanics though. We all started somewhere!
     
  8. delpod

    delpod Active Member

    what is the forefoot to rear foot relationship? also, did you take a STJ neutral non-weight bearing measurement? i know that is something i overlooked quite often as a student but as a new grad, i am learning that it is far more important in orthotic prescription than i ever gave it credit for.

    quite interested to see some more patient details :)
     
  9. efuller

    efuller MVP

    Welcome Spike, (is that your real name?)

    It's hard to know where to start. Ask your instructors if it is possible to have a foot that is maximally pronated and in neutral position. Then ask them how Mert Root came up with neutral position. Then ask them how many different ways of finding/ defining neutral position can they come up with and ask them if they are all the same position.

    You have fallen into neutral position trap, as many students have, of trying to explain foot pathology. There is a gap in logic of how not standing in neutral position leads to foot pathology. Are you still being taught neutral position biomechanics without being taught other theories?

    Some thougths:
    Identify the structure that hurts.
    The pain should decrease if you lower stress in the structure that hurts.
    Not standing in neutral position does not lead to foot pain.
    What's the dividing line between hypermobility and normal mobility?
    Are they teaching you that a nuetral position orthotic will put the foot into neutral position?


    If you don't find some inconsistancies in neutral position theory you are not looking hard enough. There is a reason that many of my fellow students who got good grades in biomechanics felt like they did not understand biomechanics. It is not internally consistant.


    Good luck with your studies. Don't believe everything they tell you.

    Eric
     
  10. delpod

    delpod Active Member

    Hi Eric, in Australia, as far as I know, most of the podiatry schools teach their biomechanics based upon the root theory. I know for a fact that my school certainly touched on alternative theories, however from a clinical point of view, the orthotic therapy we learnt was very largely based upon the root theory.

    personally, this was one of the most difficult concepts of orthotic therapy for me to grasp, and only now (through clinical experience as a new grad) am begining to understand it. As a student it was something I was un able to comprehend.
     
  11. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Not at LaTrobe! Would I be right in guessing you might of trained in SA?
     
  12. delpod

    delpod Active Member

    What is the basis of biomechanics at LaTrobe?

    Correct, I went through in SA. Whilst I say we learnt the root theory, the clinical tutors did not shelter us from inversion devices. They were often prescribed where they saw it appropriate. However there were no Blake's applications of 25 degress inversion etc. Then again, what is defined as a "Blake's Device"? There may be discrepancies between schools.

    Might I say I believe the Root theory is a good starting point for students as it is one of the simpler and more widely accepted theories out there. This is probably why they teach it!
     
  13. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    They get it all....and most importantly (hopefully), they get the tools to make their own minds up as to which approach is appropriate in which context.
     
  14. Dermotfox

    Dermotfox Active Member

    Craig.


    Its quite hard to concentrate on your posts with Homer popping up all the time.
     
  15. Dieter Fellner

    Dieter Fellner Well-Known Member

    Sorry Dermotfox, I have to intercede here - Homer is my hero. Leave him alone !!

    :boxing:
     
  16. spike2260

    spike2260 Member

    hi again, in responce yes root was our main source in biomechanics howeve the problem in understanding root for us was that we were given the theory of orthotics and how to make etc, but have not really had the chance to make one, this i feel has been slightly detremntal to my learning as i feel making the orthotic would help a great deal even if it only acts to serve as an example. I love boimech and have some great teachers however its the contraints of our practice clinic which serves to hinder my learning anymore i feel,
     
  17. markjohconley

    markjohconley Well-Known Member

    And I thought I had problems ............................
     
  18. efuller

    efuller MVP

    I disagree with the notion that Root theory is simple. The more you think about it the more inconsistancies come up. Which definition of normal do think is better? How do orthotics work? If it is by supporting a deformity, do you check the position that patients stand in on top of their orthoses? etc. etc. There are plenty of threads on this site discussing Root theory.

    The commen lament of my classmates was that yes I got good grades in the class, but I don't understand biomechanics. There are incosnistancies that create this.

    It may be widely accepted, but fewer are accepting than before. I hope.

    Cheers,

    Eric
     
  19. José Salvador

    José Salvador Welcome New Poster

    Dear friend, the concept of neutral position and foot very maximumly I proswim are different. If a patient is in conditions of maximum weight and size I proswim us dá information on an increase of moments of compressive force in tarso. This compressive situation of stress in the sine, can occur throughout the different rotational positions from the axis of the joint to subdestroy, that is to say, a principle state pronation in the joint to subdestroy, can occur as much near a neutral position in support as far from her… infinite space positions of the subastragalino axis of rotation exist. I believe that to place as On guard objective a neutral foot of the ortopodologico treatment is an error, the objective of the treatment is the one to diminish stress pathological of the weave affection and that partly entails the change of the location of the centre of pressure in relation to the location of the STJA, fodder that the positional change of the foot is smaller importance. I wait for not haberte rolled but. My English is a little defective. Sorry!

    Fran Monzó
    University Miguel Hernandez de Elche
    Spain

    Reason…? one of the wonders of the human nature able to secure the greater personal triumph.
     
  20. Spike:

    By definition, NCSP, or neutral calcaneal stance position, is the frontal plane position of the calcaneus to the ground while the patient is in subtalar joint (STJ) neutral position. RCSP, or relaxed calcaneal stance position, is the frontal plane position of the calcaneus to the ground while the patient is in relaxed bipedal stance. Therefore, by definition, your patient can not be maximally pronated at the STJ in their NCSP but may indeed be maximally pronated at the STJ in their RCSP.
     
  21. brevis

    brevis Active Member

    I still have the first orthotic I ever made....It was horrible....Just ask ATLAS
     
  22. rubennpodo

    rubennpodo Active Member

    Hello from Spain!

    I-m agreement with you; rearfoot is locked to all foot and you have to see every biomecanical action (high arch, movements, too many toes, windlass..)


     
Loading...

Share This Page