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Abnormal Ontogenetic Development of the Calcaneus resulting in the PreClinical Clubfoot Deformity

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Apr 18, 2021.

  1. Brian A. Rothbart

    Brian A. Rothbart Active Member

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    The PreClinical Clubfoot deformity (PCD) is a fairly common congenital foot structure society. Below is a brief abstract of a paper published in Podiatry Today on this foot structure.

    Ontogenetic Development of the calcaneus resulting in the PreClinical Clubfoot Deformity

    ‘The calcaneus does not complete its normal ontogenetic (torsional) development. When this foot is placed in its anatomical neutral position, the bottom surfact of the calcaneus is inverted relative to the longitudinal bisection of the tibia.

    When weight is applied to this foot, at heel contact gravity forces the PCD foot to twist (abnormally pronate) in order to bring the entire bottom surface of the heel bone down to the ground.’

    The Primus Metatarsus Supinatus (Rothbarts) Foot and the PreClinical Clubfoot Deformity: A Brief Introduction
  2. Brian A. Rothbart

    Brian A. Rothbart Active Member

    A more complete description of the PreClinical Clubfoot deformity and the Primus Metatarsus Supinatus foot (abnormal genetic foot types) can be found in the following papers:

    Discussion (with embryonic photos) of the ontogenetic development of the PreClinical Clubfoot Deformity and the Primus Metatarsus Supinatus (aka Rothbarts Foot)
    Differential diagnosis - PMS vs PCCd
    Pressure plate study of the PMS vs PCCd
    Hopefully this information will open up a discussion on these two foot types and their impact on the practice of Podiatric Medicine.
  3. Brian A. Rothbart

    Brian A. Rothbart Active Member

    The PreClinical Clubfoot Deformity can cause skeletal deformation in the cranium. A radiographic investigation linked gravity drive pronation (resulting from the PreClinical Clubfoot Deformity) to frontal plane distortions in the cranial bones.
    • Rothbart BA 2013. Prescriptive Insoles and Dental Orthotics Change the Frontal Plane Position of the Atlas (C1), Mastoid, Malar, Temporal and Sphenoid Bones: A Preliminary Study. Journal of Cranio Manidibular and Sleep Practice, Vol 31(4):300-308.
  4. Brian A. Rothbart

    Brian A. Rothbart Active Member

    A preliminary study links Gravity Drive Pronation (resulting from the PreClinical Clubfoot Deformity) to an increase Beta Wave (CNS) Activity.

    "Beta waves are high-frequency, low-amplitude brain waves that are commonly observed in an awaken state. They are involved in conscious thought and logical thinking, and tend to have a stimulating effect. Having the right amount of beta waves allows us to focus." (https://ScienceDirect.com/topics/Medicine-and-Dentistry/beta-wave)

    In my practice I have seen some PreClinical Clubfoot patients fitted with proprioceptive insoles relating a decrease in disturbing, hyperactive thoughts. These anecdotal subjective reports could be explained and understood from the results of this preliminary study. Also, it dovetails with the 2013 investigation that links Gravity Drive Pronation to alterations in the frontal plane alignment in the cranial bones.

    This preliminary study on changes in B-Wave activity is not definitive and needs to be repeated with a larger N study (currently in the works).

    Alteration in Plantar Pressure Gradients (Foot Function) Linked to Alterations in Brain Wave Activity
  5. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Following is the summation of my published research on the PreClinical Clubfoot Deformity:
    • The PreClinical Clubfoot Deformity results in torsional mechanics and skewed proprioceptive signals
    • Torsional mechanics places the weight bearing joints under increased stress and increases the propensity to overuse injuries
    • Skewed proprioceptive signals results in a skewed global postural alignment, foot to jaw
    • Skewed proprioceptive signals change the vertical facial dimensions and alters the frontal plane alignment of the cranial bones.
    • Skewed proprioceptive signals alters brain wave activity!
    The impact the PreClinical Clubfoot Deformity has on the total health of the body (both mechanically and physiologically) is profound.
    This is where I believe the future of Podiatry will be directed towards - stabilizing the body mechanically and physiologically.
  6. Brian A. Rothbart

    Brian A. Rothbart Active Member

    In 2016 I published a paper that presented a differential intervention diagnosis - PreClinical Clubfoot Deformity vs Primus Metatarsus Supinatus (aka Rothbarts Foot) using Pressure Plate Analysis. Below is a reprint of the paper's abstract:

    Standing barefooted, surface area (X) and media pressure (Y) readings were recorded on 11 PreClinical Clubfoot Patients and 6 Rothbarts Foot subjects using the Podolab 2000 pressure plate analysis system. A second set of surface area and media pressure readings were then recorded after each subject used their proprioceptive insoles for 60 seconds. The collected data was statistically analyzed using ‘Best Fit’ Hypothesis. The results of the ‘Best Fit’ Hypothesis suggest that prescriptive proprioceptive insoles shift postural tonicity patterns towards homeostasis. From a clinical point of view, pressure plate readings may prove useful in prognosticating the appropriateness of specific prescriptive proprioceptive insoles when treating either PreClinical Clubfoot Deformity or Rothbarts Foot patients.
    Rothbart BA 2016. Pressure Plate Analysis of the PreClinical Clubfoot and Primus Metatarsus Supinatus Foot Deformities
    • April 2016
  7. scotfoot

    scotfoot Well-Known Member

    Do your insoles provide arch support ?
  8. Brian A. Rothbart

    Brian A. Rothbart Active Member

    The etiology of Adolescent Scoliosis has long been a discussion in the orthopedic literature. In 2013 I published a preliminary study that linked scoliotic thoracic curves to gravity drive pronation (resulting from the PreClinical Clubfoot Deformity). Below is the abstract taken from my paper:

    "Scoliosis in patients between 10 and 18 years of age is termed adolescent scoliosis. The most common type of scoliosis in this age group is one in which the cause is unknown, and still referred to as Adolescent Idiopthic Scoliosis. I have long suspected a link between abnormal foot motion (gravity drive pronation) and the development of abnormal curves in the spinal cord.

    A study I published in 2006 (JAPMA) statistically linked the unleveling of the pelvis, which forms the base of the spine, to abnormal foot pronation. It is only logical to suspect that if the base of the spine is unlevelled, it could also unlevel the entire spine. This was my motivation that led to this study.

    It is to be noted that this is a preliminary study and certainly needs to be repeated using a larger sample size. However, the outcome of this study does suggest that the development of scoliosis may indeed be linked to abnormal foot motion."​

  9. scotfoot

    scotfoot Well-Known Member

    Simple question , do your proprioceptive insoles include medial arch support ?
  10. Brian A. Rothbart

    Brian A. Rothbart Active Member

    From all that I have written above, one can appreciate that one must be diligent in the use of any type of orthotic placed underneath the feet. Orthotic intervention is a two sword blade - the potential for good is equal to the potential for harm.

    Orthotics (or proprioceptive insoles) can:
    • Increase or decrease scoliotic (and kyphotic) curves
    • Increase or decrease weight bearing joint pain (foot to jaw)
    • Increase or decrease dental malalignments
    • Improve or exacerbate visceral dysfunctions
    • Impact mentation (increase or decrease beta wave activity)!
    Just to name a few.

    When I was trained (Root biomechanics), we used orthotics (basically arch supports with or without heel posting) whenever we diagnosed abnormal (?) pronation. That protocol is now, or should be, discarded.

    Before initiating any type of orthotic (or proprioceptive) intervention, one should (must) determine the cause of that unwanted pronation. The cause of that disruptive pronation is what requires attention and will determine what type of orthotic is used (if any).

    If you disagree, let's hear it.
  11. scotfoot

    scotfoot Well-Known Member

    Do your proprioceptive insoles include medial arch support ? " let's hear it. "
  12. Brian A. Rothbart

    Brian A. Rothbart Active Member

    To expand on the link between abnormal foot function (e.g., gravity drive pronation) and malocclusions, in 2014 I published a paper in Cranio UK on this link.

    Since then, other research teams have reported similar findings. The one I find most illuminating is the 2018 cross-sectional research study conducted by Marchena-Rodriquez et al, that linked foot posture (pronated feet) to dental malocclusions in children between the ages of 6 to 9.

    Hopefully, a more global approach will be taken by our Podiatrists, realizing the entire body is interconnected. The orthotic you put underneath your patient's feet can impact their dental occlusion!

    • Rothbart BA 2014. Malocclusion and Abnormal Foot Motion. Cranio UK (Journal of the British Society for the Study of Craniomandibular Disorders), Issue No. 1, pp 26-29.
    • Marchena-Rodriquez A 2018. Relationship between foot posture and dental malocclusions in children aged 6 to 9 years. Medicine, Issue 19:97, May.

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