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Foot Embryogenesis - First Trimester

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Jun 16, 2023.

  1. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


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    Attached is a pdf file delineating the embryonic development of the foot during the first trimester of gestation.

    • At Carnegie Stage 14 the lower limb appears
    • At Carnegie Stage 17 the soles of the foot bud are cephalad
    • At Carnegie Stage 18 the feet have rotated into supinatus (soles facing each other)
    • At Carnegie Stage 23 the ankles and toes are fully visible.
    • At week 10pf, the feet have a clubfoot shape
    • At week 11pf, the feet have a preclinical shape
    • At week 12pf, the feet have primus metatarsus supinatus shape
    • At week 13pf, the feet have a plantargrade shape
    As a result of my clinical research, I contend that:
    1. If the ontogenetic development of the foot stops prematurely at week 10 pf, the neonatal is born with a Clubfoot deformity
    2. If the ontogenetic development of the foot stops prematurely at week 11pf, the neonatal is born with a Preclinical Clubfoot deformity
    3. If the ontogenetic development of the foot stops prematurely at week 12 pf, the neonatal is born with a Rothbarts foot
    4. If the ontogenetic development continues through week 13pf, the neonatal is born with a Plantargrade foot.
     

    Attached Files:

  2. Rob Kidd

    Rob Kidd Well-Known Member

    And your work is published - where?
     
  3. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Hi Rob,

    I appreciate your interest. My research on foot embryogenesis was first published in 2002 (JBMT) and later in 2004 and 2010 (PR).

    It was also published online in 2002 in ChiroZone.

    You can download copies of these papers on my Researchgate site.
    • Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
    • Rothbart BA 2004. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Podiatry Review(formerly Chiropody Review), Vol 61(1):20-23
    • Rothbart BA 2010. The Primus Metatarsus Supinatus (Rothbarts) Foot and the PreClinical Clubfoot Deformity. Podiatry Review, Vol. 67(1):
    • Rothbart BA. 2002 Etiology of Foot Hyperpronation - An Embryological Perspective. ChiroZine (Chiro Org News), Published online - May 7, 2002.
     
  4. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    My research on foot embryogenesis is also published in Europe

    • Rothbart BA 2004 Una teoria sul Primo Metatarso Supinato. il Podologo in Medicina, (28): 28-32, luglio agosto.
    You can also access my online paper - here.
    • Rothbart BA. 2002 Etiology of Foot Hyperpronation - An Embryological Perspective. ChiroZine (Chiro Org News), Published OnLine - May 7, 2002.
     
  5. Rob Kidd

    Rob Kidd Well-Known Member

    Yes, but where is it published in a referreed journal?
     
  6. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Hi Rob,

    Kindly refer to my #3 reply above. It lists the title of the publications, journals that they are published in (both journals are referreed), and the date of publication. JBMT is published in the United States, Podiatry Review is published in the UK.
     
  7. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    The PreClinical Clubfoot deformity is one of the most common causes of a severe flexible flatfoot. It also can result in debilitating chronic musculoskeletal pain throughout the body (foot to jaw).

    The clinical podiatrist will fairly frequently encounter this foot deformity in his practice. Hence, it is important to learn how to identify and properly treat it.
     
  8. scotfoot

    scotfoot Well-Known Member


    "Implementation of shoe insole and SFE for six weeks improved pain and function and altered foot pressure distribution greater than shoe insole alone in patients with symptomatic flatfoot."

    Published online 2023 Mar 29. doi: 10.23736/S1973-9087.23.07846-2
    PMCID: PMC10272929
    PMID: 36988565
    The combined effect of short foot exercises and orthosis in symptomatic flexible flatfoot: a randomized controlled trial

    Walaa ELSAYED, 1 Shaikha ALOTAIBI, 2 Afaf SHAHEEN, 3 , 4 Mohamed FAROUK, 5 and Ahmed FARRAG[​IMG] 4 ,*
    Author information Article notes Copyright and License information Disclaimer
    Go to:
    Abstract

    BACKGROUND

    Flatfoot is a musculoskeletal problem associated with dysfunctional active and passive supporting structures of the normal foot curvature. Strengthening of the intrinsic foot muscles or using shoe orthosis are recommend treatment approaches. However, investigating the effect of combining both approaches is still warranted.
    AIM

    To examine the effect of applying short foot exercises (SFE) combined with shoe insole versus shoe insole alone on foot pressure measures, pain, function and navicular drop in individuals with symptomatic flexible flatfoot.
    DESIGN

    Prospective, active control, parallel-group, assessor-blinded, randomized controlled trial and intention-to-treat analysis.
    SETTING

    Outpatient physical therapy clinic of a university teaching hospital.
    POPULATION

    Forty participants with symptomatic flexible flatfoot.
    METHODS

    A six-week treatment protocol of SFE (three sets of 10 repetitions a day) in addition to shoe insole (eight hours a day) (experimental group, N.=20) or shoe insole only (eight hours a day) (control group, N.=20). Clinic visits were made at baseline and every two weeks for monitoring and follow-up. The static and dynamic foot area, force and pressure measures, pain, lower extremity function, and navicular drop were assessed at baseline and postintervention.
    RESULTS

    Forty participants joined the study and 37 (92.5%) completed the six-week intervention period. Foot pressure, pain and function showed a significant interaction (P=0.02 – <0.001) and time (P<0.001) effects with a non-significant group effect in favor of the experimental group. Post-hoc analysis revealed that the experimental group had lesser pain (P=0.002) and better function (P=0.03) than the control group at six weeks. Navicular drop decreased equally in both groups.
    CONCLUSIONS

    Implementation of shoe insole and SFE for six weeks improved pain and function and altered foot pressure distribution greater than shoe insole alone in patients with symptomatic flatfoot.
     
  9. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    From the abstract above, it appears the authors did not diagnose the etiology of the flexible flatfoot, which is a symptom, not a diagnosis. The etiology of the flatfoot condition determines what type of insole should be used.

    Overall, their conclusions parallel my clinical experience. The only difference, when I was dealing with the Preclinical Clubfoot Deformity, I found muscular rehabilitation was not necessary. However, when used, it did expedite recovery.

    Thanks for the posting.
     
  10. scotfoot

    scotfoot Well-Known Member

    I would take issue with much of your post (#9) ,but it's old ground .

    Have you read the thread ( link below) on teaching foot strengthening and, if so, did you find the simple technique worked? If not ,why not give it a go. It has worked every time for me with foot exercise novices becoming good "domers" in a couple of minutes.

    https://podiatryarena.com/index.php?threads/teaching-foot-exercises.114067/
     
  11. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


    Gerrard, no need to take issue with me. We do not totally disagree. Clinically, I have used foot exercises to strengthen the intrinsic muscles.

    The point that I am stressing here, is that when treating the PreClinical Clubfoot Deformity, the most important tool, in controlling the gravity drive pronation, is the proprioceptive insole.

    With these patients, I have tried using intrinsic muscle exercises (similar to the above video), without insoles. The exercises alone did not attenuate the gravity drive pronation.

    In my clinical experience, when treating the PreClinical Clubfoot Deformity (in order to eliminate or attenuate the gravity drive pronation responsible for the chronic musculoskeletal pain), one can choose to:
    • Use exercises only. This failed because the effect of the exercises reduced the gravity drive pronation for a short period of time only. At which point, the gravity drive pronation and associated pain symptoms resumed.
    • Use supportive type orthotics. This failed because it only partially reduced the gravity drive pronation, not enough to attenuate the muscle and joint pain.
    • Use the appropriate proprioceptive insoles without exercises. This was very effective in reducing the gravity drive pronation and the resulting musculoskeletal pain.
    • Using both the exercises and appropriate proprioceptive insoles. This might expedite the patient's recovery. (I have done no control studies to make a more definitive statement)
    On the other hand, in mild Rothbarts foot deformities, the exercises are very effective in reducing the gravity drive pronation, sometimes eliminating the need to use any type of insole.
     
  12. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    FYI - standard rigid orthotics are effective in controlling gravity drive pronation generated in Rothbarts Foot.

    Generic proprioceptive insoles are available that effectively treat this foot structure and are being dispensed by DPMs, DCs, PTs, Osteopaths and the rare MD across the globe. They can also be purchased directly by the patient from a company in Tacoma Washington in the 3.5 and 6.0cm dimensions.
     
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