Podopostural therapy

mike weber · Jun 7, 2010

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Hi Folks I was doing some :welcome: to PA stuff last week. Here is the posts so far.

Peter W.B.Oomens said: ↑

Hello,

my name is Peter W.B.Oomens and I have been Podopostural Therapist (PPT) in the Netherlands for about twenty years. Podopotural Therapy is a way of correcting and adjusting patients posture when they have postural complaints as e.g. (aspecific) (chronic) low back pain, knee-, foot- and anklepain. By dynamically changing their balance from the feet you can change their posture and often succefully decrease their pain.
This therapy is known for almost 30 years also in Germany, France, Italy and other European countries. There is a close international collaboration, as well as representation in the European Parliament.

After retiring from my practice I have been asked as chairman of the Omni Podo Genootschap, the union of Dutch therapists. Health insurance companies pay for the treatment.
In the past I have written books and reviews, all in Dutch and I have participated in the training of new collegues. You can become PPT after a full year study and after you got a bachelor degree as e.g. bachelor physical therapy.
I really like to start a discussion later on.
For now, thanks for your time.
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m weber said: ↑

Hi Peter :welcome: to Podiatry Arena. Look forward to you thread on podopostural therapy. I would suggest that any journal papers and other stuff that you have post then up as well, as some have found out Evidence and mechanical discussion are very important in new idea presentations.
Good luck and look forward to the discussions.
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Peter W.B.Oomens said: ↑

Half the border of the Netherlands lies along the sea. We have wide sandbeaches which invite you to walk. Studying the barefoot prints in the sand is my hobby.
Have you ever noticed that where we find the medial arch of the foot the print in the sand is the less deep? This can not mean else that when the foot pronates there is an activity which automatically corrects this pronation.
This brings me to a study of Benno M.Nigg in 1986, Biomechanics of running shoes, page 151-153, ISBN 0-87322-002-1, in which he concludes: 'the result that the medial support clearly did not reduce total pronation is surprising and was not expected at all. We (Nigg) expected that there would be a clear difference between (sport)shoes without and with medial support with respect to total pronation".
One of his conclusions was that the more the medial archsupport was placed tot the rear, the most effective it was. But not more effctive than barefoot. Might it be possible that pronation is a physiological phenomenon, which normally corrects itself?
Will be continued.
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Peter W.B.Oomens said: ↑

What else is remarkable at the foot?
26 small bones have to bear 50 to 100 % of the bodyweight. Looking at the columna vertebralis and the kneejoint, bones more or less are stapled, the underlying bone bears the bone above, and so on. Biomechanically this a kind of 'form closure'. Feetbones instead lies next to each other, and need to be strongly connected. The only structure that is able to do so: the intrinsic footmuscles, of course helped by the strong, plantar ligaments (only found with men!) All intrinsic, plantar foot muscles are placed in the length of the foot, except the m.obliquus transversus. Biomechanically we call this 'force closure'. The human point of gravity, with healthy people, is (standing) projected in between the inside malleolus of both feet. When people start, for whatever reason or disease, to hang forward, the toes have to grip to prevent falling; this is an activity of both extrinsic and intrinsic bending muscles. Indeed the (loaded) foot is a very sensitive part of the body, constantly controlled by the cerebellum, more than a static, rigid part of the body.
Thereover next time.
Thanks again fot reading.
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So I thought I would open up the discussion to the wider community.

I went a googling and came across this web site, not much info but here is their take on feet.

http://www.livit.nl/shoes-inlays and here is the google page findings again not alot of info. http://www.google.se/search?sourceid=navclient&aq=1h&oq=&hl=sv&ie=UTF-8&rlz=1T4ADRA_svSE362SE362&q=podopostural+therapist

Anyone got an option or maybe Peter can provide some good papers etc

ps sorry about the extra letter in the heading Help Admin, went to edit it but you can not edit the title ?

Robertisaacs · Jun 7, 2010

Functional foot typing again.

http://www.youtube.com/watch?v=6kmTNObny3k

THEY'RE COMING OUT OF THE WALLS!!!!!

Although to be fair he does include the disclaimer

* The foot types described above occur frequently and do not always result in complaints. Besides there are many possible combinations in which positions of the feet might occur. There are also more severe defects of the foot which are not described here.
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I had a mulling on this very thing on holiday last week. I have a significant asymmetry in static stance, much more pronated R>L. When I looked at my footprints in the sand however, they were identical.

Anyway. Wet footprints yea.

mike weber · Jun 8, 2010

Peter does not seem to want to come over here and say hello.

Here is his lastest update.

Peter W.B.Oomens said: ↑

Hi Michael,

the official website for the Podopostural Therapy in the Netherlands is http//:www.omnipodogenootschap.nl
However it is only in dutch.

regards, Peter W.B.Oomens
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Peter W.B.Oomens said: ↑

Is that the only remarkable at the feet?
No, sure not. A lot of neurologic and physiologic research has been done on the plantar side of the bare foot. Just read the conclusions of Kennedy and Inglis: Distribution and behaviour of glabrous cutaneous receptors in the human foot sole: jp.physoc.org/content/538/3/995.abstract (2002), regarding the possible role of foot sole skin receptors in standing balance and movement control.
Anyone knows that you can walk barefoot over a rough underground, bust most of us can not stand tickling of the footsole. The foot sole is loaded with receptors that continiously informs the central nerve system and, as far as movement is regarded, the cerebellum.
This system now can, if understood and well applied, influence the human posture and help diminish patients postural and foot problems or even resolve them. I know, because I did it twenty years! Very important is that this therapy, which we call podopostural therapy, is often needed for a certain period and not for lifetime
Mechanic foot support than can be used when our subtle, exteroceptive system does not function anymore...
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Ive added the Paper. It has got me thinking about something ....

mike weber · Jun 8, 2010

This is from the web site

Therapy
The therapy is based on the phenomenon that any deviation from the state of a foot deformity is higher in the body entails. Conversely, any deviation an attitude change of foot position result. These stands and attitude changes can cause various symptoms, including chronic knee, hip, back and neck pains.

Proprioception, what is that?
In the muscles and tendons of us are called proprioceptive musculoskeletal elements respond to pressure and tension. They are important for maintaining posture and protect the muscles from overstretching. When a muscle is stretched, or there is pressure exerted on the nervous system provides for increased muscle tension.

The regulation of posture and movement is done through the proprioceptive mechanism.
Research and treatment.

The podoposturaal testing is:

• A conversation about the complaints:
• Examination of the musculoskeletal system, which relationships are accurately assessed.
• Examination of both standing and walking.
• Measurements: leg length, position of the pelvis, curvature of the spine, muscle tension.

Using a print window blueprints are made to determine the type of foot. The prints also serve as a pattern in the manufacture of insoles.

Closely mirror the printing surface of the foot looked at and evaluated. While the client to closely mirror elements are thin, usually of cork, in specific places within the top foot. These elements have an immediate effect on muscle chains, allowing the body posture changes.

Correction Soles
The effects continue to make these elements incorporated into an insole. Garment Manufacture is not possible because each complaint and each person is different. When the soles are wearing the body some time to adapt. This may be the first few weeks of pain in muscles. The different muscle chains are in fact different proceedings.

To a great transition to avoid working with a therapist podoposturaal the accrual system. Usually follow after the first visit a number of checks at intervals of several weeks or months while the necessary corrections.

Then the checks once every half year or full year. If there are interim symptoms occur you should contact the therapist to incorporate.

No insoles
The proprioceptive soles should not be seen as insoles. Insoles, the name says it all, support the foot and take positions on the structures of the foot can no longer perform. When the foot soles podoposturale proprioceptive the point to the attitude change and thus reduce complaints.

Other shoes
With special foot deformities, such as occurring in rheumatic patients and patients with diabetes, often shooting the sole proprioceptive deficit. In this case, the therapist podoposturaal support and / or relief pads make. These are shoes that cause the pressure under the foot as favorable as possible.

The normal foot
This is the normal basis with the attitude that goes. People with such attitudes are usually free of symptoms, but that does not mean we should have such an attitude to complaints to be free. A little asymmetry in posture is normal.

The Holvoet
On the left you Holvoet and attitude that goes with it. Holvoet characterized by claw toes, sensitive feet and increased muscle tone. Low back and neck and for foot pain may arise therefrom. The symptoms worsen at rest situations (such as standing, lying and sitting) and decrease in movement.

The flatfoot
The flat foot is a flexible base with weak muscles. Here is the corresponding back hanging position shown. Complaints to the knee and lower back, skull headache pain and fatigue are often the result. Usually dull pain that is present at rest and on movement increase decrease

Opinions
• Wear shoes with a flat surface, so no built-in support or foot beds.
• Observe a maximum heel of 4 inches
• Wear the therapeutic adaptations always, even during sports. Intensive sports like reporting.
• Consult with podoposturaal therapist about any exercises.
• If you are also being treated at another way, we ask you to inform us so that treatments can be harmonized.
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Here websters online Dictionary take on Propriception

Definition: Proprioception

Part of Speech Definition
Noun 1. The ability to sense the position and location and orientation and movement of the body and its parts.[Wordnet].
Source: WordNet 3.0 Copyright © 2006 by Princeton University. All rights reserved.

Top

Date "Proprioception" was first used in popular English literature: sometime before 1948. (references)

Extended Definition: Proprioception

--------------------------------------------------------------------------------

Proprioception

The cerebellum is largely responsible for coordinating the unconscious aspects of proprioception.
Proprioception (pronounced /ˌproʊpriːəˈsɛpʃən/ PRO-pree-o-SEP-shun); from Latin proprius, meaning "one's own" and perception) is the sense of the relative position of neighbouring parts of the body. Unlike the six exteroceptive senses (sight, taste, smell, touch, hearing, and balance) by which we perceive the outside world, and interoceptive senses, by which we perceive the pain and the stretching of internal organs, proprioception is a third distinct sensory modality that provides feedback solely on the status of the body internally. It is the sense that indicates whether the body is moving with required effort, as well as where the various parts of the body are located in relation to each other.

Tests for Proprioception
In domestic animals, there are a number of relatively specific tests of the subjects ability to propriorecept, these are used in the diagnosis of neurological disorders. These tests include the visual and tactile placing reflexes[1].

History of Study
The position-movement sensation was originally described in 1557 by Julius Caesar Scaliger as a 'sense of locomotion'. Much later in 1826 Charles Bell expounded the idea of a 'muscle sense' and this is credited with being one of the first physiologic feedback mechanisms. Bell's idea was that commands were being carried from the brain to the muscles, and that reports on the muscle's condition would be sent in the reverse direction. Later, in 1880, Henry Charlton Bastian suggested 'kinaesthesia' instead of 'muscle sense' on the basis that some of the afferent information (back to the brain) was coming from other structures including tendons, joints, skin, and muscle. In 1889, Alfred Goldscheider suggested a classification of kinaesthesia into 3 types: muscle, tendon, and articular sensitivity.

In 1906, Charles Scott Sherrington published a landmark work which introduced the terms 'proprioception', 'interoception', and 'exteroception'. The 'exteroceptors' were the organs responsible for information from outside the body such as the eyes, ears, mouth, and skin. The interoceptors then gave information about the internal organs, while 'proprioception' was awareness of movement derived from muscular, tendon, and articular sources. Such a system of classification has kept physiologists and anatomists searching for specialised nerve endings which transmit data on joint capsule and muscle tension (such as muscle spindles and Pacini corpuscles).

Proprioception vs. kinesthesia
Kinesthesia is another term that is often used interchangeably with proprioception. Some differentiate the kinesthetic sense from proprioception by excluding the sense of equilibrium or balance from kinesthesia. An inner ear infection, for example, might degrade the sense of balance. This would degrade the proprioceptive sense, but not the kinesthetic sense. The infected person would be able to walk, but only by using the sense of sight to maintain balance; the person would be unable to walk with eyes closed.

Proprioception and kinaesthesia are seen as interrelated and there is considerable disagreement regarding the definition of these terms. Some of this difficulty stems from Sherrington's original description of joint position sense (or the ability to determine where a particular body part exactly is in space) and kinaesthesia (or the sensation that the body part has moved) under a more general heading of proprioception. Clinical aspects of proprioception are measured in tests that measure a subject's ability to detect an externally imposed passive movement, or the ability to reposition a joint to a predetermined position. Often it is assumed that the ability of one of these aspects will be related to another; unfortunately, experimental evidence suggests there is no strong relation between these two aspects. This suggests that, while these components may well be related in a cognitive manner, they seem to be separate physiologically.

Much of the foregoing work is dependent on the notion that proprioception is essentially a feedback mechanism; that is, the body moves (or is moved) and then the information about this is returned to the brain, whereby subsequent adjustments could be made. More recent work into the mechanism of ankle sprains suggests that the role of reflexes may be more limited due to their long latencies (even at the spinal cord level) as ankle sprain events occur in perhaps 100msec or less. Accordingly, a model has been proposed to include a 'feedforward' component of proprioception where the subject will also have central information about the body's position prior to attaining it.

Kinesthesia is a key component in muscle memory and hand-eye coordination, and training can improve this sense (see blind contour drawing). The ability to swing a golf club or to catch a ball requires a finely-tuned sense of the position of the joints. This sense needs to become automatic through training to enable a person to concentrate on other aspects of performance, such as maintaining motivation or seeing where other people are.

Basis of proprioceptive sense
The inititation of proprioception is the activation of a proprioreceptor in the periphery[2] The proprioceptive sense is believed to be composed of information from sensory neurons located in the inner ear (motion and orientation) and in the stretch receptors located in the muscles and the joint-supporting ligaments (stance). There are specific nerve receptors for this form of perception termed "proprioceptors", just as there are specific receptors for pressure, light, temperature, sound, and other sensory experiences. Proprioreceptors are sometimes known as adequate stimuli receptors.

Although it was known that finger kinesthesia relies on skin sensation, recent research has found that kinesthesia-based haptic perception strongly relies on the forces experienced during touch.[3] This research allows the creation of "virtual", illusory haptic shapes with different perceived qualities.[4]

Applications

Law enforcement
Proprioception is tested by American police officers using the field sobriety test where the subject is required to touch his or her nose with eyes closed. People with normal proprioception may make an error of no more than 20 millimetres. People suffering from impaired proprioception (a symptom of moderate to severe alcohol intoxication) fail this test due to difficulty locating their limbs in space relative to their noses.

Learning
Proprioception is what allows someone to learn to walk in complete darkness without losing balance. During the learning of any new skill, sport, or art, it is usually necessary to become familiar with some proprioceptive tasks specific to that activity. Without the appropriate integration of proprioceptive input, an artist would not be able to brush paint onto a canvas without looking at the hand as it moved the brush over the canvas; it would be impossible to drive an automobile because a motorist would not be able to steer or use the foot pedals while looking at the road ahead; a person could not touch type or perform ballet; and people would not even be able to walk without watching where they put their feet.

Oliver Sacks once reported the case of a young woman who lost her proprioception due to a viral infection of her spinal cord.[5] At first she was not able to move properly at all or even control her tone of voice (as voice modulation is primarily proprioceptive). Later she relearned by using her sight (watching her feet) and vestibulum (or inner ear) only for movement while using hearing to judge voice modulation. She eventually acquired a stiff and slow movement and nearly normal speech, which is believed to be the best possible in the absence of this sense. She could not judge effort involved in picking up objects and would grip them painfully to be sure she didn't drop them.

Training
The proprioceptive sense can be sharpened through study of many disciplines. The Alexander Technique uses the study of movement to enhance kinesthetic judgment of effort and location. Juggling trains reaction time, spatial location, and efficient movement. Standing on a wobble board or balance board is often used to retrain or increase proprioception abilities, particularly as physical therapy for ankle or knee injuries. Standing on one leg (stork standing) and various other body-position challenges are also used in such disciplines as Yoga or Wing Chun. In addition, the slow, focused movements of Tai Chi practice provide an environment whereby the proprioceptive information being fed back to the brain stimulates an intense, dynamic "listening environment" to further enhance mind / body integration. Several studies have shown that the efficacy of these types of training is challenged by closing the eyes, because the eyes give invaluable feedback to establishing the moment-to-moment information of balance. There are even specific devices designed for proprioception training, such as the Proprioceptor system, which consists of shoes with specially designed balls on the soles to make athletes work harder to balance. [6]

Impairment
Apparently, temporary loss or impairment of proprioception may happen periodically during growth, mostly during adolescence. Growth that might also influence this would be large increases or drops in bodyweight/size due to fluctuations of fat (liposuction, rapid fat loss, rapid fat gain) and muscle content (bodybuilding, anabolic steroids, catabolisis/starvation). It can also occur to those who gain new levels of flexibility, stretching, and contortion. A limb's being in a new range of motion never experienced (or at least, not for a long time since youth perhaps) can disrupt one's sense of location of that limb. Possible experiences include these: suddenly feeling that feet or legs are missing from one's mental self-image; needing to look down at one's limbs to be sure they are still there; and falling down while walking, especially when attention is focused upon something other than the act of walking.

Proprioception is occasionally impaired spontaneously, especially when one is tired. One's body may appear too large or too small, or parts of the body may appear distorted in size. Similar effects can sometimes occur during epilepsy or migraine auras. These effects are presumed to arise from abnormal stimulation of the part of the parietal cortex of the brain involved with integrating information from different parts of the body.[7]

Proprioceptive illusions can also be induced, such as the Pinocchio illusion.

The proprioceptive sense is often unnoticed because humans will adapt to a continuously-present stimulus; this is called habituation, desensitization, or adaptation. The effect is that proprioceptive sensory impressions disappear, just as a scent can disappear over time. One practical advantage of this is that unnoticed actions or sensation continue in the background while an individual's attention can move to another concern. The Alexander Technique addresses these issues.

People who have a limb amputated may still have a confused sense of that limb existence on their body, known as phantom limb syndrome. Phantom sensations can occur as passive proprioceptive sensations of the limb's presence, or more active sensations such as perceived movement, pressure, pain, itching, or temperature. The etiology of the phantom limb phenomenon was disputed in 2006, but some consensus existed in favour of neurological (e.g. neural signal bleed across a preexisting sensory map, as posited by V.S. Ramachandran) over psychological explanations. Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, such as after amputation of the breast, extraction of a tooth (phantom tooth pain), or removal of an eye (phantom eye syndrome).

Temporary impairment of proprioception has also been known to occur from an overdose of vitamin B6 (pyridoxine and pyridoxamine). Most of the impaired function returns to normal shortly after the intake of vitamins returns to normal. Impairment can also be caused by cytotoxic factors such as chemotherapy.

It has been proposed that even common tinnitus and the attendant hearing frequency-gaps masked by the perceived sounds may cause erroneous proprioceptive information to the balance and comprehension centers of the brain, precipitating mild confusion.

Proprioception is permanently impaired in patients who suffer from joint hypermobility or Ehlers-Danlos Syndrome (a genetic condition that results in weak connective tissue throughout the body). It can also be permanently impaired from viral infections as reported by Sacks. The catastrophic effect of major proprioceptive loss is reviewed by Robles-De-La-Torre (2006).[8]

References
Introduction to Neurology, 2nd Edition 1976, A.C.Palmer, Blackwell Scientific, Oxford
Sherrington C.S., Brain 29:467-485,1907 http://brain.oxfordjournals.org/cgi/reprint/29/4/467
Robles-De-La-Torre G, Hayward V (2001). "Force can overcome object geometry in the perception of shape through active touch". Nature 412 (6845): 445-8. PMID 11473320.
the MIT Technology Review article "The Cutting Edge of Haptics"
Sacks, O. The Disembodied Lady, in The Man Who Mistook His Wife for a Hat and his autobiographical case study A Leg To Stand On.
The Proprioceptor System
Ehrsson H, Kito T, Sadato N, Passingham R, Naito E (2005). "Neural substrate of body size: illusory feeling of shrinking of the waist". PLoS Biol. 3 (12): e412. PMID 16336049.
Robles-De-La-Torre G. The Importance of the Sense of Touch in Virtual and Real Environments. IEEE Multimedia 13(3), Special issue on Haptic User Interfaces for Multimedia Systems, pp. 24–30 (2006).
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mike weber · Jun 8, 2010

Sounds all like this thread which did not end so well, but was very funny.

Another type of Proprioception device thread

Peter W.B.Oomens · Jun 11, 2010

Hi,

surprising! Reading is an art. You are talking about propriocepsis, I am not. You are talking about a certain Brian Rothbart, I am not. I am trying tot explain that the footsole is loaded with skinreceptors that are sensistive to pressure: Vater, Pacini, Krause, Ruffini, Meisner and free nerve endings. I am talking about exterocepsis!Of course under constant cerebellair control. In fact I am talking about alfa-gamma co-activation. I am talking about intrinsic footmuscles that seem to be active in a loaded foot:
http://www.aptei.com/articles/pdf/IntrinsicMuscles.pdf
Podopostural therapy has proven to be effective for over 30 years now, at least in Europe. Of course I am familiair with the placebo effect, but thousands and thousands helped patients? My professional attitude was always to be critically open to new ideas. This made me a succesful therapist for over 20 years.
Reason for participating in this 'arena' was my wish to share. No more no less..

Robertisaacs · Jun 11, 2010

Oh hey Peter.

I am talking about exterocepsis!
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Big hand for the FIRST posturologist we've seen to understand the difference between exteroception and proprioception! :drinks . Craig will be delighted.

Podopostural therapy has proven to be effective for over 30 years now, at least in Europe. Of course I am familiair with the placebo effect, but thousands and thousands helped patients?
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Proven? Has it hell! Even more patients have been "helped" by homeopathy. Or Crystals. Or faith healing. Doesn't prove it does'nt work of course but it sure as hell doesn't prove it DOES either.

From your article

Excessive pronation is the primary biomechanical cause of many foot and ankle disorders

Rigid foot orthotics are clinically essential and should be the primary management option for many foot and ankle pain syndromes related to abnormal pronation

Rigid orthotics are required to maintain the subtalar neutral position and to stop / limit pronation in many foot and ankle pain syndromes related to abnormal pronation

The purpose of retraining of the intrinsic foot muscles is to change the static foot posture and the height of the medial longitudinal arch

Intrinsic foot muscles can be retrained using phasic towel toe curl exercises
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I doubt you would find more than one or two podiatrists here who would support even half of these statements. Number 3 in particular was out of date 40 years ago.

Tell you what. This is a bit of a big topic. What say, if you want to discuss this, we hone in on one or two simple statemens and / or claims which would be of interest to discuss.

Like for a lead in, do stronger intrinsics correlate to lower arches or higher ones.

Podopostural therapy

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Distribution and behaviour of glabrous cutaneous receptors in the human foot..pdf

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Peter W.B.Oomens Member

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introducing podopostural therapy

Tactile Therapy Shift Patients Toward Equilibrium

Treating plantar fasciitis; American Physical Therapy Association guidelines

Testosterone replacement therapy is associated with increased odds of Achilles tendon injury

Video Based Game Exercise Therapy for Flat Feet

Use of extracorporeal shock wave therapy for children’s foot, ankle and leg concerns

Leech therapy and Ayurveda for diabetic foot ulcers

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Podopostural therapy

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