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Foot Mobilisation Techniques (FMT)

Discussion in 'General Issues and Discussion Forum' started by krome, May 10, 2006.

  1. krome

    krome Active Member

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    Good Afternoon Everyone from sunny England

    I am always interested to read about preventions and interventions relating to heel pain (very sad person!). I have just opened the latest AJPM and found an advert relating to workshops on FMT. Can anyone pass onto to me any information about this technique?
  2. admin

    admin Administrator Staff Member

    I do not think that the manipulation from that course is specific to heel pain (thats more of a marketing angle for the course). It is being run by Ted Jedynak. The Functional Manipulative Therapy used has been discussed here: Manipulation
  3. musmed

    musmed Active Member

    Dear Krome

    My name is Paul Conneely (I am not a podiatrist) and I have been performing mobilisation and manipulation to the foot and ankle for many years. I have been teaching these teechniques for over 12 years.

    Both myself and Shane Toohey (podiatrist, University lecturer in podiatry as well as an orthotic manufactuerer for 20 years or so) teach these techniques in Australia for 12 years (where we live) and In the United Kingdom for the past three years.

    I can state without hesitation that mobilisation and manipulation has a major place in the armamentarium of a treating podiatrist.

    I have applied these techniques to over 105000 feet (a computer generated number from my notes). The process is simple to perform and extremely effective in relief and treatment of all manner of podiatric problems.

    Despite the great number of feet I have addressed, I still get pleasant suprises on how simply pain and dysfunction are changed forever.

    The podiatry teaching University in Western Australia is going to make these techniques part of the new undergraduate programme for year 2 and 3 undergraduates.

    If you wish for more information please send me an email on musmed@ihug.com.au and I will be only too happy to answer any queries.

    Paul Conneely
  4. Ian Linane

    Ian Linane Well-Known Member

    Hi Paul

    I trained up in Manipulative techniques for the foot earlier this year. I have to agree that they have been a useful adjunct to some of the other soft tissue work for foot pain etc. Certainly found it useful for increasing ankle dorsiflexion, after injury. once things had settled down.

  5. kevin miller

    kevin miller Active Member

    I am Kevin Miller, I to use mob.manip constantly. I am in the inviable position of being in a university setting where I get to work with cadavers. I think you will see in the relatively near future, that those who study mob/manip, its effects and how it works, will soon turn lower kinetic chain biomechanics on its head. There is simply quite a lot of searching for a ghost in a house that isn't haunted. i.e., STJ theory, while having many correct points, cannot explain foot an kineteic chain function. Neither can searching for joint axes and such. What we see is that the foot was meant to be perfectly adaptable to any terrain- there is no "set" axis. You only get a predictable axis after the normal foot function has been destroyed and the kinetic chain has had to adapt ....or you test the person on a flat surface. What say you, Paul?
    Kevin Miller
  6. Rich

    Rich Member

    Havind used mobs for the past 12 years I too find these a very useful adjuct with and often without what one would call conventional podiatric therapy.It amazes me that it iis ot a more widely used modality of treatment
  7. musmed

    musmed Active Member

    Dear Rich.

    I could not agree more.

    I note in the threads of Bojsen-Mollor articles, that a quote was made about Hughes et al that they examined 160 asymptomatic feet.

    I would like to bet that if they were examined correctly they would have a different outcome. Thye would be hard pressed to find that many people in a month of sundays.

    The story is different after hands on treatment.

    Keep up the good work and spread the word.

    Paul Conneely
  8. musmed

    musmed Active Member

    Dear Kevin

    Good to see you are back.

    I could not agree more with your points. Like you and many podiatrists trained in mobilisation and manipulations we have seen what one would call the classic overpronated foot and once mobilised and or manipulated this image that under a "no hands-on treatment protocol" would have simply been issued orthotics, now needs nothing but a smile and a review in three months or so if necessary.

    Two other points I find are lost in the thinking.

    First part:
    The foot is designed to have two major functions.
    A. to watch for the enemy ie standing
    B. to evade the enemy by:
    - running
    - jumping
    - climbing.

    In evolution B came before A. Just have a look at neurology.
    L5 supplies all the lower limb

    S1 came later and thus supplies far less.

    Thus we have two feet.

    Next the subtalar joint.

    I feel it is of no consequence, it is so just simple to grasp and thus "Treat".

    Before one gets on their high horse, consider this:

    The calcaneus has two major mobile joints and a third.

    The first is the talocalcaneal: The talus has no muscles attached and thus is reliant on resultant forces alone ie the result of all pressures applied to it. This not only incudes the extrajoint forces but also the intrajoint forces (stiffness/flexibility/hpermobility/hypomobility etc)

    The second is the calcaneo-ground (thanks to Stanley Beekman for this one).

    Both of these joints are fully mobile. They allow the foot to ADAPT and thus stop shudder abnormal forces etc up the spine.

    The foot is able to adapt to two main things:
    the ground on which it stands= below upwards
    adapt for small leg length differences = above downwards

    Thus in an ideal environment tensegrity of the system is produced.

    Failure to do so produces pain some where or more than one-somewhere.

    We now wear shoes and walk on concrete. Who and what can adapt to these surfaces????

    We have not evolved to perform these tasks.

    I think this explains so many back aches, neck aches, etc aches that just have no aetiology. They are just pure failure of tensegrity. Nothing else.

    I see it constantly in my musculoskeletal practice.

    What do you think, Kevin.


    Paul Conneely.
  9. Paul

    Just out of interest, is there such a thing as a "locking" of the superior tib/fib joint and if there is, what is the effect on ankle ROM?


    Mark Russell
  10. davidh

    davidh Podiatry Arena Veteran

    Hi Musmed,
    I can't resist jumping in here.

    You said:
    "We now wear shoes and walk on concrete. Who and what can adapt to these surfaces????

    We have not evolved to perform these tasks"

    This is certainly my belief.

    Would you like to comment on one of my other beliefs - that the STJ works optimally around it's neutral position?

  11. Bob Woodward

    Bob Woodward Member

    Hello Mark

    I do believe there is "locking" of the superior tib-fib joint. We have seen this with athletes who have grade II or III inversion/plantar flexion ankle sprains. As the calcaneus inverts and the talus rotates in the ankle mortice the tensile load on the lateral ligaments draws the fibula distally and the superior tib-fib jt. to its end range of motion pedally. It is common to find a limitation in eversion of the subtalar joint and poor posterior glide of the talus in the talo-crural jt. accompanied by a limitation in ankle dorsiflexion with this presentation. You also need to check talo-navicular and calcaneo-cuboid jts. for limitations as well.

    Conversely a tightness strain or tear of biceps femoris, due to its attachment on the fibular head,will tend to draw the fibular caudally and have effects on the above mentioned joints but in the opposite manner of the distally distracted fibula.

    If these areas have not been addressed during rehabilitation of an injury there will be an effect on the peroneal group and the myofascia of the lateral compartment of the lower limb, as well as biceps femoris and the myofascia of the lateral and postero-lateral thigh.

    Hope this helps.

  12. kevin miller

    kevin miller Active Member

    Paul. Et al,

    I am short of time, but this conversation has turned to my love and course of research - as Paul knows. I would ask all who are following this thread to think WAY outside the box for a moment. When I decided that STJ theory had validity but was missing some important points, I did as most would do and went to the Pod literature. Folks, the entire profession has been so focused and narrow sighted that they have missed the obvious. Other science fields have done the work for us, but we were too busy trying to prove something that we didn't let the truth reveal itself to us. (How 'bout that one, Paul)

    Consider - and please don't make me hunt the articles down unless you really want to read them. Thay are in a huge stack waiting to be filed and ordered. For verification at this point, Paul has seen them, so maybe he will vouch for me. Here goes: Limb length discrepancy is normal. The body, a Tensegrity mechanism which uses gravity to its advantage to remain at its lowest energy level and remain efficient, did not - until the last few hundred years - have ANY evolutionary pressure to shoot for symmetry. In fact, the Hox genes that determine limb length are bilateral and answer to different enzyme "switches." One anthropological theory suggests that asymmetry was an advantage in a tripedal, knuckle walking, inter-stage prior to fully upright gait. Walking on constantly varying and uneven surfaces negated any LLD. What was important was force transfer to the spine . There was a study done where each individual did a gait test barefooted and in various durometer heels within shoes. These intrepid fellows had force transducers implanted in their spinal disks. No matter the durometer of the shoe, the impulse that made it to the spine was close to the barefoot baseline. Meaning what? The spine, in order to operate efficiently within the gravitational field, required "X" amount of force impulse from heel strike. It got it, no matter what. The moral? Cushioned shoes make your back (read that as kinetic chain, as it is a Tensegrity mechanism) work harder. Here is something else to consider: Any flexible rod, bent into an "S" shape, flexed laterally, will rotate on its long axis. For those of you who have often wondered why our paraspinals aren't any bigger than they are, considering the work we ask them to do, here is your answer. Again, following physics, the mechanism got the most bang for its buck. A little lateral flexion causes pelvic rotation so that you can get one foot in front of the other. The other curves provide counter rotation so that the head can remain upright and centered. (Think vestibular mechanism here) The little intertransverseri muscles have no great lever-----but they are full of muscle spindles, giving us some insight into spinal function. Both mechanically and neurologically, the spine is the master. You can't even open a door knob without a bunch of little paravertebral muscle spindles firing of. (The door knob has momentum, your hand, connected to the arm, connected to the floating, large articulating scapula, connected to about 2/3 of the spine directly, created enough force to overcome that door knob's momentum without you even feeling you center of gravity shift.......meaning that your COM's momentum was precisely countered by the contraction of a multitude of muscles.

    Here is a bit of trivia to set you mind a-whirl. We have gait patterns built into our spine. That, along with other proprioreceptive actions account for several lamina. (At least part of their function). The cerebellum has more cells than the rest of the brain put together. The basal ganglia and their counterparts are responsible for smooth motion. The upper cortex gives up a sizable portion of its volume simply to control where you are going. i.e., I would bet that 85% of your CNS has something to do with gait. (Don’t forget that vestibular system and acoustic centers - those things that take over for a blind person - which means I forgot to mention the eyes. Why is this? Because the principle purpose of any organism is to reproduce, and if the organism is one of those who produce relatively few offspring, to raise the offspring to breeding age. This is the difference between a Salmon who swims up river, does the nasty, and dies vs. the Bear that eats them and shows her cubs how to do the same.

    And what, pray tell, did the first bipeds require to exploit their environment - which essentially became everywhere with the increase in cranial size that allowed him to begin manipulating his environment, rather than be a slave to it? An operational FOOT

    Now, a Tensegrity mechanism is in constant flux. Since we have established that the spine controls it all via the CNS, then we begin to understand the importance of why foot function - the ability to transfer force in the proper amounts, at the proper time, were so important to our 5000yr old ancestors (Need another piece of trivia to support this? All bi-peds and pseudobipeds - birds like ostriches, etc., all have those little intertransversari muscles, full of spindles and so weak that they couldn't laterally flex the back alone unless you were falling down a hill, all get scoliosis if the intertrasversari are cut or, more importantly for our treatment of "idiopathic" scoliosis, force is not transferred through them.) Another hallmark of a Tensegrity system is its ability to adapt to changing conditions. What if Uga, the cave man, sprained his ankle and he could not establish another way to walk via biomechanical adaptation? He either starves or gets eaten. What if he sprains his ankle while the bear is after him? Both the spinal cord and the brain (reticular formation) tells him; "Everything is just fine, RUN DAMMIT!!" But even then, the entire kinetic chain from that ankle to the opposite shoulder, the head---everything, made adaptations to keep him alive to ---breed. How extensive is this adaptive mechanism? Consider the injured soldiers you have seen or car accident victims - use our imagination. Until the basal ganglia or the cord, or the cerebellum go, the kinetic chain will figure out a way to walk. It won't be as efficient as it once was, but the organism is still moving, exploiting the environment to stay alive and-----breed. (And raise the young) What happens, though? At some point, all these adaptations add up and other problems show up...like maybe back pain or something like that. But as long as the individual can move, even some of that can be overcome. (What does the big football player with the "bum" knee do? He runs until it stops hurting...thank you reticular formation, which sends fibers almost all the way down the spine. It only needs to go to L2 anyway....no more cord after that.)

    Anyway, back to reality, and to a point made earlier. What have we introduced that counters EVERYTHING I just wrote about? Flat, hard, not varying surfaces..... All of the things that were evolutionary advantages for Uga become our bane. We all have an LLD. We all have one clavicle longer than the other. We have these differences because they were not selected against. But what happens to any soft tissue asked to do repetitive motion -endlessly - non stop. It fails.

    Our foot, the gateway of the force impulse to the spine, the organ (maybe) that determines the force amount and timing that the spine has to work with is NEUTTERED! How long does it take for collagenous tissue to permanently deform under sub-tearing threshold stress? About 20 minutes. Have you every worked all day long and had you feet sore and tired at the end of the day? Who hasn’t? At what age does this start? I would ask, what body weight to collagen strength ratio we must meet to see failure. That is, a young fat kid that plays video games all day will tear up his foot much faster that a kid in shape, who stresses his collagen enough to strengthen it. Anyway, what happens when all of this soft tissue begins to fail? Why, the bones SHIFT to the edge of their congruency “sweet-spot” and hang up. Anything past that is a Charcot foot. (Pardon the slight exaggeration.)

    For 40 years, or however long we have been studying foot function, we have been norming pathology. How could we avoid it? That is why manipulation is so vital. Here is a prediction…..in the next few years, as more and more people learn to “fix” the foot instead of “prop it up” with a bi-planar post, researchers will figure a way to hold the foot in the “fixed” position and finally we will see some normative data. So, Hail Ye Who Manipulate.

    Cheers, cheers,cheers,
    Kevin Miller
  13. Kevin

    Wow! That made my head hurt and I guess I'll have to go over it a few more times just to try and grasp the concept. Most enlightening! I asked the question regarding the superior tib/fib joint as I currently have a patient with severe foot problems that pose quite a challenge. She is a middle aged lady with debilitating sesamoiditis, mid tarsal pain and post tib dysfunction. Clinical examination shows STJ pronation and nil ankle dorsiflexion, and in addition she also has painful medial knee pain.

    I did a video gait analysis with her last week and sent this out to some colleagues for their opinion - and one commented that he thought she had a "locked" sup tib/fib joint that required to be manipulated before she would be able to achieve anything like normal ankle ROM. Over the weekend I had her doing stretching exercises to no avail - in fact she reported an increase in her knee pain and still achieved no measurable ankle dorsiflexion.

    However, this afternoon I booked her a session with our osteopath who manipulated her superior tib/fib, calcaneo-navicular and calcaneo-cuboid joints in a 40 minute session and quite amazingly I now have her walking with good ankle dorsiflexion and no knee pain whatsoever. I'm using a 2-5 forefoot pad with a medial heel wedge to relieve the acute symptoms from her sesamoiditis and obviously will have to stabilise the foot with a similar prescriptive device, but I am surprised just how much progress she has made from just one session of manipulation. Early days I know, but there seems to be more to this than some give credit for.


    Mark Russell
  14. musmed

    musmed Active Member

    Dear Mark

    A very good question and here is my reply.

    The body has 4 major circles. They are:
    - the pelvis
    - the jaw
    - the radio-ulnar complex
    - the tibio-fibular complex
    Only the pelvis represents a circle in a 'maths' sense.

    You cannot break a circle in one place. How many times have you read the quote or heard the quote, "he hit me and broke my jaw and he broke it oin two places!".

    Those who have two breaks are lucky. There has to be two injuries and if the bone is broken only in one place, the TMJ must suffer on one side.

    Now the superior tib-fib joint is prone to being jammed up high and posterior on the right side. Why?

    Most of us drive cars with the right foot on the accelerator. Here the mechanics are the knee-thigh does not move only the foot (most) tib-fib (very slightly).

    When driving the quads are acting along with the hamstrings to stabilise the knee's position for driving.

    The quads are not going to pull up the patella but the biceps femoris can pull the superior tib-fib joint up and posteriorly. This is extremely common finding when I check this joint. It is part of the ankle, the other end of the circle.

    To try and push the superior tib-fib joint down can produce an easy 9-10 pain and over 90% of the time the patient does not know it is there.

    An aside: the joint can refer pain to the middle of the knee (from mild to debilitating) = failed arthroscopy. They are out there.

    Say we have a right joint that is pulled up and posterior (stuck in this position), when you invert the right ankle and then compare it to the left (say it is normal) you will have a reduced motion.

    This superior locking may also have a small to a major effect on passive dorsiflexion. The biggest effect on dorsiflexion was seen when I was In Perth teaching with Shane Toohey. One of the podiatrist had a 10+ degree increase in passive dorsiflexion after just mobilising this joint.

    The biceps femoris will be short on length testing.

    This is a common finding in sportspeople who have the "tricky ankle" or the "ankle that I go over on all the time”.

    Basically it is the second injury to the circle. Very often the lower tib fib joint is the one who complains and gets all the treatment, while the upper one is the problem (no complaining) and gets nil. One must look at all the joints of both ankles and feet.

    Here is a good example. I consulted with a woman (whom I last saw in 2000) on the 29 April 2006.

    In 2002 she injured her left ankle. The injury was: she is overweight primary school teacher who was ascending several steps when out of the corner of her eye she saw a child’s lunch on the steps and she set about to avoid standing in it.

    In doing this she inverted her left ankle and then stumbled down two steps with her foot and ankle in this position. Immediately she had pain over the lateral ankle into the lateral foot.

    Mrs. X has kept a VERY detailed record of all her treatments.

    She has seen three orthopaedic surgeons.
    Two foot surgeons
    Her GP
    A rheumatologist.
    Three MRI’s. I can never understand why they do this. The chances of the second finding something the first has missed is almost zero, so why the third? The only thing I can think of is she is on workers’ compensation!
    Two CT’s
    Two sets of X-Rays
    Two ultrasounds. The second using an 18MHz probe. These are fantastic for seeing perioesteal fractures than CT and MRI have missed. All were reported as normal.

    All up about 3500 Aussie dollars!

    She has had over 200 treatments to her left ankle performed by many different people.

    The Compo people want to medically retire her. She has lost over 18 months of work due to the pain. She wants to work as she is 52.

    She was using a walking cane and had a pronounced limp with a slow antalgic gait.

    I asked her if she had had any treatment to her left ankle. Answer NO

    I asked her if anyone had examined her left superior Tib-fib joint answer NO.

    Mobilisation of the left ankle (quite hypomobile) her right ankle was loose+++ due to all the treatment except for the inferior tib-fib joint. This was the area of her pain.

    Upon attempting to mobilise the superior tib-fib joint, I scraped her off the ceiling. A 10/10 pain produced with an extremely gentle pressure. Lots of heat and extremely gentle mobilisation over 10 minutes or so rendered her 4 years of pain and dysfunction to her left ankle gone.
    As of last week she was still pain free and back at full time work.

    Lesson: One has to look at the whole circle, and never assume that the other lookers actually looked or knew where to look.

    Hope this helps.


    Paul Conneely
  15. musmed

    musmed Active Member

    Dear Davidh

    I agree that the STJ works optimally around its neutral position.

    The operand in this statement is, "its neutral position".

    The subtalar joint I feel is always in "its neutral" because its position is determined by resultant forces produced by all the other joints and forces applied to the ankle and foot from moment to moment.

    Muscle tone also plays a major part here. Tone (whatever it is) changes from moment to moment and just using this factor alone (forgetting everything else) can have a dramatic effect on "neutral".

    Thus subtalar joint neutral is never static it is dynamic as it should be, provided the joint is mobile on both sides of the joint.

    The subtalar joint is a joint that seperates the two foot components. That is the standing foot and the walking foot and thus the 'subtalar joint neutral' represents the results of the forces applied to the two sides of the joint, the standing foot from below and the runnin/jumping/walking/etc foot from above.

    When this joint is dysfunctional, coronal plane motion of the foot cannot be produced and thus abnormal forces are applied to the spine and in an attempt to reduce the abnormal foces the individuals gait changes. This is classically seen in the externally rotated foot with the resultant foot/knee/hip/pelvic/spinal changes in motion.


    Paul Conneely
  16. musmed

    musmed Active Member

    Dear Mark

    You are lucky you head only hurt! by reading Kevin's notes. Wait till you hear the lecture!!

    To the lady you mention.

    I see these results constantly. They are easy to learn. Practice is the answer.

    Regarding the sesamoiditis.

    As your osteopath does he know of Jones' strain counterstrain technique for sesamoiditis.

    This is an extremely simple technique to perform on "Jones' Point" of the sesamoid. It takes 90 seconds with a resultant 60-80% reduction in pain then and there with total resolution in three days.

    If he does not know this technique, leet me know and I will post it on my website.

    I use it several times a week. I assume every woman who has been in a rear end motor vehicle collision has this problem wether they know it is there or not.


    Paul Conneely.
  17. davidh

    davidh Podiatry Arena Veteran

    Hi Paul,
    This makes much sense to me, as does the statement by Kevin Miller that limb length difference is normal.

  18. musmed

    musmed Active Member

    Dear David

    This is from left field, but....

    The body is supposed to be symmetrical for good outcome. but.....

    There has been an experiment where several men, both symmetrical and non symmetrical ( this means the face is not vertical, bigger/smaller boob/fist/foot etc) spent 4 days getting a sweat up = no one washed etc so that their sweat shirts were exactly that. They stank.

    Now in come thre women to sniff the shirts. They were asked to pick the best male for themselves.

    The first time they had not to be ovulating. Results no differences.

    When they were ovulating they could sniff out the symmetrical from the non symmetrical males. Basically we are doomed!

    Trick is to get a good bird when they have a sinus attack!

    There is evidence that the divorce rate has a direct relationship to those on the pill at the time of being wooed. Once off the pill divorce occurs because their attraction sense whatever this is is lost by being on the pill and they would not have married the bugger in the first place.

    There is no risk the Y chromosome is under great risk. Unfortunately the body that holds it is also under the same conditions!!!!

    There is also a direct correlation between their (hers) immune system and the partner they pick,again the pills buggers this.

    Maybe this is the reason why asthma is so common in the so called clean world???

    Enjoy while you last.

    Come and help me build this concrete bunker!!

    Regards in our misery... ACHOOOOOOOOO!!!!

    Paul Conneely
  19. Paul

    Could you explain?

    Mark Russell
  20. Bob Woodward

    Bob Woodward Member


    I went to your website and found the link. I will try it with my next patient that presents with irritated sesamoids. Do you ever do workshops in North America, particularly in Canada?

    Last edited: Jun 1, 2006
  21. musmed

    musmed Active Member

    Dear Mark

    I hate this question. Even Jones' could not explain it. When asked what is a Jones' point he would say a Jones' point is a Jones' point only when you can turn the pain off using the technique required for that particular point.

    There is over 200 of them from head to toe.

    These tender points (as they are called- they can be blindingly tender when palpated with an extremely light touch).

    They occur most commonly where tendons or ligaments join or cross bones.

    In a nutshell, the pain is in the agonist while the antagonist has the problem.

    Eg. You crouch down to do some weeding. You have been there for 25 min or so. The phone inside the house rings, you suddenly stand up and develop severe disabling back pain - you freeze. This happens all the time.

    Hang on, back pain. The erectors have been on stretch, but the psoas has been placed on the slack. This causes the muscle spindles to turn off. With the sudden standing up they fire like crazy to shorten to protect the spine.

    But the contracting erector spinaes spindles are firing also. Competition occurs and the erectors feel the pain when in fact the psoas is the problem. Thus the muscles are reporting a strain when none exists. It can be then can become a lifelong problem.

    If you place these people back into the shortened position (most of these people sleep with their knees bent and get out of bed at 90 degrees but find they now have to stand up. Back pain, +++). It is the psoas all along.

    so if the muscle is shortened held there for 90 seconds and then slowly yes SLOWLY returned to its neutral position, the pain goes.

    The same applies to the sesamoid bone. Very often the position of no pain when the sesamoid is compressed is great toe joint distraction, external rotation and extension. Every thing that will put the fl. hall long on stretch, ie you have shortened the ext. hall. longus the problem.

    Seeing the method performed and the results then and there is something to behold. The pain may have been there for many a year. This is another classic thing about Jones' points. They resisit all manner of therapy including steroid injections. They only respond the Jones' technique due to the agonist antagonist relationships. I do not know of another 'treatment' form that does this so successfully.

    Hope this helps

    Paul Conneely
  22. musmed

    musmed Active Member

    Dear Bob

    Good to see you visited my website.

    The main thing when one performs any Jones' correctionsis that you need feed back from your patient. Once they say the pain ahs gone, do not move at all.

    After 90 seconds, very slowly return the toe to neutral and retest.

    A good trick is to get them talking prior to you testing the toe. if it is still blindingly tender they will stop talking but most continue on, when challenged about the spot you usually get the replies that, 'you are not on the spot' or 'you are not pushing as hard' etc.

    Get them to see if they can find it. Usually they just look at you with a blank look.

    Bob, I have posted a private email on podiatry arena for you.

    Paul Conneely
  23. kevin miller

    kevin miller Active Member

    Hey Mark, Paul, others,

    Glad I could be of some help. There are plenty of detractors out there, I was once one, but we are just beginning to learn how the foot works. For instance, did you know that there is a little "sling” ligament between the lat cun and the cuboid that prevents hyper rotation (medial) of the cuboid? I have only found it in the first 5 cadavers I have looked at, so it could not exist in any others, but I doubt it......if there were only time to publish. (The whole series is called the intercuneiform ligaments. I can find very few references to them and fewer on their function, which seems to be up for debate.) Pick up you best foot model and look at the STJ. See the facets? Now try and make then all congruent at once. Now, congruency that I am speaking of is that which allows maximal, efficient force transfer through the joint. I.e., it must be maximally congruent. I've got 6 sets of dry bones and a bunch of cadavers, and I can't get any of them congruent. But if I make the posterior facet congruent while I simulate heel strike...that'll get me force transferred to the spine. At mid stance, I can get the anterior facet congruent - this would also match Bojsen-Moller's High-Gear position. Again, good transfer. At toe off, the ant-med facet lines up nicely. Again, I have not done enough of this to be conclusive or feel safe publishing or speaking outside of casual conversation. I may be running into anomalies. But if this the norm, what does it say about searching for the STJ axis or axes? If this turns out to be true, then the axis depends on the surface. Any foot that can get a constant axis in is either on perfectly flat ground or already torn up. It's nothing short of heresy, I know, but if you have read "The Spinal Engine", by Gracovetsky, haven't you ever wondered how the spine gets an impulse to "fuel" it after heel strike? This could be the explanation, and I stumbled onto it trying to glue a foot back together so I could x-ray it!! SO much to learn so little time to confirm..........

    Kevin M
  24. musmed

    musmed Active Member

    Dear Kevin

    This is fascinating to say the least. These discoveries you are making are the best examples of applying microanatomy with applied biomechanics.

    I can see your work as the starting point of a whole new way of looking at the human kinetic chain.

    Do you think these lateral sling ligs between the cuboid and lateral cunieform bones is what changes sagittal plain motion to become transverse-or-frontal plain motion thus allowing forces from the gastroc/soleus/biceps/stored energy be applied to the medial foot and thus get us to coronal motion that the spine longs for?

    If so, then applying a cuboid scive would decrease the actions of normal and abnormal foot motion?

    Keep up the good work.

    Paul Conneely
  25. kevin miller

    kevin miller Active Member

    I hadn't thought about it like that, but we do know that the sooner the LCNC joint complex (lat cun, nav, cub) "locks up'" the quicker the medial and lateral column begin acting as a unit. In fact, stabilizing the LCNC complex will STOP pronation in its tracks. So, when angular acceleration is create/increased by a stable met head parabola, (in low-gear walking, if you followed the Bojsen-Moller’s thread), then there is more momentum to be turned into vertical lift at COM transfer. When that angular momentum hits the 1st met with its two sizeable sesamoids, the COM is lifted to stored energy to be used by the spine in its function. That is why, despite what some folks teach to the contrary, the met head parabola both exists and is needed. Does that mean you find it in everyone? Certainly not! Patients with severe pronation, Post Tib syndrome, or Charcot foot may have their mets in a straight line - the same can be said for acquired hypo mobility, so look around and see if you don’t notice this – I’ll bet my hat you see more than you expected.

    Kevin M
  26. musmed

    musmed Active Member

    Dear Kevin at al

    Thanks for that.

    So may I add if one is walking say round 2m/sec the calcaneus motion is to initially lock the cuboid in anticipation for stopping and then continues to cause the cuboid to internally rotate (is itself rotates everts) and thus via the sling motion transfer some forces medially but not enough to give a spring in the step, ie full fl. hall. long function.

    When you increase speed the lateral side of the foot is more likely to contact the ground earlier (just watch rubgy players feet when running for the tryline The backs wear very flexible shoes) thus eliminating the stopping sequence of walking and more force across the sling is applied and the LCNC complex is accelerated into action causing quicked mid cunieform locking and more explosive use of the fl. hall longus and thus the foot develops rotational forces more quickly and efficiently.

    How do you feel about this idea?

    Paul Conneely.
  27. kevin miller

    kevin miller Active Member

    Paul wrote: So may I add if one is walking say round 2m/sec the calcaneus motion is to initially lock the cuboid in anticipation for stopping and then continues to cause the cuboid to internally rotate (is itself rotates everts) and thus via the sling motion transfer some forces medially but not enough to give a spring in the step, i.e. full fl. hall. Long function.

    When you increase speed the lateral side of the foot is more likely to contact the ground earlier (just watch rugby players feet when running for the tryline The backs wear very flexible shoes)

    I Don’t know Paul. I think we will get into trouble saying that calcaneal motion is to lock the cuboid. I think it’s more appropriate to say that the lat cun locks the LCNC complex so that the synergy of muscle, tendon and bone can most efficiently and at the lowest energy level shift the com from one foot to the other while getting maximum lift of the cog in the gravitational field so that the back can function efficiently as well. Also. I think the “walking on the side if the shoe” by the rugby player when they speed up may be an illusion created as their gait phase narrows. When shifting to Bojsen-Moller High Gear, the gait phase (the sin function shaped pattern of the com demonstrated by the f-scan, etc.) narrows so that the parabola of the foot is no longer used to created angular momentum, which is then converted to vertical motion by the first ray. The increased velocity of the com is enough to lever itself over the 1st ray and raise the com in the gravitational field without any help. Does that help? Or did I misunderstand the question/statement?

    Cheers, cheers, down under where it is cold,
  28. musmed

    musmed Active Member

    Dear kevin

    Hi, we have had the wettest day for a year and the coldest for 10! They say it will last a week or so but it is not raining in the catchment areas. It just does not rain there any more.

    Some of your answer is yes and so no.

    I think i step motion is: stop -motion-stop, but if we continue we have stop-motion-prepare to stop - motion.

    but when we increase speed: motion-about to enter stop but continue on to- motion.

    Try this little one. Say the left one. Manipulate a foot (in your case a living one), turn them on their tummy.

    allow a little dorsiflexion say 5 degrees and rest the toes on your chest.

    with your left hand hold the calcaneus

    with your right thumb and index fingers grasp the cuboid.

    see if it will internally rotate, change the angle of dorsiflexion to almost neutral when the cuboid will move.
    Now very slowly evert the calcaneus while trying to rotate the cuboid, eventually calcanean motion stops it.

    continue very slowly everting the calcaneus, and bingo the cuboid will move again.

    Let me know of your thoughts on this.

    Regards from wet and cool Sydney

    Paul Conneely
  29. dingo

    dingo Member

    can anyone please tell me how I can access courses/ literature/ information relation to the area of mobilisation/ manipulation techniques speciric to the area of podiatry, Cheers.
  30. musmed

    musmed Active Member

  31. dingo

    dingo Member

    Dear Paul, I have just been onto your website and I see that you are doing a course in Glasgow in August of this year. I live in Scotland (Edinburgh) and was wondering if you would be any courses in scotland in 2007.
  32. TedJed

    TedJed Active Member

    Foot Mobilisation Techniques (FMT) Courses will be conducted in England in April 2010.
    Further information available at www.footmobilisation.com
  33. Michael David

    Michael David Welcome New Poster

    Foot and ankle manipulation, been doing it for years, it has fantastic benefits for the patient.
  34. TedJed

    TedJed Active Member

    So why are so few podiatrists using FMT in their practices? Why isn't FMT part of undergraduate training?
  35. musmed

    musmed Active Member

    Dear Ted

    Medicine takes forever to change.
    The great discovery of circulation by Willian Harvey took 100 years to beleived.

    Initially he was a heretic and was to be cooked at the stake but took refuge in the church just around the corner from the tower in London. His name i on the honour roll there.
    he then left and spent over 20 years in the catherdral at Hexam near Newcastle. again his name is inscribed on a major homour roll in the main catherdal.

    He had to do this to survive. Lucky we do not live in the same society, or do we?

    Nobody wants newthings because simply put, you then have to learn something new that takes TIME.

    The real hurdle is that you have to convince the kings and queens at the top of the list, and as you well know it is almost impossible to get an appointment, so basically nothing has changed.

    Paul c
    36C here today in Sydney, 42C tomorrow.
  36. Michael David

    Michael David Welcome New Poster

    [/QUOTE] here today in Sydney, 42C tomorrow.[/QUOTE]

    Well that's made me envious!!

    Foot and ankle mobilisation/manipulation techniques are taught at undergrad level by Osteopathic colleges, not sure about Chiropractic though. My experience is that these techniques are a powerful adjunct to orthoses fitting either prior to the device assessment or as a great patient adjustment mechanism post fitting. On occasion it can circumvent any device at all.
    IMO Podiatry colleges should at least include rudimentary articulatory techniques not only as an assessment tool but as a treatment modality. The rest could easily be incorporated into a postgrad course.
  37. musmed

    musmed Active Member

    Dear Michael
    you can some of the heat free, no charge, for NIX!

    I agree with you that the mobes should be taught as part of Podiatry.
    I feel that these techniques should be taught as part of undergraduation not post graduation.

    Over the past 10 years of teaching mobes all over the place to over 700 pods, the common statement made by them is 'why do they not teach us this at uni?'

    Paul C
  38. Tom Brett

    Tom Brett Member

    Dear FMT Forum

    I have read for the first time the threads and postings on FMT. I have a question, which relates to the law.

    FMT seems to be developed from the work of John Martin Hiss, who was, according to my information, an osteopath and an orthopaedic surgeon. Both disciplines employ manipulation with the difference the former manipulate the conscious and the ortho's manipulate the unconscious. It would follow that de facto the techniques used in FMT are osteopathic.

    FMT (Foot Mobilisation Techniques) should, according to the description, be applied movement within the physiological range. However some of the texts and videos on FMT show manipulation, which is beyond the physiological range into the paraphysiologal and hopefully within the anatomical barrier.

    If FMT is only mobilisation there should be no legal problem. Should FMT include applied movement into the paraphysiological range practise and teaching could be in breach of statutory law in various jurisdictions.

    In Western Australial I believe the statutory act is the OSTEOPATHS ACT 2005.
    S 82 Persons who may practise osteopathy
    A person must not practise osteopathy unless that person is a registered person.

    In the south of Australia I believe the statutory act is the CHIROPRACTIC AND OSTEOPATHY PRACTICE ACT 2005.
    S 37 Restrictions on provision of chiropractic or osteopathy by unqualified persons.
    (1) A person must not provide restricted therapy unless -
    (a) the person is a qualified person;
    (7) "qualified person", ... ... a person authorised by or under this Act ...
    I believe only a osteopath or chiropractor can provide the therapy or a person exempted by the Governor by proclamation.

    Just so there is absolutely no doubt whatsover in the statement of law
    (7) states at
    (a) the manipulation or adjustment of the spinal column or joints of the body involving a manoeuvre during which a joint is carried beyond its normal physiological range of motion ...

    I believe that exemptions exist for medical practitioners and physiotherapists.

    My question is
    Are podiatrists exempt from this proscriptive piece of legislation in Australia?

    In England similar Acts have been passed. Breaches under Osteopaths Act 1993 have attracted fines of up to £27,000 plus costs.


    Tom Brett DO BSc(Hons) LL.M
    Clinical Manipulative Therapist, Master Bonesetter, Master of Laws and Podiatrist.
  39. David Wedemeyer

    David Wedemeyer Well-Known Member

  40. TedJed

    TedJed Active Member

    This is an interesting issue Tom.

    I believe this stemmed from perceived dangers to the public associated with spinal manipulations. (There is as yet, no empirical evidence to suggest spinal manipulation is hazardous to the public.)

    How medical practitioners (who receive no practical undergraduate training in spinal manipulation in Australia) get exemption is a testament to their lobbying power I guess...

    It's interesting Tom that you have chosen to not refer to the legislation, guidelines and references that specifically apply to podiatrists.

    In Australia, the Podiatry Practice Act 2005 defines podiatry as;

    The key adjective here is 'therapeutic' which is defined as;

    The Act also states that

    The Podiatrists' procedural terminology of the Australasian Podiatry Council lists services defined under the heading of 'Physical Therapy' which includes the national Item Code

    In the UK, the 'HPC Standards of proficiency for podiatrists'
    http://www.hpc-uk.org/assets/documents/10000DBBStandards_of_Proficiency_Chiropodists.pdf section 2b.4
    also defines the practice of podiatry to include;

    A key adjective here is 'appropriate'. If a podiatrist was performing a spinal manipulation to
    then I believe they may be in breach of said statutory laws.

    I note you quote;

    Unless a podiatrist declares themselves to be a chirporactor or osteopath or practising chiropractic or osteopathy, there is no relevance in this Act for podiatrists. Podiatrists are governed by the Podiatry Practice Act and must abide accordingly.

    Physical therapy is clearly part of podiatric practice. Why podiatry practice would be subject to the Acts of Chiropractic or Osteopathy does not seem logical. I understand you are basing your deductions on one definition of manipulation but I find this a rather long bow to draw.

    I wonder if the public benefits in any way from precluding podiatrists to practice physical therapies. Is this what you are proposing?

    As you are a practitioner of Manual Therapies, I would expect you would be supportive of podiatrists improving their skills in the field of Physical Therapies as indicated on your website;


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