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Foot Pronation, Cranial Bones, Headaches - Are They Linked?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Oct 1, 2013.

  1. Brian A. Rothbart

    Brian A. Rothbart Active Member

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    Foot Pronation, position of the cranial bones and the development of headaches - Are They Linked?

    On May 20th, 2008, in a thread (on this Podiatry forum) David Simons MD (co-author of the preeminent textbook on trigger points, myofascial pain and related dysfunctions) wrote:

    "The association between your observations [abnormal foot motion changing the facial dimensions - Rothbart BA 2008, JAPMA] is no surprise to me. What is not clear is the chicken and egg relationship. [That is,] Are they both the result of a common cause or does the foot influence facial proportions....."

    It saddens me that Dr Simons did not live long enough to read my radiographic study published in the October 2013 issue of Cranio - Craniomandibular and Sleep Practice (the dental journal on craniomandibular orthodontic interventions). On of the purposes of this current study was to determine if insoles could affect the position of the cranial bones and/or atlas. Below is the abstract of my paper which is available online at http://www.Cranio.com.


    The purpose of this Series of Case Studies was to determine if the frontal plane position of the cranial bones and atlas could be altered using dental orthotics, prescriptive insoles, or both concurrently.

    Methods: The cranial radiographs of four patients were reviewed in this study. Three of the patients were diagnosed as having a TMJ dysfunction and a PreClinical Clubfoot Deformity. The fourth patient was diagnosed as having a TMJ dysfunction, a PreClinical Clubfoot Deformity and a Class II Sacral Occipital Subluxation.

    Each patient had a series of 4 cranial radiographs taken by a board certified D.C. radiologist in atlas divergency, using a modified orthogonal protocol. The first cranial radiograph was taken with the patient using neither the dental orthotic nor proprioceptive insoles were used (baseline measurement). The second cranial radiograph was taken with the patient using only the dental orthotic. The third cranial radiograph was taken with the patient only using the proprioceptive insoles. The final cranial radiograph was taken with the patient using both the dental orthotic and proprioceptive insoles concurrently.

    The degree of change in angle between the various specified cranial landmarks and atlas were measured directly off of these radiographs and compared to one another.

    Results: In two patients, improvement towards orthogonal was achieved when using both prescriptive dental orthotics and prescriptive insole concurrently. Improvement towards orthogonal was less apparent when using only the prescriptive dental orthotic. And no improvement or a negative frontal plane shift was noted when using only the prescriptive proprioceptive insoles.

    In the third patient, the frontal plane position of the cranial bones and atlas increased (away from orthogonal) when using the generic proprioceptive insoles alone or in combination with a prescriptive dental orthotic.

    In the fourth patient, the frontal plane position of the cranial bones improved using the dental orthotic. However, the proprioceptive insoles when used alone, or in combination with the dental orthotic, increased the frontal plane position of the cranial bones and atlas.

    Conclusion: This study demonstrates that changes in the frontal plane position of the cranial and atlas bones can occur when using proprioceptive insoles and/or dental orthotics.

    This paper provides compelling radiographic data demonstrating why we must be cognizant of the impact (both positive and negative) insoles can have on the cranium. For example:

    One of the patients in my retrospective study (patient A.D.) developed debilitating 'squeeze like' headaches several months following the successful use of insoles for her heel pain. (generic insoles purchased from an internet vender). She consulted several healthcare providers (including, if my memory serves me right, a neurosurgeon) in an attempt to isolate the cause of her ongoing headaches, with no success.

    During her initial evaluation, I ran a series of computerized tests and then sent her in for a series of cranial radiographs. The radiographs revealed an increase in the Pls (absolute sum of the planar line shift) while wearing her insoles (greater divergence from orthogonal) suggesting an increase in pressure between the cranial sutures.

    Removing the insoles from her shoes, immediately dissipated her headaches.

    Coincidence? Most likely not. On several occasions A.D. tried using her insoles again. On each occasion her headaches returned.

    For nearly a decade now I have suspected a link between orthotic intervention and cranial topography.

    Rothbart BA 2008. Vertical Facial Dimensions Linked to Abnormal Foot Motion. JAPMA, Vol 98, No 3.
    Rothbart BA 2006. Cranial lesions initiated by abnormal foot motion. Price-Pottinger Foundation, Journal Health and Healing Wisdom 30(1):6-7

    This current radiographic study demonstrates that link.

    Professor Rothbart
  2. Brian

    Attached Files:

  3. wdd

    wdd Well-Known Member

    It's a funny old word wanker. It seems odd that a word that describes the activity of nearly 100% of men and a rapidly increasing percentage of women can still be used as an insult.

    It's odd that a word that describes such an omnipresent natural activity can be used to describe such unnatural mental activity in one man.

  4. Admin2

    Admin2 Administrator Staff Member

  5. HansMassage

    HansMassage Active Member

    "Are they both the result of a common cause or does the foot influence facial proportions....."
    In my opinion based on clinical experience and X-ray measurement they both come fro pelvic distortion. Or conversely distortion in the foot or cranial alignment can profoundly require pelvic adaptation and influence the other end of the kinematic chain.

    Hans Albert Quistorff, LMP
    Antalgic Posture Pain Specialist
  6. Peter

    Peter Well-Known Member

    A case series of 4 doesn't provide compelling evidence. Academic researchers would barely blink at the evidence ( I would conjecture).
  7. Used strictly in its pejorative form. I think the Advertising Agency recently classed it as the fourth most pejorative term in the English language. If I could remember the top three I would have used them instead!

    It is terribly sad that an excellent academic resource like Pod Arena can be used by charlatans like Rhubarb to gain credibility not only for a sham product but a practice philosophy that rips off some of the most vulnerable people who have intractable medical conditions under a banner of cure-all for chronic pain and infertility. If anyone can suggest a more suitable moniker I would be delighted to amend my description accordingly.
  8. W J Liggins

    W J Liggins Well-Known Member

    My thesaurus does not give an alternative for 'wanker'. However, under 'Charlatan' it has:

    Imposter, Fake, Fraud, Swindler, Con Artist, Quack, Counterfeit, Pretender, and Sham.

    Please feel free to choose your favourite.

  9. Peter

    Peter Well-Known Member

    Mine adds mountebank and cheat. My Thesauraus must be out of date, it didn't have 'Rothbart' in it.
  10. My daughter understands the concept of, and need for, control groups in research, and she's 7.

    Bizarre that more accomplished people forget that very simple concept.
  11. wdd

    wdd Well-Known Member

    Maybe that's the word you need and it could possibly be defined as: one who finds all activities, acceptable, desireable and admirable that lead to personal financial reward

  12. I would add
  13. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Be patient - the October issue should be online within the next few days.

    Professor Rothbart
  14. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Actually Peter, you are wrong. Four cases demonstrating the changes radiographically is very significant.

    Professor Rothbart
  15. "In two patients, improvement towards orthogonal was achieved when using both prescriptive dental orthotics and prescriptive insole concurrently. Improvement towards orthogonal was less apparent when using only the prescriptive dental orthotic. And no improvement or a negative frontal plane shift was noted when using only the prescriptive proprioceptive insoles."

    Which suggests it's the dental orthotics that are doing the work, not the proprioceptive insoles. But really this study is not designed well enough to draw any conclusions.
  16. So the message is that to cure the headaches you need e30,000 worth of insoles... AND a dental orthosis?!

    That's beautiful.

    In other news, aspirin and sticking a pencil up your nose cures headaches (although the pencil alone does nothing) . Anyone who wishes to buy one of my magic pencils for £20,000 quid should pm me for more details.
  17. Sicknote

    Sicknote Active Member

    Is this sarcasm or are you being serious?.
  18. BTW, I just got back from a lecture tour in Spain where I was referred to as "Professor Spooner", this does not mean that I hold a chair at the University that I was lecturing at, it means that in Spain they refer to all lecturers as "professor". I believe it's the same in Italy where Brian is based.

    The "Professor Rothbart" is all just part of his shameless subterfuge. What a wanker.
  19. And showed significant change in the cranial radiographs after the orthoses were removed? If your intimations above were correct, that: a) the head-aches were caused by the relationships/ pressure between the cranial sutures and B) the removal of the insole resulted in "immediate dissipation of the headaches", then we should be able to observe immediate changes in the relationships/ pressure between the sutures with and without the insoles in situ. I should think this would be pretty easy to perform- x-ray patients head without insole; x-ray patients head with insole; observe changes in sutures; check for brain, Brian. I await this data. Except we cannot measure pressure between sutures (kinetics) from the positional data from x-rays (kinematics), right Brian? So by looking at radiographs we have no idea of the pressure.

    Rob, do you remember that published study of marigold paste in hallux valgus in which they used x-rays from different peoples feet to provide a deceit of the effect of marigold therapy?

    Did you do anything with that scanning software for microsoft kinect? I was thinking of giving it a blast now I have a little time.
  20. I did as it goes. There's some promising software out there actually. I was limited by the processing power of my laptop, which started to smoke and shake like a dog s***ing wasps when I asked it to render in 3d. But promising start for certain. I'll email you what I was using when I get chance.

    And yeah, this has startling resemblance to several bits of marigold research. And nail laser research come to that! Confirmation bias abounds.
  21. Poe's law made manifest.

    Deadly serious sickness. Would you like to buy one of the special pencils? Generally they're £20,000 but if you want one to do your own research with I'll let you have it for £50!
  22. Are you using this software: http://www.faro.com/scenect/ ? I'll buy a kinect sensor this weekend, do I need kinect for windows or will the xbox version plug into a windows based PC and work?- maybe we should have this conversation within the 3d printing thread...

    Craig, why does podiatry arena automatically parse the word "kinect" to a hyperlink?
  23. Nope, I've been playing with brekel kinect and Skanect 1.5 for body scanning and 3d object scanning respectively. I can scan a whole body in 3d, but I only get 1-2 FPS (and you want about 30) so its a bit of a tease. Brekel also builds a skeleton in realtime based on articulations which is very cool.

    So far as connectivity, there are several versions of the kinect hardware, the earlier version (which I have) needs an adaptor to plug into a PC (bout a tenner) , the later one plugs directly in. You'll also need Python.

    Apparently its also possible to get a wiifit balance board to talk to a PC via bluetooth! There's a nice project there for a software developer with a bit of imagination.

    Its all very doable, if you have a computer which was not built back when they used wood in the construction.
  24. Cheers Rob, you got a link for the software? I'm generally an Apple man, but have a PC I run my CAD software on which has super duper graphics cards- but it runs XP, do you know if these things will run on XP? If not I'll have to burn the Mrs Laptop.

    Craig, maybe worth splitting this off to a new thread- "microsoft kinect for foot model acquisition"?
  25. Yes, apologies for the off topic stuff (although silly thread was silly to start with.)

    Skanect, I believe, needs windows 7 or better. Brekel and skanect run on xp.



    People who know tell me its the graphics card which is slowing me down so you should be fine. The trick seems to be to scan from a distance, but to calibrate the range on the scanner so it ignores everything but what you want. Barrels of fun.
  26. You scanning feet or casts or both?
  27. Feet. Clear early on that it needs images from several angles, which the computer stitches together. Also bodies. Cos, you know, its just really cool.
  28. Do you sit on photocopiers too? If you were scanning casts the low FPS wouldn't matter- right? I'm guessing you could cut the negative cast down to get line of site and put it on a slow revolving turntable to get full coverage.
  29. Easier to leave the casts still and move the scanner.
  30. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Just received notification from Cranio. Their October Issue will be available online October 14th.

    Professor Rothbart
  31. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Hi Hans,

    Several years ago I published a paper in JAPMA that statistically linked anterior rotation of the innominates bones to [gravity driven] pronation.

    On my research website (and recent publications) I present a Pure (theoretical) Ascending Postural Distortional Model initiated by abnormal (gravity driven) pronation:

    • Abnormal pronation linked to Anterior Innominate Rotation
    • Anterior Innominate Rotation Linked to Posterior Temporal Rotation
    • Posterior Temporal Rotation Linked to Cranial Distortions clinically observed in resulting facial distortions.

    I suggest looking at the most distal distortional segment when analyzing the Ascending Postural Patterns. In the presence of either the Primus Metatarsus Supinatus foot structure or the PreClinical Clubfoot Deformity, that segment would be the feet.

  32. Dananberg

    Dananberg Active Member


    I have no doubt that changes in head/neck posture can be seen with changes in foot orthotics, but the description you provided showed that the inserts provided created negative changes in ½ the cases, with the others being essentially of no consequence. How you can say that this somehow proves you contention is puzzling….to say the least.

    I can remember hearing you speak 20+ years ago at the American Academy of Pain Management. You commented that each year, 5-6 patients you treated ended up in the hospital as their entire bodies “ceased” and they required some fairly heavy medication to reverse this process. What happened to “an above all…..I swear to do no harm”? In the thousands of orthotics I made during my career, I can honestly say that no one ever ended up in the hospital. Sure, I had some outcomes that were not successful, but this is in no way comparable to what you described.
    It is likely time to give a hard rethink to your model. Going from Washington State to Mexico, and then throughout Europe one step ahead of the review boards gives one pause before selecting Rothbart Model as the one to use in treating chronic musculoskeletal pain.

  33. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Hi Howard,

    It has been a long time since we last talked.

    To answer some of your questions:

    Up until the early 1990s I was still an advocate of Root's Biomechanics. It led me down some blind alleys and created potential problems. One of the potential problems was that the biomechanical insoles I was using at that time (and published on in the American Journal of Pain Management), if used inappropriately, could cause harm. The cases you alluded to in your post, were patients that did not follow my specific directions - they did not break into the insoles as instructed. Instead, they wore the insoles 8 hours the first day - something you just never do when using devices that impact the entire body.

    Whether you choose to rethink my neurophysiological model or not is your choice. I can tell you that having my paper published in Cranio is a tremendous validation of my research.

    Your comment regarding 'one step ahead of the review boards' is erroneus and surprising. I never expected you to behave in this manner.

    FYI - Dr Joseph Addante is a strong advocate of my work. If you go on my twitter account you will see that he has endorsed my expertise in many different areas.

    Professor Rothbart
  34. Brian A. Rothbart

    Brian A. Rothbart Active Member

    All 4 patients in this study had TMJ dysfunction and a PreClinical Clubfoot Deformity. Both were impacting their health. Analysis of the radiographs demonstrated that foot or dental intervention alone can increase the frontal plane divergence of the cranial bones and atlas (clinically linked to exacerbation of their symptoms).

    This is why the Podiatrist must use due diligence and maintain a global vision (of the entire body) when using foot insoles.

    Professor Rothbart
  35. Then we'll have to await the full text, because what was posted at the beginning of the thread says fairly clearly..

    If the study actually shows that foot OR dental intervention ALONE can increase frontal plane divergence then its certainly not clear from the abridged version! It sort of says the opposite!

    Not that a 4 subject, uncontrolled trial would prove anything much even if it said that insoles alone DID affect the skull... which it doesn't.
  36. HansMassage

    HansMassage Active Member

    Earlier in this thread it was mentioned that Brian Rothbart was here in Washington state. During the latter part of his time here I started working for a chiropractor the was investigating his materials and advising him on what was and what was not working. His theory gave us a starting point to help people with what the chiropractor called bio-implosion. What we discovered is that clients were not theoretical but actual with individual and constantly variable needs.

    What we settled on was using a flexible base plate and adding and removing adhesive felt to assist the client in holding the ankle in neutral position as there skeletal alignment improved. Eventually if there was no deficiency of bone development no orthotic was needed.
  37. fishpod

    fishpod Well-Known Member

    start the music. oh the toe bones conected to the met bone the met bones conected to the ankle bone the ankle bones connected to the it goes on and on and on. i think you and david ike would be good mates . ps do you wear purple alot brian.
  38. Rob Kidd

    Rob Kidd Well-Known Member

    I know that we all type too quickly - I am first in the guilty list. However, the quality of grammar and general English here leaves one with a worrying thought - especially from someone who is supposed to be a professional.
  39. Dananberg

    Dananberg Active Member


    I have long made orthotics which impacted "the entire body", and have had many patients ignore my advise and wear them all day on the 1st day. I will repeat, that NEVER have I had any patient end up in the hospital....let alone 5-6/year.

    With a treatment with a potential to be injurious, how has your model changed over the years from the met primus supinatus and the posting you place under the 1st met head which would prevent it from plantarflexing? How has treatment changed in light of the potential for injury?

    As far as you stating that my comment of Review Boards was "erroneus and surprising", why exactly did you leave Washington State, and then practice/leave Mexico, and then Italy and then Spain?

  40. HansMassage

    HansMassage Active Member

    Sorry but I intended it as written. Rothbart expects all clients to match his theory but actual clients clients are individuals with variable needs. Therefore his standard insoles seldom met the needs of our clients. Particularly troublesome is the wedge shape under the first met which caused a lateral slide and increased the problem for most clients.

    I believe that the foot pattern the Rothbart claims as his own is often caused by a compensation for the head forward by swaying the back to bring the head over the feet. This unstable pattern causes a lifting of the toe to prevent falling backwards.

    As to the original question are they connected, I answer yes but Rothbart's insets did not prove to be the answer.

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