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Foot to jaw problems

Discussion in 'General Issues and Discussion Forum' started by drkeller, Oct 19, 2010.

  1. drkeller

    drkeller Welcome New Poster

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    Can anyone explain how a foot problem can lead into a jaw joint problem.
    what is the chain of events.

    thanks in advance
  2. :welcome: To Podiatry Arena.

    I can´t, still don´t see the link, but we looked at it in this thread http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=43566 if I remember correctly this thread has lots of links to papers which might help.

    ps If you work it out please come back and tell us.

  3. Growl....
  4. MCA

    MCA Member

    sagittal plane blockade from functional hallux limitus or ankle equinus can lead to forward tilt of the upper body when walking which inturn alters head, neck and jaw position
  5. No it cannot.

    Unless you can show evidence to the contrary. This is a logically sound theory, but it remains only a theory. That which is asserted without evidence can be dismissed without evidence. One could as well say that "overpronation" causes jaw problems by the rotation of the legs causing anteversion of the pelvis, lordosis of the lower back and associated change higher up. With the minor drawback that the evidence is still pretty vague at best, downright negative at worst, and does not show that "logically sound theory" to be "true".

    Moreover, the relevant question for us is generally, can orthoses therefore help with the proximal condition (jaw in this case). And that is ANOTHER quantum leap.

    Also, what time of day are we talking about? Will the patients jaw problems be affected by the diurnal variation which affects muscles, being more so when the equinus is more noticable?
  6. he he he he he he - I wish you get could bets on what posts would get which person to respond to.

    Just mention propropproception or STJ motion and the jaw, Roberts your guy :D:drinks:drinks:drinks

    ps I´m probably not that far behind !!
  7. LOL. You had me at "foot to jaw".

    We all have our little peeves.

    I think its exteroteroteroception though, rather than propropproception! ;)
  8. David Wedemeyer

    David Wedemeyer Well-Known Member

    can any of you access this study?

    Voloshin AS, Burger CP. Interaction of Orthotic Devices and Heel Generated Force Waves. Ninth Intl. Congress on Applied Mechanics. Canada, 1983.
  9. Rick K.

    Rick K. Active Member

    I constantly see foot to jaw issues - with all the times I or others put their foot in their mouth. It is why I was my socks in peppermint Tide.
  10. LOL

    Pretty sure this is NOT what Dr Keller had in mind


    Stand in short forward stance
    Chamber leg
    Rapidly extend leg, aiming to contact jaw with lateral / plantar forefoot.
    Jaw breaks.
  11. I bet the bloke on the right hopes that the bloke on the left hand does not punch forward in somesort of reflex action. Now what name would that reflex be called ?
  12. Its a while since I was an instructor but I think that was called "yo gooli crunchi"
  13. Sorry David have looked and it gets referenced alot but not go, I´m trying to get a copy of something else same authors maybe related - may be good for our S1-L5 discussions

    Nice :D
  14. footinmouth

    footinmouth Member

    Foot problem -> investigation -> treatment -> present my account -> jaw drops.

  15. musmed

    musmed Active Member

    Dear Team

    There is a linkage.
    In the 80's Crane's school of chiropractic used to talk about the eternal triangle:
    the Si Joint
    The TMJ
    The atlanto occipital joint

    If there is a problem in one another can be the symptomatic one. It is not uncommon.

    Secondly: Atatomy Trains by Myers worth a look.
    Finally tensegrity, but that would be mortal sin!

    Paul Conneely
  16. Did you know there is a direct link between the Auricularis (the muscle just above the ears) and the H wave reflex in the triceps surae? Thats why wearing glasses causes Severs and, conversely, stretching the triceps surae may releive Earache caused by tension in the auricularis (because this in turn causes tension in the lower portion of the typanic membrane). The visible symptom is caused by a problem elsewhere. I see this all the time in practice.

    Or it could all be so much excreta. That, of course, being my point. We can widdle in the wind, confidently stating what IS the case and hypothesising reasonable extrapolations of tiny nuggetts of dubious data, but the truth is without any kind of evidence, and ascending pattern wise we struggle to make it past the hips, one unsupported claim is much the same as another!

    Do you believe that wearing glasses causes severs disease now I've told you? Anyone?!
  17. musmed

    musmed Active Member

    Dear Robert
    The difference between you and me is that I do go from head to toe in treating patients. I am not a podiatrist but have a great interest in foot biomechanics and its role in the whole kinetic chain.
    I have spent a fortune going to different workshops all over the world over the past 30 years or so.
    I have musculoskeletal experience commencing in 1966 but there again mabe this is not long enough to see what I write about.

    Paul conneely

    ps regarding muscles: try an EMG needle into the left peroneal longus while contracting your right forearm flexors. Fascinating!
  18. I think you miss my point Paul. The question, for me, is the basis upon which one holds a position. 34 years it a lot of musculoskeletal experience to be sure, but even with that level of experience one cannot simply say "it is thus". There may be a link between function of the jaw and the foot, there may not. The point is, all we have is supposition, ideas, and unsupported claims. And saying it don't make it so. I can strap a firework to my back and call myself boba fett but that don't mean I can fly.

    Its not a question of whether one views the body holistically or not, its a question of the level of proof / rationale one requires to extrapolate a causal link between the internal kinetics of the foot and the internal kinetics of the jaw, neither of which are well understood, and what that link may be.

    Ok, try this one. There is evidence of a link (albeit shakier than a poodle crapping thumbtacks). I hypothesis that supinating the feet has a negative / harmful effect on the TMJ, that using it is akin to trepanning. Right area, little understanding, faulty assumption, harmful treatment. Is there any evidence to show my hypothesis to be weaker than the one which shows benefit to the patients overbite from orthoses.
  19. musmed

    musmed Active Member

    I like your thoughts, but I must say one may never prove anything using modern criteria.
    What ever happened to grandma used this and that and it worked.
    Just try using naphthelene ball in the bottom of the bed for night cramps. It either works or does not.
    I can guarantee your patient will tell you they went away for the weekend and spent all night up with cramps because they forgot the goods.

    You will never have data that stands up, but it works.

    Experience leaves many things for dead.
    Like I saw a report from an eminent surgeon stating that a man had multilevel spinal degeneration disease.
    Since when is getting old a disease? He obviously believes it and the insurance company is happy to read this as it makes his case harder to prove it is due to his work related injury lifting 80KG.

    I always like to use the old case," what controls the tides?', everyone will yell, 'the moon'.

    It is like back pain 80% of people will spend at least one day in bed from back pain in their lifetime so one can tie anything to back pain including the post on foot position.

    I await the day they remove the moon and see what happens in the 'double blind study'.

    There again the French gave the name 'Lunartic' to those unfortunates.....

    Like your thoughts
    Paul Conneely

  20. I think we are on the same page. :drinks We just disagree. Which is wholesome.

    Lets look at your examples.

    Not everything has to be tested by double blind study. There are other forms of study (I know you're well aware of this so please don't take it as condescending, its for those reading along). For example, were I to carry our a study correlating the position of the moon with the area of the earth where high tide is, I would find a 100% correlation. The correlary to the study in question would be to remove the jaw bone and study the gait. Not required, to establish causality.

    In a short phrase, EBM. There are many, many "grandma used to do it" things which have been discontinued in medicine, either because they have been shown to have no actual medical benefit beyond placebo, because they are inconsistant with base principles or bench data, or because they have been found to be harmful. Trepanning being the obvious example. Another being the obvious spurious belief that thunder curdles milk. We KNOW that it doesn't because it is incompatible with what we know. Thunder and curdled milk are both effects. A dubious correlation is found, presumably because milk often curdles in the same way as

    And as you say:-

    Or indeed eating bread (98% of back pain suffers do) or being out in the rain.

    And finally to

    Indeed. I didn't know this one so I googled it. Naphthelene came out with a list of side effects from inhalation, most nasty. So the mechanism is one of 2 things

    1. Pure placebo
    2. Medical link between the chemical and night cramps.

    If 1 then fair enough. If 2 then we are using a dangerous chemical without knowing how it is working and without the fallback of it being an approved drug. If its "real" it could do harm (there was a woman on the net who tried to poison her husband with mothballs under the bed!!!) Which leads us back to

    And to you...
  21. musmed

    musmed Active Member

  22. Footproman

    Footproman Member

    I once saw a gait video on Functional Hallux Rigidous (FHL). A patient presented with TMJD, headaches and neck pain. A foot exam revealed that he had FHL. The gait video showed that due to the shortened gait caused by the FHL he walked with his head down and shoulders shrugged forward. The poor posture, over time, essentially affected his TMJ, shoulders, neck, etc. Once the FHL was addressed posture improved, neck pain went away and TMJ also improved.

    I've also seen this in our practice. When FHL is addressed posture improves and head, neck and jaw pain is alleviated.
  23. Oh well. I'm sold then.:bang:

    Sorry. Its just that another anecdote shows nothing!
  24. Graham

    Graham RIP

    Actually! In some cases of non resolved TMJ you can see an improvement in pain and Posture over time, using video analysis, when specifically treating the FHL. How this works is obviously up for debate. Non the less I have seen this a number of times. It may be anecdotal but it shows something that may be worth investigating.
  25. MCA

    MCA Member

    I'm sure those of us that practice sagittal plane facilitation have all seen many cases where an orthotic has helped jaw pain/TMJ. While the results may be anecdotal, for the many people who have had their lives changed by an improvement in their jaw pain/TMJ/headaches/neck pain by simply wearing an orthotic, they have proof of the connection. Of course, one orthotic type is not right for everyone, in orthotic therapy, as with many other therapies, there's some practitioner artistry needed along with the science to get clinical results.
  26. Funny thing is I use tissue stress to make my clinicial discissions and use alot of "sagittal" plane orthotic variables to reduce loads on tissue and have never come across jaw pain getting better- not even once. Infact not even once has a patient said by the way as well as the result with X my jaw pain has gone. LBP yes, jaw never.
  27. Graham

    Graham RIP

    Must be something in the water I guess!
  28. MCA

    MCA Member

    I am talking about people who are coming specifically for TMJ pain - thus they are monitoring it, rather than someone coming for something else and they happen to comment that their jaw pain has improved - a person coming for treatment of back pain would probably not think to tell you that, if he had had jaw pain before, it has coincidentally improved.

    Or maybe you just don't have the mix of artistry and science just right;)
  29. If your treating TMJ pain where is your scientific proof or mechancial diagram on how it works COM, COP , Moments - Internal,External the whole nine yards ?

    Ps we could discuss the FHL is a result of mechancial changes not the cause, some maybe its the TMJ causing the FHL .

    pps MCA You seem to be making little comments today, which I don´t care unless you don´t have a name so whats your name ?
  30. I was just about to say the same thing!! I've issued thousands of orthoses of which probably a few thousand had sagittal plane facilitation in mind and like Mike, not one patient has ever reported an improvement in dentition.

    Post hoc ergo propter hoc?

    I had a patient once who fell in love just by wearing an orthotic. I was surprised myself but I issued an orthotic and a year later they were married. The result is anecdotal but he has proof of the power of the "Amour-o-thotic".

    I'm open to the idea there is a link twixt jaw and foot function. But I'm unconvinced that the orthotics fix jaws. Most medical problems follow a pattern, get worse, peak/plateau, get better. Regression to the mean. Therefore any treatment given for any given condition will have a success rate. Give someone with rabies an orthotic (along with other treaments) they will get better. Give someone with a bad back a questionaire, tell them they're in a study and 27% of them will show solid improvement! (Haake 2007). Give them a placebo and that shoots up to about 40%. That means if you tell 100 patients that your insoles will treat their back pain, you could walk away with 40 anecdotes that they did just that, even if the insole is a bit of flat cardboard. Thats back pain, I see no reason that jaw pain should be different.

    Verruca are the classic example. The world throngs with people convinced that any number of bizarre preparations, leaves, legumes and other odd things cured their verruca. Does'nt make it so.

    This is not "proof of correction". Its a lay persons opinion based on incomplete data and what they are told. Truth is not relative, the insoles don't provide proof of success based on one or even a few anecdotes. Proof is proof. It is portable. Proof is not local to one individual.

    Anecdotes remain anecdotes. Interesting, and certainly a catalyst for research, but nothing more. Not "proof" of any kind, and certainly not enough to be able to confidently describe the relationship as everyone seems so keen to do.

    German Acupuncture Trials (GERAC) for Chronic Low Back Pain Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups Michael Haake, PhD, MD; Hans-Helge Müller, PhD; Carmen Schade-Brittinger; Heinz D. Basler, PhD; Helmut Schäfer, PhD; Christoph Maier, PhD, MD; Heinz G. Endres, MD; Hans J. Trampisch, PhD; Albrecht Molsberger, PhD, MD

  31. MCA

    MCA Member

    I am a clinitian not a researcher. I look at other people's research work and implement certain things that make sense to me into my clinical practice. My coments are all about clinical results. I don't claim to have a "proof". I am just stating that in clinical practice we have great results. Hopefully the researchers among you will one day find the proof! Just like Jenner observed that milk maids didn't get small pox - eventually he discovered that it was because they all get cow pox which inturn gives them antibodies to small pox, and thus developed the small pox vaccine. If he hadn't been so observant in seeing patterns and coming up with a theory, which at first could not be substantiated, this would never have happened.
  32. I´m a clinical podiatrist as well, so is Robert and Graham - but that still does not answer any of my questions.
  33. True enough. And in Africa people observed that if an HIV victim slept with a virgin they lived longer. So the word got about and people with HIV started trying to get healthy by doing just that. They noticed a pattern (a false one) and started acting on it.

    As I said, a series of good data points DO point the way for research. But that is not what is happening here. People are not saying that there are a series of co-incidences and that this may be fertile ground for research. Instead we seem to have seen a pattern formed a hypothesis, and jumped straight to the conclusion, skipping the intervening steps.

    Your first post on this thread, MCA,
    To a new, inexperienced or naive clinician this carries all the certainty of a known fact rather than a shaky hypothesis. And that is my problem with the whole "foot to jaw" thing. Its not that people think there is a link, its the fact that people are describing it as if its an investigated and agreed on mechanism based on science, rather than a subjectively observed and suspect pattern.

    I'm also a clinician, full time. But that does not mean I cannot base my practice, what I tell my patients and what I state to my colleagues on evidence, as well as experience. There are plenty of things I do every day which don't carry an EBM stamp, and I describe them as such. I am also quite happy to use placebo, the most versatile and powerful thing in medicine, but when I do I recognise it as such. I don't start beleiving my own propaganda, nor spreading it.

    No, but you did claim THEY have proof.

    Which is nearly the same thing. The implication of anyone having proof is that proof exists. Which it does not.
  34. Footproman

    Footproman Member

    Gee. Sorry to have wasted your time, then. One wonders why there's doubt, when reading various papers on the subject, postural issues relating to Fhl are said to be "well established" through study? Seems to me that there's generally little doubt.

    When does anecdotal evidence rise to the level of proof, especially given years of such evidence?
  35. MCA

    MCA Member

    This all started by someone needing a simple explanation of foot-jaw connection. I see this forum is for a elite group who blow everyone, not like-minded, out of the water.
  36. Anecdotal evidence never rises to the level of proof. The plural of anecdote is anecdotes, not data. This is pretty basic ebm.

    I'm afraid I have to disagree on the concensus in the literature. But if you want to argue that one the you know how it works. Find the paper which says such a thing. If there is such evidence, it will be referenced. Then we can talk! If it is as widely agreed as you say they'll be plenty!

    Been accused of elitism before, generally in this same situation. Someone makes a huge and unsupported claim or statement, then gets pouty whe asked to support or justify it.

    Consider this. We have people come along here making a wide variety of such statements. Should we, as professionals, accept ALL of them without question? Or should we question all of them? It's actually much harder to beleive less, to be honest enough to say "we don't know", and a lot less popular. But it helps keep the errors down!
  37. I asked you to explain it. I´ve asked at least 15 different people to explain it - I´ve tried to look myself at many papers as in the thread I posted the link too.

    So can you explain it to me MCA ? (still don´t have a name maybe I just call you Manitoba Canada )

    So Manitoba the floor is yours explain the link please or if you can´t show me the research that you have read which discribes the link.

    No, not the case but I told you, so it true does not cut it.

    If there is a link I would like to know about itso then I can help more people that´s why I come on here to learn and help others develop as well -

    So Manitoba explain it too me - the floor is all yours.
  38. Alright foot what if I said to you that I beleive FnHL at certain stages of the gait cycle is a good thing.

    What if I said that I beleive increased dorsiflexion stiffness of all the metatarsal heads at certain stages of the gait cycle is a good thing.

    What if I said I beleive that the FnHL is in fact a result of Joint coupling not the other way round. ie that FnHL causes the gait changes discribed in sagittial plane mechancis.

    Here is an experiment for you and Manitoba if you in to try on a patient friend etc who has very little dorsiflexion stiffness, lateral deviated STJ axis ie during the Jacks test you see kinematic changes with STJ supination.

    stage 1 dorsiflex the 1st MTPJ in midtarsal

    stage 2 flex the knee a little dorsiflex the 1st MTPJ in midstance

    stage 3 flex the knee more dorsiflex the 1st MTPJ in midstance

    stage 4 flexed knee same as stage 3 but now flex the hip dorsiflex the 1st MTPJ at midstance

    what has happened to the dorsiflexion stiffness on the 1st during the 2 - 4 stages?

    Why would having increase Dorsiflexion stiffness of the MTPJ´s be a good thing at certain stages of the gait cycle ?
  39. HERETIC!!!

  40. :D:D:D made me laugh - which I needed !!!

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