Published statistical research studies have validated the following chain of pathomechanical events:
Members do not see these Ads. Sign Up.
Gravity drive pronation pattern of right > left results in a functionally short right leg (FLLd right short)
- Gravity drive pronation (pathognomonic of the PreClinical Clubfoot Deformity and Primus Metatarsus Supinatus foot structure, Rothbart 2010) drives the innominate bone anteriorly
- The more pronated foot is ipsilateral to the more anteriorly rotated innominate bone (Rothbart 2006)
- The more anteriorly rotated innominate bone is ipsilateral to the shorter leg (Cummings G, Scholz JP 1993)
Gravity drive pronation pattern of left > right results in a functionally short left leg (FLLd left short)
Significance of these findings:
- Treat the etiology of the FLLd, e.g., the PreClinical Clubfoot Deformity or the Primus Metatarsus Supinatus foot structure
- Do not use heel lifts to treat the symptoms, e.g., the FLLd
Cummings G, Scholz JP et al 1993. The Effect of Imposed Leg Length Difference on Pelvic Bone Symmetry. Spine Vol 18:3, pp 369-373.
Rothbart BA 2006. Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation. Journal American Podiatric Medical Association;96(6):499-507
Rothbart BA 2010. The Primus Metatarsus Supinatus (Rothbarts) Foot and the PreClinical Clubfoot Deformity.Podiatry Review, Vol. 67(1):
Page 1 of 2
-
-
Leg Length Difference is divided into two distinct categories:
- Functional LLd
- Anatomical LLd
- FLLd is a symptom that results from an asymmetrical rotation of the innominates
- Heel platforms are counterindicated
- The underlying cause of the anterior rotation of the innominates needs to be treated directly
- Two of the most common causes of anterior innominate rotation are: the PreClinical Clubfoot Deformity and the Primus Metatarsus Supinatus foot structure
- ALLd is a true difference in the length pattern of the legs.
- It is a primary cause and may require direct intervention
- If required, use a foot platform under the short leg
-
More research publications are appearing in the European orthopaedic literature that links gravity drive pronation to the coronal plane distortions in the foot's medial column, resulting in forefoot pathology. (Lalevee M et al 2022).
Coronal plane distortions in the foot's medial column are the hallmark of the Preclinical Clubfoot Deformity and Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot).
- Matthieu Lalevée, Hunter D. Briggs, Nacime Salomao Barbachan Mansur, et al. 2022. Coronal Plane Rotation of the Medial Column in Hallux Valgus (HV), Progressive Collapsing Foot Deformity (PCFD), and Combined PCFD HV: A Retrospective Case Control Study. Foot & Ankle Orthopaedics 7(4)
- Zaidi R, Sangoi D, Cullen N et al 2022. Semi-automated 3-dimensional analysis of the normal foot and ankle using weight bearing CT - A report of normal values and bony relationships. Foot and Ankle Surgery, December (article).
-
Another study that links medial column instability to coronal plane distortions (supinatus) pathognomic of the PreClinical Clubfoot Deformity and Rothbarts Foot (Schmidt 2022).
In this research report presented by Schmidt, et.al. they pictorialize the progressive collapsing of the medial column of the foot initiating at the head of the talus. This study is a validation of my research which links talar head supinatus to the PreClinical Clubfoot Deformity and Rothbarts Foot.
The below animation is a weight bearing CT
Eli Schmidt; Kepler Carvalho, MD; Ki Chun Kim, MD; Amanda Ehret; Edward O. Rojas, MD; Francois Lintz, MD MSc FEBOT;Scott J. Ellis, MD; Nacime SB Mansur, MD; Matthieu Lalevée, MD; Cesar de Cesar Netto, MD, PhD
(PDF) Factors Influencing Different Classes in Progressive Collapsing Foot Deformity. Available from: https://www.researchgate.net/publication/365649976 Factors Influencing Different Classes in Progressive Collapsing Foot Deformity [accessed Dec 29 2022]. AOFAS Annual Meeting.Last edited: Dec 30, 2022 -
Brian , what foot strengthening exercises do you recommend to your clients?
-
Hi Scot,
Depends on the pathology - if you can be more specific, I can give you a more specific answer. -
"Hi Scot " ? Well it's different then "Hi Gerald" !
Could we begin with a couple pathologies of your choice which you think require foot strengthening and the exercises you would prescribe? This presumes of course that you think any pathologies merit a foot strengthening program . I can find nothing on your website on the subject, just material on your orthotics. -
Sorry, Gerrard,
I note your moniker (Scotfoot), thinking your first name is Scot. (early Somezeimer symptom)
I only treat the RFS and the PCFD. Neither of these foot deformities requires foot strengthening exercises if the appropriate insole is used. If inappropriate insoles are prescribed (e.g., arch supports) the ILA will weaken. In that case, strengthening the posterior and anterior tibialis muscles would be a starting point.
I believe you are an advocate of strengthening the plantar fascia, intrinsic muscles and increasing foot flexibility. -
-
What symptoms (dynamic or static) do you correlate with weak toe flexors?
Do you believe flexor weakness is the result of wearing shoes? I believe shoe gear is secondary to this weakness. The primary driver, IMO, is found in the scaffold (bony framework) of the foot.
I propose that structural instability results in the remodelling of the foot's soft tissue, intrinsic muscular weakness being one example. Address this structural weakness, soft tissue weakness automatically abates.
Both the RFS and the PCFD are examples of structural instability in the foot's skeletal framework. -
-
The pathology resulting in patella pain syndrome can be due to many possible events, from pathomechanics (which can result in intrinsic muscle weakness), trauma, autoimmune and infectious diseases just to name a few.
Shoe gear can definitely prevent the intrinsic muscles from functioning correctly. This can lead to weakness, more in some people, and less in others.
Hallux Valgus, its relationship to soft tissue changes, and the pathomechanics behind its’ development is a whole other discussion. No doubt, tight-fitting shoes can change the alignment in the 1st MPJ and inchoate hypertrophy of the 1st met head. But why do some women who wear high-heel-pointed shoes develop HV deformity, and other women wearing exactly the same shoes, do not? Obviously, there are other factors involved.
You are correct, the nomenclature I introduced over 20 years ago is not generally accepted by Podiatrists. But that is slowly changing
One’s proclivity in strengthening the intrinsic muscles to stabilize the feet, hinges on whether you view this as the primary or secondary event leading to abnormal pronation. I view it as secondary and hence do not generally incorporate it when treating RFS or PCFD. -
The toe flexors probably have a major role to play in COP location during standing tasks . Posting may also help with this but posting may give a less stable foot during gait, IMO. -
The insoles I use to treat RFS are positioned under the medial column of the foot only. Placing a wedge underneath the lesser metatarsals would jam the MPJs (and possible inflammatory changes).
Can you elaborate on the link between weak intrinsic foot musculature and abnormal compensatory hip movement? -
The functional importance of human foot muscles for bipedal locomotion
- January 2019
- Proceedings of the National Academy of Sciences 116(5):201812820
"With the PIMs blocked, the distal joints of the foot could not be stiffened sufficiently to provide normal push-off against the ground during late stance. This led to an increase in stride rate and compensatory power generated by the hip musculature, but no increase in the metabolic cost of transport. The results reveal that the PIMs have a minimal effect on the stiffness of the LA when absorbing high loads, but help stiffen the distal foot to aid push-off against the ground when walking or running bipedally. "
-
From what I have read your orthotics do work for some people. However, my question was "is there any research that shows they work any better than what was already available" i.e. medial wedge under a number of the met heads.
The generic insoles sold by a company in Tacoma are specifically used to treat RFS and they work well if used correctly. However, if used incorrectly, e.g., by someone who does not have the RFS (e.g., PreClinical Clubfoot Deformity), they will not work satisfactorily. Axiomatically, use the right insole dictated by the individual’s foot structure. Unfortunately, it is not uncommon for insoles to be dispensed without first determining the primary etiology (abnormal pronation, flexible arches etc. are symptoms, not primary aetiologies).
My instinct here is that a wedge that sits beneath a single met head will interfere with the so called "metatarsal parabola foot stiffening effect" more than a medial wedge that sits beneath a number of met heads in a graduated way.
Read the paper on the aetiology of the RFS and PCFD. It will clarify the reason medial wedges under all the metatarsals are counter indicated when treated these two foot deformities.
https://www.researchgate.net/public...s_Supinatus_Foot_Deformity_aka_Rothbarts_Foot -
Would you accept that placing a wedge under the 1st met head has a mechanical effect ? -
In their paper, RFS is termed Morton's Toe. The reason for this goes back to the research I was discussing with Janet Travel MD (1996). At that time we thought RFS was the vertical dimension of Morton's Foot. Further research clarified that RFS and Morton's Foot (Toe) are two different foot structures. RS Hartz still labels RFS as Morton's Toe.
Other research teams in Iran have conducted studies on the Proprioceptive Insole I invented. I can provide you with a link, if you so desire.
FYI, In 2015 my research was voted by the PPM Editorial Pain as the best advance in pain therapy using proprioceptive insoles.
At one point I thought the rate of occurrence of RFS might approach 80%. Now I think the RoC of PCFD might approach 40-50%, RFS less. More research needs to be done in this area.
Regarding whether the medial column wedge acts mechanically or neurophysiologically, I have discussed this in detail 2011 (PositiveHealth Online) and 2015 (JCIM).
- Rothbart BA 2015. The Link Between the Foot And Cerebellum. Resolving Chronic Musculoskeletal Pain. Journal Comprehensive Integrative Medicine. Vol 1(2), 45-57.
- Rothbart BA 2011. Twisting Foot and Musculoskeletal Pain: Root's Biomechanical Model vs Rothbart's Neurophysiological Model. 186(9).
Last edited: Jan 1, 2023 -
To be perfectly honest I know little about orthotic devices and have little interest in there construct and use.
I would ask how your invention differs from the orthotic designed by Morton for Morton's toe ( RF) ?
My interest lies with the mechanics of a healthy foot and with toe flexor strength. It astonishes me that so many foot specialists ignore foot strength deficits and are unaware of some aspects of foot mechanics. For example Dr Hartz seems to know nothing of the mechanical effects of the metatarsal parabola in stiffening the foot at toe off . It's a question of simple geometry .
With met heads arranged in a "parabola", toe off sees adjacent met heads move apart anteroposterioly and closer together mediolaterally . This gives a more marked transverse arch in the distal aspect of the foot. Here is a link to a youtube video of a very simple example.
https://youtube.com/shorts/MPTYdPIit_4?feature=share -
There is so much misinformation on foot biomechanics, specifically regarding the RFS and PCFD, it astounds me.
To distill and conceptualize my viewpoint regarding RFS or PCFD, muscle strengthening exercises are not necessary if the correct proprioceptive insole (with correct dimensioning) is prescribed. That is, the insoles must be fitted individually to each patient, not generically dispensed.
Addressing muscle weakness in any other foot deformation, I have no comment nor opinion. -
- Rothbart BA 2009. Morton's Foot vs Rothbart's Foot. Are They the Same? Podiatry Review, Vol 66(3):6-9.
Attached Files:
-
-
-
Also do you accept the mechanism described here -
With met heads arranged in a "parabola", toe off sees adjacent met heads move apart anteroposterioly and closer together mediolaterally . This gives a more marked transverse arch in the distal aspect of the foot. Here is a link to a youtube video of a very simple example.
https://youtube.com/shorts/MPTYdPIit_4?feature=share -
RE - https://www.youtube.com/shorts/MPTYdPIit_4?feature=share: I've watched this video. Do you see this narrowing of the met head parabola at toe-off relevant in the treatment of RFS or PCFD? -
Dr Hartz wrote
"Despite millions of years of evolution, the first metatarsal bone remains too short to participate fully in upright ambulation.
This common failure of evolution to accommodate walking on two feet can lead to hallux valgus, bunions, hammer toes, and neuromas."
Perhaps you could draw her attention to the video. -
According to Elftman and Zitzlesperger, the primary mechanism is STJ supination. My research is consistent with theirs. I have done many gait studies validating this viewpoint.
I attached a paper discussing this in more detail (Rothbart, 2002).
Elftman H 1960 The transverse tarsal joint and its control. Clinical Orthopedics
16: 41
Zitzlesperger S 1960 the mechanics of the foot based on the concept of the skeleton
as a statically indetermined space framework. Clinical Orthopedics 16:47–63
Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46Attached Files:
-
-
-
-
- Anjana Jayabandara, Dileni Rodrigo, Shaminda Nadeeshan et.al. 2021. Prevalence of Flatfoot and Its Correlation with Age, Gender and BMI among Undergraduates at the Faculty of Allied Health Sciences, General Sir John Kotelawela Defence University. Journal of Pharmacy and Pharmacology 9(9) DOI: 10.17265/2328-2150/2021.09.001
-
"At one point I thought the rate of occurrence of RFS might approach 80%. Now I think the RoC of PCFD might approach 40-50%, RFS less. More research needs to be done in this area.""Just read a paper published in the Journal Pharmacy and Pharmacology investigating the incidence of flatfeet in 533 asymptomatic undergraduate students (Allied Health Sciences, General Sir John Kotelawela Defence University). They reported 184 students had flatfeet (34.7%), closer to what I estimated above from my practice (through 2022)."
Are you saying anyone with flat feet has one of your foot types ? -
-
So why no strengthening exercise in your treatment plans for this foot type ( PCFD as you have called it ) ?
Randomized Controlled Trial
. 2019 Mar;38:19-23.
doi: 10.1016/j.foot.2018.11.002. Epub 2018 Nov 6.
The effect of additional activation of the plantar intrinsic foot muscles on foot kinematics in flat-footed subjects
Kazunori Okamura 1, Shusaku Kanai 2, Kengo Fukuda 3, Satoshi Tanaka 2, Takeya Ono 2, Sadaaki Oki 2
Affiliations expand
- PMID: 30530189
- DOI: 10.1016/j.foot.2018.11.002
Background: Strengthening exercises of the plantar intrinsic foot muscles (PIFMs) are often prescribed to flat-footed subjects because of the capacity of the PIFMs to support the medial longitudinal arch (MLA). However, it is unclear whether the capacity of the PIFMs to support the MLA is enough to change the foot kinematics in flat-footed subjects. To confirm this, the current study examined changes in foot kinematics in flat-footed subjects during standing and gait accompanied by changes in the activity of the PIFMs.
Methods: Eighteen flat-footed subjects were randomly assigned to an electrical stimulation group (ESG) or a control group (CG). In the ESG, electrical stimulation to the PIFMs was applied during standing and gait to simulate reinforcement of the PIFMs. Then, foot kinematics were measured using 3D motion analysis, and the amount of change from baseline (when no electrical stimulation was applied) was compared between the groups.
Results: In the gait analysis, the time at which the MLA height reached its minimum value was significantly later in the ESG, with no reduction in the MLA height at that time. Moreover, forefoot inversion angle and tibial external rotation angle were significantly increased in the ESG at that time. In the standing analysis, there were no significant differences between the groups.
Conclusion: The results revealed that in flat-footed subjects, the PIFMs have the capacity to support the MLA enough to change foot kinematics during gait. Strengthening these muscles may be effective in preventing or treating lower extremity overuse injuries related to flat-foot alignment.
- PMID: 30530189
-
Keeping the above analogy in mind:
Two choices when dealing with ILA collapse (flat-footedness) in the presence of PCFD
- Maintain the ILA height by strengthening the muscle but the PCFD will force the ILA to collapse again when the muscle strengthening exercises are terminated
- Or address the PCFD with the appropriate insoles and the ILA automatically maintains it contour (e.g., does not collapse)
And yes, supporting the ILA with arch supports or muscle strengthening exercises will alter foot kinetics (forces and torques). -
When dealing with RFS, research has demonstrated that the plantar pressure gradients across the midfoot (e.g., ILA) increase when arch supports are used and decrease when the appropriate proprioceptive insole is used. That is the ILA becomes stronger (maintains its' contour) with the proprioceptive insole and weaker (collapses) with arch supports.
This supports my viewpoint that the gold standard in treating RFS (or PCFD) are the proprioceptive insoles that I designed over 20 years ago. -
To be fair a lot of research on foot strengthening and its benefits has been done only recently but that does not mean it should be ignored. Not everyone can afford thousands of dollars for orthotics but we can all do exercises. Once you have strengthened your feet, maintenance is all that is required . Say 15 mins 2x a week?
Strengthening also brings benefits that orthotics don't e.g. large increases in toe flexor strength which is linked to balance, falls etc.
Here is the abstract from another paper on flat feet and foot strengthening. There are now many .
Corrective exercise for intrinsic foot muscles versus the extrinsic muscles to rehabilitate flat foot curving in adolescents: randomized-controlled trial
Sport Sciences for Health volume 18, pages307–316 (2022)Cite this article
- 507 Accesses
- 1 Citations
- Metricsdetails
Background
Extrinsic and intrinsic foot muscles actively support the foot’s arches, particularly the medial longitudinal arch. Previous studies have focused on strengthening the intrinsic muscles, and some suggested focusing on extrinsic muscles as a useful intervention to improve flat feet.
Aims
The current study aimed to compare the effectiveness of extrinsic and intrinsic foot muscle exercises in improving the medial longitudinal arch in adolescents with flat feet.
Methods
Subjects were 36 adolescents with flat feet who were randomly divided into three groups (n = 12). Group 1 performed the extrinsic muscles exercises, and group 2 performed the intrinsic muscles exercises. The control group did not experience any exercises or other treatments. The navicular drop test was used for the foot posture examination in two statuses with and without weight-bearing.
Results
The one-way ANCOVA for between-group comparison and repeated-measures ANOVA for within-group comparison was used to analyze the data. There was a significant difference in the mean of navicular drop index between pre- and post-test for both exercise groups (p < 0.05). There was also a considerable difference between the two exercise groups, with the control group favoring the exercise groups. In comparison between the two exercise groups, the mean of navicular drop index was significantly different, favoring the intrinsic muscles exercises group.
Conclusions
This study showed that the intrinsic exercises were more effective than the extrinsic exercises, and it is suggested to target this group of muscles to design exercises to correct the flat foot deformity of adolescents.
-
- The insoles I designed, increases ILA strength without supporting the ILA
- That arch supports, decrease ILA strength (contour collapses)
It is long overdue that my innovative research, be recognized on this forum.
Gholamreza Aminian, Zahra Safaeepour, Mahboobeh Farhoodi, Abbas Farjad Pezeshk, Hassan Saeedi, Basir Majddoleslam 2013. The effect of prefabricated and proprioceptive foot orthoses on plantar pressure distribution in patients with flexible flatfoot during walking. Prosthetics Orthotics Int. Jun 37(3):227-32. -
I asked "Are you saying there is proof your orthotics produce foot strengthening?"
You are saying "yes" and citing a paper about orthotics and the changes in plantar pressures that using them produces.
Muscle strengthening is not even mentioned in this paper!
-
From your comment I can only assume that you are not an expert in this area of kinetics.
Regards Golds Gym, totally off this thread's discussion. However, an important one, nevertheless. Start a new thread/discussion on Linear vs Torsional Biomechanics and we will discuss the importance of linear mechanics in weightlifters.
- Rothbart BA 2004. Pressure Plate Analysis of the Medial Column Foot Insole. A Statistical Study. Online Journal of Sports Medicine (Italian), November Issue.
-
You have no proof of strengthening .
As far as I can make out, your methods don't involve strengthening of the foot at all . Whilst this was probably common ten years ago it is much less common now.
Page 1 of 2
Loading...
- Similar Threads - Functional Leg Length
-
- Replies:
- 0
- Views:
- 2,007
-
- Replies:
- 5
- Views:
- 5,471
-
- Replies:
- 1
- Views:
- 919
-
- Replies:
- 1
- Views:
- 1,803
-
- Replies:
- 3
- Views:
- 2,071
-
- Replies:
- 0
- Views:
- 1,262
-
- Replies:
- 3
- Views:
- 2,383