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How to prevent from overpronation

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Peter W.B.Oomens, Nov 28, 2012.


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    How to prevent from overpronation?

    Intrinsic Foot Muscles (IFM) ór Rigid Orthotics, that is the question…

    a hypothesis by
    Peter W.B.Oomens




    In 1995 I wrote in the Dutch journal for integral medicine (Nederlands Tijdschrift voor Integrale Geneeskunde, 1995; 11(2), 108-112) my hypothesis that in a loaded human foot, at least in the length, we find a co called ‘force closure’ of the foot joints, maintained in the first place by the intrinsic foot muscles, sustained by the strong plantar ligaments, such as the aponeurosis plantaris, lig. calcaneonaviculare, etc. These ligaments are not found with mammals as e.g. the bear, which also can walk and stand on flat feet. A hypothesis at that time, but more and more found realistic.

    I have a small recreation chalet near the Dutch beach and walk endless along it. Looking at the sea and the birds, but especially at thousands of barefoot sand prints from adults and children. The more I looked at them the more I found it surprising that with a percentage of 12 % Dutch people having flat feet (pes planovalgus) I never have noticed it from their footprints. All sand imprints are the less deep where I expected them to be the deepest: at the medial arch!
    I have tried to find an explanation for this phenomenon, the most probable may be that barefoot pronation is physiological and corrects itself.

    Is there a difference between barefoot walking or with shoes? With or without orthotic devices?
    Benno Nigg published in 1986 ‘Biomechanics of running shoes’. He concluded that medial arch supports, placed in the rear part of the arch, against the calcaneus,
    reduces the initial pronation, while placed more forward the effect became less. However compared to barefoot running he still found more pronation wearing shoes.



    Neurologic of the plantar foot
    The glabrous foot sole has a great number and variety of neuroreceptors: Ruffini, Krause, Vater, Pacini, Meisner, free nerve endings, etc. All of them are specified to a certain function, but many of them are also sensitive to pressure, as cutaneous mechanoreceptors. A Total of 104 mechanoreceptors were identified in the glabrous skin of the foot sole. Kennedy at all found, with the foot in an unloaded position no discharge activity in any of the cutaneous recceptors in absence of the intentionally applied stimulation. These findings suggest that skin receptors in the foot sole behave differently from those receptors found on the glabrous skin of the hand. This may reflect the role of foot sole skin receptors in standing balance and movement control.

    Podopostural Therapy, based on the theory of Dr.R.J.Bourdiol, stimulates the foot sole to a postural correction with patients suffering from all kind of postural complaints as e.g. low back pain, but also with foot- and ankle disorders.
    According to Bourdiol this stimulation is caused by very thin inserts of cork (1 à 3 mm), glued on a thin insole on an individual base.
    It was Bourdiol’s hypothesis that such an insert, placed under the medial arch, stimulates directly the nucleair chain- and bagspindle of the m. abductor hallucis which leads consequently to a contraction of this muscle, activated by the ą – motorneuron..


    therapy insole according to Bourdiol (not covered)


    Analyzing the local skin and the underlying tissues (together up to 5 mm) it is not very probable that a 1 mm cork element activates the у-fiber within the muscle… The only sensors that can be activated consequently are the mechanoreceptors as mentioned before. Facilitation of the skin of the foot sole under the medial arch area, brings the m. abdutor hallucis to a contraction. The role of the у-system is presetting a basic tonus. In fact the α – and у – fibers fire almost together and we therefore call it an
    ą - у co-activation.

    Let’s now theorize the function of the medial arch orthotic. The moment the foot tends to pronate, the inside of the foot becomes lower and longer, and the inside bones such as calcaneus, cuneiforme, metatarsals, etc are spread from each other. A medial arch support of course ends further pronation, but in fact pushes these bones even more from each other and makes it more difficult to the m.abdutor hallucis to contract and restore the inside arch!! Probably the reason that wearing arch support seems to lead to an even increasing pes planovalgus.

    The ‘Bourdiol system’, either proprioceptive and/or exteroceptive way, activates the m.abductor hallucis, instead of supporting this arch mechanically. Once the muscle chains (agonists) toward cranial, innervated from the same segment, are activated, the antagonists reciprocally will relax.
    With this controllable, visual, measurable and repeatable system the patients posture can be influenced as can his related pains. Which I did for almost 20 years.

    Peter W.B.Oomens, November 2012
    WbD, Netherlands




    Peter W.B. Oomens
    research on posturology
    Villa d'Este
    Vesta 15
    3962 LP Wijk bij Duurstede
    Netherlands
    tel: +31 343 442563
    mob: +31 6 41995554
    peteroomens@xs4all.nl
    peter@oomens.net
    http://www.drbody.nl



    LITERATURE:

    • Distribution and behavior of glabrous cutaneous receptors in the human foot sole
    This information is current as of January 18, 2008
    Paul M.Kennedy and J.Timothy Inglis
    http://jp.physoc.org/cgi/content/full/538/3/995
    This is the final published version of this article; it is available at:
    JournalsRights@oxon.blackwellpublishing.com

    • Continu activiteit van de intrinsieke voetspieren tijdens het staan
    Peter W.B.Oomens
    Nederlands Tijdschrift voor Integrale Geneeskunde 1995; (2):108-ll2

    • Evaluation and Retraining of the Intrinsic Foot Muscles for Pain Syndromes Related to Abnormal Control of Pronation
    Bahram Jam, Mphty (Manip), BScPT, FCAMT

    http://www.drbody.nl
     
  2. davidh

    davidh Podiatry Arena Veteran

    I'll jump right in.

    Peter,

    You said: "I have a small recreation chalet near the Dutch beach and walk endless along it. Looking at the sea and the birds, but especially at thousands of barefoot sand prints from adults and children. The more I looked at them the more I found it surprising that with a percentage of 12 % Dutch people having flat feet (pes planovalgus) I never have noticed it from their footprints. All sand imprints are the less deep where I expected them to be the deepest: at the medial arch!
    I have tried to find an explanation for this phenomenon, the most probable may be that barefoot pronation is physiological and corrects itself."

    Overpronation is accentuated by a hard, flat surface. Give the overpronating foot a softer surface and it will tend to conform to that surface.
     
  3. Oh my.

    There's not a lot here I can agree with, but lets pick one of the more obvious points.

    Just to be clear that we're not having a language issue here (and your English is much better than my Dutch!:drinks), are you theorising that contraction of the abductor hallucis is what restores the arch?

    Is there any blinded evidence whatsoever that this system works? I've not seen any.
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Without getting in to debates about exactly what "overpronation" is, there is only ONE way to stop it: a greater force has to be applied to medial side of the subtalar joint axis. There is no other way. That force has to either come from the ground, orthotic, shoe or muscle activity.
     
  5. drsarbes

    drsarbes Well-Known Member

    How to prevent from overpronation?.......
    Simple
    Move to a planet with no gravity.

    Steve
     
  6. efuller

    efuller MVP

    Hi Peter, Welcome to the arena.


    You might want to check your English on this question. It doesn't quite make sense.


    I'm not sure what a force closure is. It sounds like you are referring to a tied arch or possibly a beam.


    As I recall the paper Nigg was referring to velocity of pronation not total amount of pronation. He also explained it quite well by looking at the location of ground reaction force relative to the STJ axis. A shoe will tend to create a longer lever arm about the STJ axis compared to the bare foot.

    Here is where we need a definition of what is normal pronation and what is over normal pronation. I don't believe that there is a definition.


    I don't understand why you need the depth of discussion that you went into on skin receptors to further your points. I'm also not sure whether you are referring to the barefoot point above or the "proprioceptive insole" point below.



    We have discussed, here on the arena, a similar concept that we have jokingly referred to as the Spikethotic. That is a sharp spike placed under the medial arch will tend to make the muscles work harder to prevent arch lowering.



    Othotics basically push upwards. I don't see how they can separate bones. One theory of how medial arch orthotics work is that they apply a force to the foot in a position that is medial to the STJ axis. This will create a supination moment. This will only stop pronation when the there is a net supination moments are greater than pronation moments acting around the STJ. This is why, in some people, orthotics with high medial arches really hurt. The supination moment from pressure in the arch is not enough to overcome the pronation moments acting on the foot and the foot still attempts to pronated into the medial arch, ouch. The other theory is that medial arch orthoses cause, through some mechanism, the supinatory muscles to fire more. My hypothesis on that is that this latter effect is a pain/ discomfort avoidance response of the CNS. I believe both effects are in force at least part of the time.


    Evidence?

    Eric
     
  7. drsarbes

    drsarbes Well-Known Member

    OR..............

    Perhaps there are less flat feet imprints on the beach since it's more painful to walk on a soft surface with a pronated foot thus less people with pronated feet take long walks on the beach (especially barefoot.)

    OR.......

    There is a socio-physiological inverse relationship between persons with flatfeet and their gravitation towards enjoying beachfront property.......

    OR........

    People with pronated feet walk closer to the waters edge where it is more compact and thus the footprints get washed away before you can view them.......

    OR......

    the beach in your particular area slopes more than usual so the "down slope" foot is more or less corrected resulting in a unilaterally corrected pronated gait (quite unusal I understand)

    OR.....

    the original study resulting in a finding of 12% "pronation" in the Dutch population was in error.

    OR......

    The degree of pronation defined in the study as "pronated" was not enough to result in a visual "flat foot" in a wet sand imprint.


    and Peter........I'm over worked today and just wanted to have a little levity at the end of my day!!!!! Nothing personal......I do get like this sometimes.

    Steve
     
  8. davidh

    davidh Podiatry Arena Veteran

    Nice list - :good:
     
  9. Come on Steve....let's be a little more scientific....:rolleyes:

    OR.....

    People with flat feet are allergic to beach sand and will break out in hives if they walk barefooted on the beach.

    OR....

    Flatfooted people have the inherent ability to levitate so that they can simply float over the beach without making foot prints.

    OR.....

    The sky hook positioned over the beach lifted flatfooted people and catapulted them into the ocean before they could set their foot prints onto the sand.

    Moral:

    Always watch out for sky hooks!!;)
     
  10. All mammals, except men, walk on their toes, footbones are stapled. We call this 'form closed' (against gravity). Human foot bones are laying next to each other. So to keep these bones together, there has to be a force from aside. This is called 'force closure' (prof.dr.ir.Chris J.Snijders- Erasmus University Rotterdam). The main structure to maintain this pressure are the layers of intrinsic footmuscles. This plus the fact that the roman arch itself is weightbearing must is normally enough to stop the physiologic pronation. Furthermore only the human foot has plantar ligaments and a aponeurosis. The bear, the only mammal who also can walk on flat feet, does not have these ligaments. Just look at photographs of barefoot runners. You can google them. This in my opinion isBIOMECHANICS instead of mechanics.
     
  11. Sicknote

    Sicknote Active Member

    Walking or running with the wrists firmly placed in flexion encourages supination.

    Walking or running with the wrists firmly placed in extension encourages overpronation.

    Everything is connected, the wrists being connected to the ankles.
     
  12. davidh

    davidh Podiatry Arena Veteran

    I seem to remember the great apes also walk plantigrade, or can when they wish.

    I can see another flaw in the reasoning here, but it has to do with hard, flat surfaces, the STJ axis orientation, and the position of the normal foot when it is placed in STJ neutral, so I'll save that for now...........
     
  13. Ian Linane

    Ian Linane Well-Known Member

    "All mammals, except men, walk on their toes, footbones are stapled. We call this 'form closed' (against gravity). Human foot bones are laying next to each other. So to keep these bones together, there has to be a force from aside."

    My apologies in advance in case I am misunderstanding the above emboldened aspect of the sentences. It is just that the terminology conveys to me a sense of being "stapled" together i.e. the bones do not move independent of each other in gait but are locked together. Am I misunderstanding you here?
     
  14. Yes I remember the song.

    And walking with a carrot stuck up you bottom causes a bouncing gait with a wider base of gait. What of it? This does not a treatment protocol make!
     
  15. David Smith

    David Smith Well-Known Member

    Simples - http://www.youtube.com/watch?v=NBu0OtC6m9g

    Those simple solutions that make you think 'I could have thought of that, DoH!'

    Nice one


    Dave Smith
     
  16. Science not only means what we know today but also what we learn tomorrow or the day after tomorrow . . .
    In spite of the received reactions I still think that the foot is discussed in a too mechanical way. I base this on my study of the force closure model. This study discusses the sacro-iliac joint but biomechanically there is a parallel to the foot. Both during walking and stance the foot has to bear the body weight without collapsing. A force is needed to keep the foot bones locked (thanks Ian Linane). This force is mainly generated from the intrinsic foot muscles, supported by the plantar ligaments. Of course each foot is pronating while walking and even more during unipodal stance, but this in my opinion is physiologic and does not have to be corrected. Only when this mechanism does not function anymore, some correction may be needed, when possible in combination with exercising.
    If you want more information about the force closure theory, you can find it using this link:
    http://link.springer.com/article/10.1007%2Fs00586-003-0575-2?LI=true#page-1[/URL]





    [​IMG]
     
  17. Ian Linane

    Ian Linane Well-Known Member

    Hi Peter
    Thanks for coming back on this.

    Sorry to be in a rush but am just off out for the rest of the day but wanted to explain why I asked for clarification. My concern lies in this concept that the bones of the foot are "locked" and that the forces passing through the foot and roles of the ligaments are there to keep them locked in weight bearing (unless I am misunderstanding and misrepresenting you, in which case my apologies).

    Certainly you can think in terms of some weight bearing joints in gait being more "congruent" at a point in the gait cycle but, within the same foot, other joints might simultaneously be less congruent at that same point in the cycle, only becoming congruent as they undergo GRF. It is possible Kevin, Simon, Craig and others might refer to this more in terms of stiffness, they will correct me I'm sure.

    In addition, I'm not sure that congruent can be seen to imply that they are locked. Rather it is describes the point where a particular point of an articular surface is in a close packed relationship to another point on the opposite articular surface and undergoing roll, glide and rotation over one another, around the various axes. To this extent whilst the ligaments might aid in maintaining a certain stiffness to the joints they also serve to limit any increased accessory glide of the articular surfaces as the joint undergoes its function.

    I certainly find it difficult to square the locked concept with the findings of work such as Lundgren et al (Invasive in vivo measurement of rear-, mid-, and forefoot motion during walking, Gait and Posture).

    Based upon this it might be argued that the last thing we need is force to keep the foot locked as it undermines the action that occurs within congruency as described above.

    Sorry to be brief but perhaps it might explain my earlier query. Of course I might be magnificently wrong!
     
  18. Peter:

    I have tried to stay out of making comments about your bizarre declarations up until now. But this last set of strange comments from you has forced me to speak up.

    First of all, as far as "all mammals, except men, walk on their toes" comment, you obviously haven't studied zoology, have you, Peter?

    Humans, apes, bears, raccoons, opossums, rabbits, weasels, mice, pandas, rats, hyraxes, skunks and hedgehogs all walk with their feet flat on the ground and thus are called plantigrades. Therefore, your comment was wrong since many mammal species, other than humans, walk with their plantar feet on the ground, or on their rearfoot and forefoot.

    Many more species of animals walk on their digits, including cats and dogs, and are called digitigrades. Animals that walk on the ends of their toes on hoofs, such as horses, are called unguligrades.

    And as far as you saying the foot bones are "stapled", I don't know what you are talking about. Have you ever heard of ligaments? The joints of the human foot have variable degrees of stiffness and are held together by viscoelastic structures called ligaments. Some foot joints have large ranges of motion while others have smaller ranges of motion. In addition, there is a relatively wide interindividual variation of ligamentous tensile stiffness from one person to another which causes some feet to have larger ranges of motion (i.e. low stiffness) and other feet to have smaller range of motion (i.e. high stiffness).

    Certainly using an mechanical analogy of a staple, or any other metal fastener, as the structure which best mechanically describes the load vs deformation characteristics of the foot is a very poor one. Perhaps, you would do best to more carefully choose your words here on Podiatry Arena. Better yet, Peter, I suggest that if you don't know something is true, don't make that statement here on this academic forum unless you do know that it is true. It may serve you well in the future in your discussions here on Podiatry Arena if you were more careful in your statements.
     
  19. drsarbes

    drsarbes Well-Known Member

    "A force is needed to keep the foot bones locked (thanks Ian Linane). This force is mainly generated from the intrinsic foot muscles, supported by the plantar ligaments..............."

    Well, one small point I'd like to interject.
    If this above statement was true then the effects of PTTD or traumatic rupture of the posterior tibial tendon would not result in severe pes planus since this is an extrinsic muscle. Apparently the intrinsics and the plantar ligaments need a bit of help.

    In fact, if one were to ask me to create a severe pes planus by cutting one structure in the foot it would NOT be a plantar ligament nor the plantar fascia nor any one of the instrinsic muscles, I would simply take my #15 blade and cut the Posterior tibial tendon.

    Job done. Thank you

    Now lets head to the beach.

    Steve
     
  20. Yes, many people feel that we should discuss biomechanics in a less mechanical way.

    Don't know how this situation crept in.
     
  21. davidh

    davidh Podiatry Arena Veteran

    Small point - rabbits don't walk plantigrade. Not cottontails (which we call rabbits in the uk) anyway.
     
  22. David:

    You may want to check out this Wikepedia reference:

    http://en.wikipedia.org/wiki/Plantigrade

    ...and also this Wikipedia reference...

    http://en.wikipedia.org/wiki/Digitigrade

    When moving by walking, rabbits will go up on their toes briefly, and lift their heels off the ground, just as the plantigrade human will not always have the heel on the ground during walking locomotion. When rabbits hop fast, they will keep their heel off the ground just as a sprinting human will not have their heels touch the ground. When rabbits rest on all four limbs, they are plantigrade just as the bipedal human rests their heels on the ground during relaxed bipedal stance. Rabbits are therefore plantigrade, even though, during higher locomotor velocity, they are only up on their toes.

    Below are two examples of rabbit skeletons.
     
  23. David Smith

    David Smith Well-Known Member

    Yes Robert I have to agree, I always think that when discussing forces and structures and biomechanical mechanisms it is best to be less mechanical, stands to reason - innit! :wacko: Ahh! I've got it lets talk Bioschisms, Hooray!

    Schisms A disagreement that causes a split of affiliation

    Bioschism - the inability to agree with anything to do with the body combined with the tendency to start a new paradigm of non mechanical models.

    I've started Bioschisms.com anyone like to be a founding member (Robert?:drinks)

    Watch this space

    Dave:D
     
  24. toomoon

    toomoon Well-Known Member

     
  25. toomoon

    toomoon Well-Known Member

    David.. in Australia, rabbits are vicious nasty rodents, not unlike that seen in the pit in Monty Python's Holy Grail. Best to steer clear of them at all costs.. but..I have to agree with Kevin, as they take off to leap for ones throat.. they are plantigrade.. S
     
  26.  
    Last edited by a moderator: Sep 22, 2016
  27. Rabbits are plantigrade unless......they are killer rabbits....

     
    Last edited by a moderator: Sep 22, 2016
  28. davidh

    davidh Podiatry Arena Veteran

    Thanks for coming back on this one guys.
    I have to confess to being a bit of a rabbit-watcher. I shoot them sometimes, for food (human or canine), mostly at close range (sub-30 metres), and this can involve me laying-up in a hedge for several hours at a time. Sometimes I watch instead of shooting.......

    I can't think i've ever seen a rabbit ambulate heel-to-toe, but I can certainly see the difference in skeletal makeup between a rabbit and a horse.

    BTW both my dogs (lurchers) will frequently rest with both feet (heel and toe) on the ground.
    When standing, walking or running they go onto their toes of course.

    For me, the most interesting part of this thread;).
     
    Last edited by a moderator: Sep 22, 2016
  29. davidh

    davidh Podiatry Arena Veteran

    Just to add I was out this morning at first light. I watched three rabbits. If they can get away with it in cold weather and they are in or near cover, they will creep silently away rather than run. This is probably as near as they get to walking. Otherwise they hop which starts off as foot-flat, then a light spring forward. So no heel-strike, but certainly foot-flat and onto toes - interesting!

    Kevin, you were right.

    In creeping rabbit's heels do not touch the ground.

    I watched one of my dogs come up from a crouch when both back feet (heels and toes) were on the ground. It's the same action as the bunnies when hopping - a bit more energetic though.
     
  30. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Hi Peter,

    I agree with you in that the foot is too frequently discussed in terms of pure mechanical models. Many Podiatrists view foot motion and and the resulting postural distortions in terms of Newtonian Physics.

    Last year I wrote a paper that suggests another paradigm might be in play. I termed this model Neurophysiological.

    Take a read and let me know what you think.

    Brian
     
  31. efuller

    efuller MVP

    Brian, it's unfortunate that your reputation has made is so I'm not going to bother to read the link. You are welcome to post a short or long version of your Neurophysiological theory for critical review. However, the neuro physiological can be, and has to be, included in the Newtonian physics explanation of what happens to the foot. When things move, something has to applied forces to make it move. When things break, forces were applied to break it. The neuro part is the signal to the muscles to contract. When the muscles contract there are forces applied and these forces have to be accounted for in a complete Newtonian physics analysis of foot injuries.

    Now, I concede that there are some neurologically mediated cases of foot pain. There you do want to understand how the nerve is damaged. It could be mechanical damage to the nerve at some location outside the foot or it could be chemical damage (e.g. diabetic neuropathy). Brian, can you give an example of when Newtonian physics has been discussed too often? I'd say that when we discuss Newtonian physics, we have been discussing mechanically caused pain.

    Eric
     
  32. Brian A. Rothbart

    Brian A. Rothbart Active Member

    The paper was peer reviewed. Having it published was no small feat considering how controversial the subject is.

    If you are not inclined to read the paper, so be it. However, It would make an interesting discussion because what I suggest is so different from the traditional biomechanical paradigms of Root and others.

    Brian

    "Those that can, do. Those that can't, criticize"
    Socrates, 411BC
     
  33. efuller

    efuller MVP

    Then go ahead and post it here. Do it, Brian.
     
  34. Brian A. Rothbart

    Brian A. Rothbart Active Member

  35. Yeah, Brian, Mert Root never suggested that his orthotics would cure infertility.

    And that is the problem with doing what you do, Brian, making outrageous claims and making statements that are, frankly, laughable. Even though you may know something, no ethical or intelligent podiatrist will ever take you seriously because of your bizarre behavior and outlandish claims.

    So Brian, you first practiced in the USA, then moved onto Mexico, then moved onto Italy and now you are in Spain.....what country will next be the guest of the famous Father of Chronic Pain Elimination?
     
  36. Yeah! Physics! Pfft. What's that got to do with motion? Crazy idea!
     
  37. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Eric,

    It is posted. Have you read the paper?

    Brian
     
  38. Oh that one! Yeah, I wrote a response in the same journal the following month. Perhaps Bill might like to reproduce it.

    Love how you included the miraculous Down's syndrome before and after photos. Real classy.
     
  39. toomoon

    toomoon Well-Known Member

    PMS??? I think that nomenclature has already been reserved Brian.. for the storm before ...'the curse"..
     
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