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Is foot pathology all in the foot?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by achilles, Jul 29, 2006.

  1. achilles

    achilles Active Member

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    Dear All,
    I somewhat sadly have been reading many of the threads on the forum lately and what seems to become very apparent is that many of the pathologies etc focus purely around foot disfunction.
    There seems to be some who believe that foot function affects little above the lower limb, and I would argue that many of the concepts we apply are still to be judged on their efficacy, although many would say they do work.
    I would like to know what the opinions are regarding the of the upper body etc on foot function. e.g the effect of weak external rotators allowing excessive internal rotation of the leg and subsequent torque conversion with the effect of possibly STjt pronation occuring.
    This is just one example of many I am sure, but would appreciate thoughts on this.
  2. Craig Payne

    Craig Payne Moderator

    Tony - there is no doubt that proximal things do affect foot function, but I just wish someone could give me some rational theory on the links rather than some irrational rant about it.

    For eg, there is no doubt that weak gluteals could affect foot function, but why do the irrational believe that all foot pronation can be treated with strengthening the gluteal muscles and orthoses can be thrown away? I call them irrational as I do not think they have even bothered to look at muscle function charts to see when these muscles actually fire (...duh?) or they ignore things like a forefoot varus, that has to pronate to get the medial side of the forefoot to the ground - how can strong external rotators stop that? or tight calf muscles that pronate the mid-foot ...how can strong external rotators stop that? (?duh)

    One of the most dramatic n=1's I have seen is a patient I treated many years ago - both feet pronated equally and no matter what I did to the foot orthoses I could not stop the left foot pronating - despite the similarity between feet....I was dumbfounded :confused: . They had a 3 monthly appointment with an osteopath for a problem in SI joint --- as soon as it the SI joint was manipulated, the left foot orthoses finally started working!! i rang the osteopath for an explanation. No one has yet been able to give me a rational explanation.

    I think the issue is that when it comes to the distal affecting the proximal (ie foot affecting further up the kinetic chain), we do have some good ideas that are biologically plausible and theoretically coherent and have some data to back them up. When it comes to the proximal affecting the distal, what we have is not necessarily biologically plausible and theoretically coherent and many of the proponents very clearly have a very very poor understanding of foot function. I need researchable hypotheses that make sense.

    The best I have found so far is Wolfgang Schamberger's: The Malalignment Syndrome: Biomechanical and Clinical Implications for Medicine and Sports, but that is also limited by a poor understanding of foot function.
    Last edited by a moderator: Jul 30, 2006
  3. conp

    conp Active Member

    Who said throw away orthoses? (Yes that would be irrational)

    However, is it irrational to think that better proximal 'form' may benefit things distally? Not from where I see it. I always get a wheel alignment with my new set of tyres.
  4. Craig Payne

    Craig Payne Moderator

    I have sat thru 2 presentations in which physiotherapists have claimed exactly that...."strengthen the gluteals/external rotators and you don't need orthotics"

    There was some comments on this in this thread:
    Running barefoot vs running with shoes

    Here is one comment I made in the that thread;
  5. achilles

    achilles Active Member

    I agree with your comments, and would not suggest " throwing the baby out with the bath water!"
    However, when I read and digest the different arguments for types of orthoses and application of biomechanical (physics?) paradigms, they are all foot centred.
    Now I realise this is a Podiatry forum and therefore has a natural bias towards the foot,but as conp has said :
    When having a service do we not check the engine??
    We spend a lot of time looking at the extrinsic factors that affect the foot,should we not also look at the intrinsic factors that affect the foot also.
    Do these not have equal merit??

  6. Ian Linane

    Ian Linane Well-Known Member


    Just back from a sports therapy course focusing on Mobs from foot to hip. Intersting stuff and good to pick it up again. Also interesting to be reminded how hip mobs certainly changed foot contact by reducing the level of external rotation at heel contact.

    Particualrly intriguing was a chap with marked inversion of the heel in stance and gait. Main reason: missing calcaneo fibula and posterior talofibula ligament. The other foot, intact was also markedly inverted in stance and gait. Chap also exhibited marked hip external rotation in stance and gait.

    OK soft tissue stuff recognised. Being the only pod there I mentioned that although some mobs had begun improving foot function the guy was actually structuraly unstable and could likely benefit from orthosis or lateral wedging intevention. Head against a brick wall springs to mind. He did not "feel unstable" he says. Well he is not likely to as he has always, since memory, walked like that.

    Sadly I was not able to demonstrate the remarkable postural change he could have undergone with simple wedging.

    There was certainly some, apparrently, positive gait changes via the mobs at the hip and knee
  7. Brian A Rothbart

    Brian A Rothbart Active Member

    Dear Achilles,

    Have you been reading my posts?

    Brian R
  8. Scorpio622

    Scorpio622 Active Member


    Nutation is thought to tense the hamstrings and potentially decrease available external hip rotation. Perhaps this has something to do with it- that is if you buy into the notion that the tiny motions of the SIJ have biomechanic consequences.

    Another possibility- SIJ pain caused reflexive guarding that limited external rotation.

    Just some thoughts........

  9. efuller

    efuller MVP

    Newton's third for moments

    Hi all,

    When looking at the proximal controlling the distal you have to look at the moments created and understand that for every action there is an equal and opposite reaction. If your foot is on the ground and you contract a muscle that externally rotates the thigh on the hip, the muscle will also create a moment that will "internally" rotate the hip and trunk on the thigh. Yes, there is a lot of inertia in the trunk, but it is not stabilized by anything, but the foot is stabilised by the ground. So to get the foot to supinate, the supination moment from above has to be greater than the pronation moments from the ground.

    Additionally, you have to look at the force transmission from the femur to the tibia and then to the talus. It would be interesting to look and see how torsionally stiff the knee is in regards to transverse plane motion. Would the knee be "happy" transmitting this torque?

    As Craig pointed out there can be changes in foot function after changes at the hip. This could be explained by before treatment there being some pain associated with the motions seen and then after treatment the pain avoidence is gone. I'll leave it to others to figure out how gluteal strengthening effects foot motion. I'm still working on the foot.

  10. Freeman

    Freeman Active Member

    Personally, I could not imagine encouraging a person to wear good shoes, orthotics and not, as well try to maintain optimal "whole body" good posture. I do not spend a great deal of time in my office trying to teach posture but when I see some hideous postures, I send them out to physios, chiropractors, massage therapsists, osteopaths and OT's...with whom I have good relationships. As a pedorthist who spends more than his share of time at grinders, casting and on hands/knees, they all have helped me stay relatively fit and comfortable in 25 years of this ergonomically stressful business. Our business logo is "I Stand Corrected".

    Freeman Churchill
  11. Heather J Bassett

    Heather J Bassett Well-Known Member

    What a Brilliant LOGO! hj

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