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Is Scoliosis Linked to Abnormal Pronation?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Nov 22, 2022.

  1. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


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    Is gravity drive (abnormal) pronation linked to Scoliosis?

    I have theorized that:
    • Left foot Gravity drive (abnormal) pronation drives the left innominate bone forward and downward
    • This anterior rotation of the left innominate bone displaces the acetabulum cephalad, and with it, the head of the left femur.
    • The cephalad displacement of the left femur head thus functionally shortens the left leg (e.g., Functional Leg length Discrepancy)
    • Standing, the pelvis tilts downward towards the left side until the left foot rests on the ground
    • This left tilt in the sacral base can destabilize the superincumbent spine and result in a left thoracic scoliotic curve.

    If this proposed algorithm is valid, one would expect:
    • A gravity drive pronation pattern of left > right, would be linked to a left thoracic scoliotic curve.
    • A gravity drive pronation pattern of right > left, would be linked to a right thoracic scoliotic curve.
    In a research paper I published in Podiatry Review (2013), 25 patients demonstrating gravity drive pronation, 23 of those patients followed the above algorithm.

    Rothbart BA 2013. Preliminary Study: Adolescent Idiopathic Scoliosis Linked to Abnormal Foot Pronation. Podiatry Review Vol 72, No 2:8-11.
     
    Last edited: Nov 22, 2022
  2. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Gravity Drive Pronation (GDP) is a symptom just as a fever is a symptom. To effectively reverse or prevent AIS (Adolescent Idiopathic Scoliosis), the cause of GDP must be determined and treated directly.

    Two of the most common causes of Gravity Drive Pronation are:
    • PreClinical Clubfoot Deformity and
    • Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot).
    An orthopedic group in Cyprus forwarded Xrays of an AIS patient in which they used proprioceptive insoles (only). The Cobb Angle decreased 12 degrees within 12 months! (See Attachment - Pre vs Post ProStim Tx)
     

    Attached Files:

  3. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Avoid Surgery, if possible - Case Study

    History: The parents of a 15-year-old girl were concerned over the visual appearance of their daughter’s back and that it might be getting worse. They brought her to see an orthopedist.

    Initial Xrays were taken at the hospital. The radiologist's report indicated that the girl's double scoliotic curve was well compensated (stable).

    Postural photos suggested the patient as having a PreClinical Clubfoot Deformity.

    The Orthopaedist disagreed with the Radiologist's report.
    • He diagnosed the girl as having adolescent idiopathic (cause unknown) scoliosis. (In fact, the cause of the AIS was the PreClinical Clubfoot Deformity)
    • He told the parents that the right thoracic curves are most unstable around the time of the beginning of menstruation and that these curves are prone to worsening if not surgically stabilized.
    Based on the orthopedist’s recommendation, the parents consented to the surgery.

    Surgical Results: PreOp vs Immediately Post-Op (See Attachment 1)
    • Xray A: Cobb Angles immediately before surgery: 32/28°
    • Xray B: Cobb Angles immediately after surgery: 36/22°
    Follow-Up:

    Six months after the surgery, the parents brought their daughter to see the orthopedist, anxious over the cosmetic appearance of their daughter’s back, which appeared to be worse than it was before the surgery (See Attachment 2)

    The patient was referred to a radiologist for another set of Xrays.
    • The right thoracic curve was 52 degrees (a 20-degree increase compared to before the surgery was done)
    • The left thoracolumbar curve had lost its surgical correction and was now measuring 28 degrees (the same as prior to the surgery) (See Attachment 1).
    Discussion:
    • Prior to the surgery, the 15-year-old female had a well-compensated (stable) double curve pattern.
    • One year post surgically, the spinal curves were unbalanced, unstable and getting worse.
    • The girl’s cosmetic appearance had deteriorated.
    This presents a strong argument of avoiding surgery, if possible, especially in the presence of a PreClinical Clubfoot Deformity.


    Attachment 1.jpg
    Attachment 1 (Pre Surgery, Immediately Post Surgery, 6 months Post Surgery)

    Attachment 2.gif
    Attachment 2

    Reference:
    Weiss HR 2007. Adolescent Idiopathic Scoliosis - case report of a patient with clinical deterioration after surgery. Patient Safety in Surgery Journal, 1(7) Online at www.pssjournal.com/content/1/1/7
     
  4. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Most common Complications encountered with spinal fusion

    1. Loss of normal spinal function, irreversible loss of the normal ability of the spine to move. Spinal fusion is correlated with significantly reduced range of motion over the entire spine, including the nonfused segments [1, 2].

    2. Strain on unfused vertebrae as the patient attempts to carry out normal activities requiring spinal motion [1, 2].

    3. Post-surgery pain which can immediately after surgery or after 10 years or more, is the primary reason patients have to be operated on more than once [1].

    4. Reducing the lateral curvature in thoracic scoliosis can exacerbate the sagittal deformity and cause flattening of the cervical, thoracic and/or lumbar spine beyond that caused by the deformity itself [5].

    5. The rib hump can worsen after spinal fusion [3].

    6. In one study 40% of the patients treated surgically as adults required salvage surgery within a follow-up period averaging 55 months after surgery [4].

    • 1. Hawes M: Impact of spine surgery on signs and symptoms of spinal deformity. Pediatr Rehabil. 2006, 9 (4): 318-39. 10.1080/13638490500402264.
    • 2. Goldberg CJ, Moore DP, Fogarty EE, Dowling FE: Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery. Spine. 2001, 26: 42-47. 10.1097/00007632-200101010-00009.
    • 3. Hill D, Raso VJ, Moreau K, Moreau M, Mahood J: Long-term follow-up of surgically treated AIS patients. Stud Health Technol Inform. 2002, 91: 477-80.
    • 4. Berven SH, Kao H, Deviren V, Bradford D: Management of thoracic pseudarthrosis in the adult: is combined surgery necessary?. Proceedings, Scoliosis Research Society 36th Annual Meeting. 2001
     
  5. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Gravity Drive pronation, when asymmetrical, can result in a Functional Leg Length Discrepancy

    1. Gravity Drive Pronation (due to PreClinical Clubfoot Deformity, RFS, or any other primary aetiology) pulls the innominate bones anteriorly (forward and downward)
    2. This forward and downward rotation of the innominate bones displaces the acetabulum and femur heads cephalad.
    3. The cephalad displacement of the femur head functionally shortens the legs.
    4. Standing, the pelvis drops downward towards the side in which the acetabulum is more superiorly displaced.​

    The attached animation pictorializes the pathomechanical events associated with a Gravity Drive Pronation pattern is left > right.

    1. The left foot is more pronated (e.g., the PreClincal Clubfoot Deformity is greater in the left foot)
    2. This drives the left innominate bone is more anteriorly (relative to the right innominate bone) which results in the left acetabulum and femur head being more cephalad (superiorly) displaced relative to the right acetabulum and femur head.
    3. This results in a Left Functional leg length discrepancy (left leg functions short)
    4. Standing the pelvis drops to the left (on the transverse plane) until the left foot reaches the ground.​

    If the Gravity Drive Pronation pattern is right > left, the pathomechanical pattern is the mirror image of the above resulting in a Right Functional leg length discrepancy (right leg functions short).
     

    Attached Files:

  6. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    The Below animation demonstrates the frontal plane changes in the curves of the spine resulting from a Gravity Drive Pronation Pattern Left > Right:

    1. Left innominate rotated forward and downward which functionally shortens the left leg
    2. Standing, gravity pulls the pelvis downward towards the left side until the left foot rests on the ground
    3. This unlevels the sacral base, tilting to the left
    4. The spine compensates:
    Right Scoliotic Lumbar
    Left Scoliotic Thoracic


    LLD-Study-with-Spine.gif





     
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