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Let the foot pronate - it is physiologic

Discussion in 'Introductions' started by Peter W.B.Oomens, Jan 9, 2012.


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    Let the foot pronate – it is physiologic

    I walked many km’s over the beach, studying barefoot imprints in the sand. Since pronation is ‘hot’ in all kind of publications, I expected more pressure under the medial arch then lateral. . . I have not seen one sand imprint like this. . . all barefoot prints were deeper laterally. . .
    This means, at least walking barefoot, that pronation has to correct and in fact corrects itself! Which in my opinion is only possible by means of a dynamic functioning of both intrinsic and extrinsic foot musculature.



    As a posturologist I have successfully treated many patients suffering from chronic postural disorders as e.g. low back pain. For over 20 years I provided them mostly with so called podopostural insoles, always individually made. On these thin insoles pieces of cork (1 à 2 mm thickness) are glued at special zones.
    The theory behind this treatment claims that the skin of the foot sole is very sensitive to all kind of (subtle) stimuli and, loaded, for pressure (baroreceptors). We can walk barefoot on the beach, at the street and in the bush, but most of us can not resist tickling of the foot sole. This sensitivity is also known from the ‘withdraw reflex’, when we step accidently on some hurting object.
    By providing patients with these individual insoles, therapists can influence their posture and, as a result, often their pain. Once the patient’s posture has been changed the insoles can be left out.

    (Ant)agonist innervation of the lower leg and the foot:
    When we study the segmental (skin) innervation scheme of the lower extremity, starting from the foot, we’ll find the segments S 2, S 1 and L 5. Toward proximal the innervation change to the levels L 2 - L 3 - L4 (the m iliopsoas).
    However the mm gluteus maximus, biceps femoris, obturatorius internus and the m. piriformis, all at pelvis level, are again segmentally innervated from L 5, S 1 and S 2 !

    This implicates that both the m. abductor hallucis and the m. gluteus maximus are innervated from the same levels: L 5 – S 1 – S 2! To better understand this we have to talk about so called muscle chains.
    Let us discuss for a moment the m. abdutor hallucis. During pronation this muscle together with the m. tibialis posterior becomes stretched. This results immediately in a contracting force of both muscles: excentric contraction. Toward proximal the same happens to the hip abductors: mm piriformis, obturatorius internus, biceps femoris and gluteus maximus. But also the antagonists, innervated from the same segments, contract reciprocally at the same moment to avoid an overreaction. In fact we can not talk about an isolated action: we talk about a re-action from all involved muscles: a muscle chain.
    So both intrinsic and extrinsic foot muscles help to maintain a tension under the medial arch during walking and running.

    I have therefore many doubts about the almost standard use of medial arch supports in footwear by people with healthy feet…! And I am not the only one (Nigg, B.M. Biomechanics of Running Shoes. Human Kinetics Publishers,Champaign, Illinois, 1986)



    Netherlands,
    Peter W.B.Oomens
    November 2011
     
  2. MJJ

    MJJ Active Member

    Does one structure being lower than the other mean that there was more pressure there, or just that it is lower?
     
  3. Just that it is lower. Structures at different levels become innervated from the same segments. This happens only at the lower extremities, not at the arms.
     
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