Etiology of Gravity Drive Pronation

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Medial column supinatus structurally inverts the medial column of the foot (navicular, internal cuneiform, 1st metatarsal and hallux) relative to the ground. When weight is placed on this foot, gravity pulls the medial column downward until it rests on the ground. This downward pull is termed Gravity drive pronation.

Gravity drive pronation maintains the foot in a pronated position when normally it should be resupinating, e.g., the loose bag of bones syndrome. In time, this leads to many of the symptoms Podiatrists routinely see in their offices: corns, calluses, bunions, neuromas, plantar fasciitis etc.

However, Gravity drive pronation is also linked to global postural distortions (Rothbart 1994, 1995). These postural distortions can result in chronic debilitating musculoskeletal pain. This is why many of your patients may concurrently be suffering from joint and muscle pain proximal to their feet.

Rothbart BA, Yerratt M. 1994. An Innovative Mechanical Approach to Treating Chronic Knee Pain: A BioImplosion Model. The Pain Practitioner (formerly American Journal of Pain Management) 4(3): 13-18.

Rothbart BA, Liley P, Hansen, el al 1995. Resolving Chronic Low Back Pain. The Foot Connection. The Pain Practitioner (formerly American Journal of Pain Management) 5(3): 84-89​

 

Two-foot structures with medial column supinatus (and associated Gravity drive pronation):

1. Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot)
2. PreClinical Clubfoot Deformity

 

ChatGPT defined Gravity Drive Pronation:

Gravity drive pronation is a term used to describe a type of abnormal foot pronation that is driven by gravity rather than by the normal hip rotation. Pronation is the inward and downward movement of the foot that occurs during walking or running. Normal pronation helps the foot absorb shock and adapt to different surfaces. However, excessive or abnormal pronation can cause problems such as pain, injury, or dysfunction in the foot and other parts of the body.

Gravity drive pronation occurs when the foot’s structure is weak or unstable, such as in cases of Rothbarts foot or preclinical clubfoot deformity. These conditions cause the first metatarsal and hallux (big toe) to be structurally elevated, creating an imbalance in the foot. When the body weight and gravity act on the foot, they pull it inward and downward until the entire foot rests on the ground. This results in excessive pronation that is not synchronized with the hip rotation. Gravity drive pronation can also affect the alignment and posture of the knee, hip, back, shoulder, neck, and jaw.

To summarize, gravity drive pronation is an abnormal foot pronation that is caused by gravity acting on a weak or unstable foot structure. It can lead to various musculoskeletal problems and impair the normal function of the foot.

 

So strengthen it and keep it strong.

 

Depending on the foot structure, that could be an excellent approach.

Strengthening exercises are not my first choice of therapy when treating either the PMS foot deformity or the PreClinical Clubfoot deformity. These exercises will certainly help manage the patient´s subjective symptoms. However, if the daily routine is stopped, the pain returns with a vengeance.

 

You don't need to do foot exercises daily to gain strength in the intrinsic foot muscles . 10 mins 3 times a week should do it .

Re compliance, yes, people will fall away from the exercises over time, but they can pick them back up again when the pain starts to return.

About the terminology you use, gravity and hip drive pronation . Do I understand correctly that you mean gravity drive pronation to mean a foot that collapses whilst merely standing on one foot, but hip drive pronation to mean a more stable foot which requires greater ground reaction forces ,produced by muscular input ,for pronation to occur ?

 

Below I have summarized the research done by Close in the 1950s when he expounded on foot pronation/supination patterns.

Transverse plane oscillations of the pelvis direct the motion of the feet. In a closed kinetic state,

• Clockwise rotation of the pelvis pronates the left foot and supinates the right foot.
• Counterclockwise rotation of the pelvis pronates the right foot and supinates the left foot. I refer to this linking between the pelvis and feet as hip drive pronation.

Certain foot aberrations (PMS and PCFD) escape hip drive and forcibly enter gravity drive pronation. I posted the ChatGPT definition of gravity drive pronation, rather well done IMO.

Standing on one foot is challenging for people with PMS or PCFD. Hip drive pronation is a more stable foot structure, but greater ground reaction forces produced by muscular input is not a key factor in the differential diagnosis.

When I have prescribed foot strengthening exercises to my patients with PCFD, the exercises proved ineffective in controlling the musculoskeletal pain unless they were done daily. This may not be the case with other foot abnormalities.

 

Brian, do you know how chatGPT works? When you ask it a question it looks at websites on the internet to attempt to answer the question. If the only mentions of gravity drive pronation are written by one individual ChatGPT will repeat what it has read on the internet regardless of the source.

The single source for gravity drive pronation is someone who has said that the tools that real scientists use to describe what causes motion, gives him a headache. http://podiatryarena.com/index.php?threads/occams-razon-or-the-law-of-parsimony.113264/

The reason that gravity drive pronation is a poor explanation is that the force of gravity acting on the metatarsal is so small compared the other forces. And, so few people stand with their first met head off the ground it does not apply to most people.

This is why one should not use ChatGPT as a reference.

It would be interesting to see if we could get ChatGPT to change if we all wrote..

Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.

 

Brian, you have previously stated that these foot types are variations of progressive flat foot deformity . An orthotic with a Morton's extension gives the same results as your much more foot type sensitive insoles. Why bother with differentiating between your foot types ,PMS and PCFD , when it is not required .

Research shows that pain from flat foot deformity responds better to strengthening than orthotics. Perhaps you used the wrong exercises ?

 

Yes, I am aware how ChatGPT works.

 

Flat foot deformity is a generic term. It is not a diagnosis but rather an observation. A better term, IMO, would be Flat foot condition. I encourage you to read What exactly is a Flatfoot? Are there different types?

PMS (aka Rothbarts foot) rarely results in a flexible flatfoot. The PreClinical Clubfoot Deformity frequently results in a flexible flatfoot. These are two distinctly different foot aberrations and are treated differently.

There are no publications that state strengthening exercises respond better than my proprioceptive insoles when dealing with the PreClinical Clubfoot Deformity. (If I am wrong, please direct me to that publication) With other causes of Flat foot conditions, I offer no opinion.

Regarding the Morton´s extension pad and the insoles I designed 20 years ago to treat PMS, they are not the same insole. Using a Morton´s extension to treat a patient with PMS would result in a disappointing outcome. I encourage you to read Morton´s Foot vs Rothbart´s Foot.

• Rothbart BA 2009. Morton's Foot vs Rothbart's Foot. Are They the Same? Podiatry Review, Vol 66(3):6-9

• Rothbart BA 2009. What exactly is a Flatfoot? Are there different types? Podiatry Review, Vol 66(6):4-6.

 

So a person is walking about on a foot that has not undergone progressive collapse and this foot has a certain osseous morphology . Then the foot does start to collapse .Since the bone structure has not change from not collapsed to starting to collapse, what has changed ?
Perhaps weight gain exceeding the muscular capacity of the foot ?
Shoes make feet weak and insoles are not going to address this deficiency.

Preclinical club foot deformity is not generally recognized as a thing, except by you . You would therefore know better than anyone if there where publications comparing strengthening exercises and Preclinical Clubfoot Deformity since you seem to be the only person working with the construct.

You say you have used foot strengthening in the past for flat foot deformity. Do you still have any of the information sheets given to patients on this subject ?

Brian, you are on record, on this site , as saying that a research group treating progressive collapsing flat foot disorder with a Morton's extension got the same results you did using your orthotics . You also recently said
"For many years, I have been presenting my research on Rothbarts Foot and the PreClinical Clubfoot Deformity (in Europe, termed Progressive collapsing foot deformity)."

 

So the purpose of your statements in posts #3 and #7 were to show that you were able to mislead ChatGPT? It would be very dishonest to imply gravity drive pronation was a valid concept because ChatGPT was able quote your unscientific explanation of what causes pronation. You have said the science of understanding foot motion gives you a headache. http://podiatryarena.com/index.php?threads/occams-razon-or-the-law-of-parsimony.113264/


Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.
Gravity drive pronation is not a valid explanation of foot movement.

 

My research has been accessed over 20,000 times, on ResearchGate alone. On Academia another 5,000 or so reads.

Progressive collapsing foot deformity has been linked to a medial column supinatus. They are silent regarding the position of the calcaneus. Whereas I link PreClinical Clubfoot deformity to a supinatus in both the medial column and calcaneus. I am waiting to see where their research takes them.

The PreClinical Clubfoot deformity and Rothbarts foot were not recognized in the literature before I started publishing on my research. Is RFS only recognized by me? Absolutely not. In Austria alone there are over 200 healthcare providers diagnosing this foot structure and using the insoles I invented to stabilize this foot deformation.

So, similar to the link between the occlusion and foot pronation that I first talked about on this forum and was subject to unprofessional comments (this link is now recognized by many publications). I believe my research will be validated and not in the too far future.

Cheers.

 

Typo error - Australia not Austria

 

I think you will find that whatever the undoubted links between foot problems
and problems further up the kinetic chain ,strengthening will be a key part of any treatment plan and relying solely on orthotics will generally be seen as remiss .
Your insoles do not address underlying foot weaknesses.
Have you ever had a guide for foot strengthening exercises printed up ?

You have stated that "your " foot types are the same as progressive collapsing foot deformity ,they are not magical conditions that only you can diagnose.

 

I was the first researcher to discover these two foot types. For many years I was the only one diagnosing and publishing on these foot types. That has changed in the past 2-3 years where the European Orthopedic community has published on the progressive collapsing foot deformity.

 

So no strengthening exercises leaflet then?
Most effective thing you can do for pain from flatfoot problems, apparently.

I don't see how strengthening can be completely ignored in favour of an orthotic only approach. Posterity will not be kind to a "leave it weak" philosophy.

 

Different strokes for different folks - as they say.

 

CPD Brian ?