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Pigeon Toe Gait Corrected with Proprioceptive Insoles

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Jan 11, 2021.

  1. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


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    Take a look at this case study presented by Dr Gerald Smith and tell me what you think.

    Professor Rothbart
     
  2. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    This patient was fitted with proprioceptive insoles manufactured specifically for the Primus Metatarsus Supinatus foot disorder. Based on my research, I believe these insoles function by sending a proprioceptive signal to the cerebellum that instantaneously makes the correction in the angle of gait.
    These insoles must not be used on any other type of foot structure.
     
  3. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I have found, during my 50+ years of clinical practice (and research) that a majority of adducted gait patterns in children is a compensatory mechanism. That is, the child adducts (subconsciously) to ameliorate the discomfort resulting from gravity drive (abnormal) pronation.

    To be more specific, I have found that torsional abnormalities in the femur or tibia are far less frequent as a cause of adduction (compared to the compensatory adduction resulting from hyperpronation).

    I have also found that two of the most common causes of gravity drive pronation are:
    • PreClinical Clubfoot Deformity and the
    • Primus Metatarsus Supinatus foot structure
    These children frequently exhibit an adducted gait pattern.

    In the above example, submitted by Dr Smith, you can visually see the dramatic attenuation of the adduction when the child wears the proprioceptive insoles.
     
  4. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

  5. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Over 1000 views. Any comments?
     
  6. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    In 1988, I published a paper linking an adducted gait as a common compensation, to attenuate gravity drive (abnormal) pronation.

    The above is an excellent example. I believe Smith diagnosed this adolescent as having the Rothbart Foot Structure, which is a common etiology for gDP.

    • Rothbart BA, Esterbrook L, 1988. Excessive Pronation: A Major Biomechanical Determinant in the Development of Chondromalacia and Pelvic Lists. Journal Manipulative Physiologic Therapeutics 11(5): 373-379.
     
  7. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Over 2300 views and no comments?
     
  8. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    The efficaciousness in using RPI to reverse adducted gaits in children with PreClinical Clubfoot deformity is dramatically demonstrated in the above video.
     
  9. scotfoot

    scotfoot Well-Known Member

    First of all what patient, second, from which structures do these proprioceptive signals originate and thirdly, correct using using which muscles ?
     
  10. scotfoot

    scotfoot Well-Known Member

    Ok , I now see the link to the video of the patient in post #4 . If this is all about proprioceptive signals from the big toe, from which structures do these signals originate? Looks like a mechanical intervention to me.
     
  11. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    The proprioceptive signal are initiated from the mechanical receptors in the bottom of the foot. Specifically from the hallux to the base of the 1st metatarsal.

    Whether the insole function mechanically or as a proprioceptive signal depends on the vertical dimensioning of the medial column (vertical medial elevation). Typically, 1-3 cm acts as a proprioceptive signal. Greater than 8 cm acts as a supportive (mechanical) device.
     
  12. scotfoot

    scotfoot Well-Known Member

    Could you be more specific about which type of mechanoreceptors you think are involved and their location ? For example, do you mean mechanoreceptors located in the epidermis, dermis or in the intrinsic foot musculature?
     
  13. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Currently I believe there is no consensus of opinion as to specifically which cutaneous mechanoreceptors are involved. Inglis et al conclude that it is the vibrotactile receptors embedded in the skin (Slow and Fast Adapting Types I&II) that control the postural shifts. I believe it is the pressure receptors that control the global postural shifts.

    Inglis et al 2002 The Role of Cutaneous Receptors in the Foot. Advances in Experimental Medicine and Biology 508:111-7
     
  14. scotfoot

    scotfoot Well-Known Member

    Cutaneous pressure receptors and not stretch receptors in the intrinsic musculature?
     
  15. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Could be either. But in my research, using the insoles I designed, it seems more logical to me that it is the pressure receptors that are engaged.
     
  16. scotfoot

    scotfoot Well-Known Member

    A few points then, most of which are old ground . Sensory information from cutaneous mechanoreceptors is somatosensory not proprioceptive and so your insoles would not be "proprioceptive insoles ".

    The insoles you designed give the same results as a Morton's extension, according to you .That is to say, a 3mm thick Morton's extension does everything any variation of your insoles can.

    Elsewhere, you have said that progressive collapsing foot deformity and "Rothbart's foot" are one and the same thing. You have also said that progressive collapsing foot deformity can have many causes and therefore, since "Rothbart's foot" is the same as PCFD, Rothbart's foot may be due to a number of etiological factors . "Rothbart's foot" need not be caused by events during embryonic development. It's an inescapable conclusion based on what you have said.

    I feel that discussions around sensory information from the foot and global positioning, a hugely important area, would be more fruitful if you could leave out references to your foot types .

    Have you found that your insoles are less affective in those with foot related neuropathies?
     
  17. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Disagree. The term proprioceptive describes the action of the insoles

    As I have mentioned many times before, the insoles used for Morton´s foot and Rothbarts foot are entirely different. I have explained the difference in great deal above and other threads. Repeating this explanation again, serves no purpose.

    Progressive collapsing foot deformity is a symptom. Flexible adult flatfoot is a symptom. What you have written above is confusing. I have tried to answer these same statements many times. If you read my publications, your questions would be answered.

    Disagree.

    [/QUOTE]Have you found that your insoles are less affective in those with foot related neuropathies?[/QUOTE]

    I only use my insoles to treat RFS and PCFD only. They are very effective in reversing the associated neuropathies.

    Disagree, the terminology I use, IMO, is appropriate.

    I have answered this issue above.

    Disagree. I have attempted to explain on many occasions. RFS is NOT the same as PCFD. At this point, I think it is time to drop this line of inquiry.

    I am at a loss why you would ask this question when I have stated on many many occasions that my insoles are only used to treat RFS and PCFD.
     
  18. scotfoot

    scotfoot Well-Known Member

    Here is what it all boils down to -

    "Romero et al (2023), using a 3mm shim underneath the 1st metatarsal head (see attached photo) decreases (in Newtons) pronation and increases supination (in Newtons).
    Their findings are almost identical to my research findings using Proprioceptive Insoles to treat RFS and PCFD." Brian Rothbart


    [​IMG]
     
  19. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    The proprioceptive I designed to treat RFS (and not the PCFD) is placed along the medial column of the foot. Romero et al placed a 3mm underneath the 1st metatarsal head only. Do not confuse the two! And even so, he reported attenuation in the pronation.

    You are obviously not conversant with my research. Nor are you conversant with the differences between RFS and Mortons Foot. I referred you to an excellent paper delineating those differences, but again, apparently you have not read that paper.

    If you desire to continue this discussion, read that paper.
     
  20. scotfoot

    scotfoot Well-Known Member

    Romero et al placed a Morton's extension beneath the 1st met head only, in subjects with excessively pronated feet. This gives the same results as your variable insoles produce for "RFS" and "PCFD", according to you . Therefore a simple 3mm Mortons extension does the job for your both of your foot types but your insoles don't, they require specificity.

    No need for dubious foot typing if one merely sticks to the 3mm extension. No need for courses to differentiate between the two that I can see .

    It's simply what you said "Romero et al (2023), using a 3mm shim underneath the 1st metatarsal head (see attached photo) decreases (in Newtons) pronation and increases supination (in Newtons).
    Their findings are almost identical to my research findings using Proprioceptive Insoles to treat RFS and PCFD." Brian Rothbart

    Also, you have finally given a clear definition of what you mean by Rothbart's foot. You said "Axial rotation of the talar head is the hallmark anatomical landmark in the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot). In Europe this deformity is termed Progressive Collapsing Foot Deformity.


    You have gone on to say that Progressive Collapsing Foot Deformity has a number of etiologies, and so therefore must "Brian's foot" .

    Your research would appear to be near identical to Romero et al . Except they did with a simple 3mm extension what you claim involved a new discovery and complex radiographic analysis followed by careful treatment with non interchangeable orthotics.
     
  21. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


    Disagree. And so would 544 researchers on Researchgate.
     

    Attached Files:

  22. scotfoot

    scotfoot Well-Known Member

    Romero et al does not mention Morton's foot and neither have I .

    Your opinion piece may have had 544 reads but that does not mean 544 agree with you. In fact all 544 may have disagreed with you.

    Why would anyone use your insoles, which require some sort of foot classification process that you invented , when, according to you, a 3mm Morton's extension will do the job just as well?

    If Rothbart's foot is better known as progressive collapsing foot deformity, as you have said , why not just call it that?

    It's simply what you said "Romero et al (2023), using a 3mm shim underneath the 1st metatarsal head (see attached photo) decreases (in Newtons) pronation and increases supination (in Newtons).
    Their findings are almost identical to my research findings using Proprioceptive Insoles to treat RFS and PCFD." Brian Rothbart


    Also, you have finally given a clear definition of what you mean by Rothbart's foot. You said "Axial rotation of the talar head is the hallmark anatomical landmark in the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot). In Europe this deformity is termed Progressive Collapsing Foot Deformity.


    You have gone on to say that Progressive Collapsing Foot Deformity has a number of etiologies, and so therefore must "Brian's foot" .


     
  23. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Received many positive replies with interest regarding this paper. Not one negative reply to date. Have you read this paper?
     
  24. scotfoot

    scotfoot Well-Known Member

    Which paper? I have read the paper linked to below.
    Do you mean the Rothbart vs Morton's foot paper. Did you write this ? Your name does not appear as author that I can see.


    Here is the study (below) that you say got the same results as you. Could you direct me to the study you did with those same results?
    That is to say , Romero et al conducted a scientific study and presented the results . Have you done the same? They don't appear to have referenced your work.

    Published online 2023 Feb 24. doi: 10.3390/s23052505
    PMCID: PMC10007349
    PMID: 36904715
    Pilot Study: Effect of Morton’s Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation
     
  25. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member


    I am the author of Rothbart vs Mortons foot, available for download on Researchgate. I am familiar with the above Pilot Study. Read my paper and then we can discuss the differences between the above Pilot Study and my paper.

    I published two pressure plate studies investigating the changes associated with RFS and PreClinical Clubfoot Deformity. They are available on Researchgate and if you want to read them, let me know and I will provide you with a link for downloading.
     
  26. scotfoot

    scotfoot Well-Known Member

    Why does the article not list you as the author ? Did the original article list you as the author, and did you remove that piece of text before posting it?
    You have written the piece referring to yourself in the third person and the effect is to make it look like the article was written by someone other than you . The effect is compounded by a lack of statement of authorship.

    I would like an answer to the question asked which was- "Here is the study (below) that you say got the same results as you. Could you direct me to the study you did with those same results?
    Do you have a study that has the same results as Romero et al ?

    Re "Rothbart's" foot , I believe the term "Progressive Collapsing Foot Deformity" is in more common use. Embryology is not used in defining this condition at all . You have accepted that Rothbart's foot and progressive collapsing foot deformity are the same thing.
     
  27. scotfoot

    scotfoot Well-Known Member

    I had a poke around your page on Researchgate Brian, and found this article . So it looks like you believe your proprioceptive insoles work by increasing activity in the toe flexor muscles. Is that correct?
    Pressure Plate Analysis of the PreClinical Clubfoot and Primus Metatarsus Supinatus Foot Deformities
    • April 2016
    DOI:10.13140/RG.2.1.3627.4320
    Authors:
    [​IMG]
    Brian Alex Rothbart

    • International Academy of RPT
     
  28. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    Progressive Collapsing Foot Deformity is a term used by Orthopods to describe a foot that the ILA has collapsed to the ground. It is a symptom, not an etiology.

    PreClinical Clubfoot Deformity is a genetic foot type in which the calcaneus and talus have not completed their ontogenetic development, e.g., remain in supinatus. A symptom of this foot type is the weight bearing collapse of the ILA.

    Rothbarts Foot is a genetic foot type in which the talus and with it, the entire medial column of the foot have not completed their torsional unwinding, e.g., remain in supinatus. (In RFS the calcaneus has completed its´ torsional unwinding.) Typically, on weight bearing, the ILA is depressed, but Not collapsed. Applying the term progressive collapsing foot deformity to this foot aberration would be, IMO, inappropriate.

    My pressure plate studies demonstrated an increased toe griping in both RFS and PCFS. But the proprioceptive insoles that I designed and used to treat these foot structures apply vertical geometry along the entire medial column of the foot (RFS). And the medial aspect of the calcaneus with treating the PreClinical Clubfoot Deformity. Whether the mode of action is pressure activated or stretch activitated needs to be elucidated. One thing I can say unequivocally, my insoles do not vibrate nor do they have a rough surface (some studies suggest that vibration and/or rough surfaces activate the plantar cutaneous sensors).

    I understand your proclivity towards increased activity in the foot muscles as a possible mode of action. I disagree with you on this point.
     
  29. scotfoot

    scotfoot Well-Known Member

    Sure, the etiology of progressive collapsing foot deformity, ( Rothbart's foot , same thing according to you ) can be a number of factors, acting together or singly.

    Also, according to you, a 3mm thick Morton's extension gives largely the same results as your insoles . By inference, both of your foot types can be treated by a simple 3mm thick Morton's extension . How much is generally charged for providing an insole with a 3mm Mortons extension? I genuinely have no idea.

    Also, you have finally given a clear definition of what you mean by Rothbart's foot. You said "Axial rotation of the talar head is the hallmark anatomical landmark in the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot). In Europe this deformity is termed Progressive Collapsing Foot Deformity.
     
  30. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    I have stated innumerable times that the terms Rothbarts foot and progressive collapsing foot deformity are not interchangeable.

    Mortons extension, as initially described by Morton, was rigid and thin (almost no vertical dimension) and it extended from the 1st metatarsal head to the hallux. Since then, the extension pad has been modified by different researchers: adding vertical height, placing it only underneath the 1st metatarsal head, making it flexible, etc etc.

    In the above paper, this author placed a 3mm flexible wedge underneath the 1st metatarsal only. Technically this was not a Morton´s extension pad. If you refer to Mortons patent it describes an extension pad that is rigid and has no vertical height, e.g., it is paper thin. The intent was to functionally lengthen the short 1st metatarsal. Not to raise the 1st metatarsal.

    I believe I am the first researcher to place vertical height along the entire medial column of the foot. This included the 1st metatarsal head. If you go back to 2012 on this forum, when I 1st described my research, you can see how it was received. Basically I was accused of misfeasance, if not malpractice. That placing vertical height underneath the 1st metatarsal head would structurally damage the 1st MPJ. In the presence of RFS or the Preclinical CFD, that argument has proven fallacious. Now other researchers are placing vertical height underneath the 1st metatarsal to control gravity drive pronation.

    I have stated many many times using an insole designed to treat RFS in a patient with a PreClinical CF deformity is a misfeasance. Why you state, by inference, the same insole can be used for both deformities, again is erroneous.

    Cost of insoles vary from patient to patient, depending on the type used. Generic insoles are sold by a company in Tacoma WA. You can access their site to see the prices.

    I have written over 50 papers, published on these foot structures. Many of my papers provide a clear definition of Rothbarts foot. On this thread I have provided a clear definition. I am at a loss why you feel this was not previously done.
     
    Last edited: Feb 19, 2024 at 2:54 PM
  31. scotfoot

    scotfoot Well-Known Member

    Perhaps you have, but you have also stated "Axial rotation of the talar head is the hallmark anatomical landmark in the Primus Metatarsus Supinatus foot deformity (aka Rothbarts Foot). In Europe this deformity is termed Progressive Collapsing Foot Deformity.

    Sure, you have said an insole designed to treat " Rothbart's foot" should not be used for preclinical club foot deformity. However, you have also said that a simple 3mm thick Morton's extension gives "almost identical" results as your insoles for both types of foot . So why not just use that ?

    "Romero et al (2023), using a 3mm shim underneath the 1st metatarsal head (see attached photo) decreases (in Newtons) pronation and increases supination (in Newtons).
    Their findings are almost identical to my research findings using Proprioceptive Insoles to treat RFS and PCFD." Brian Rothbart
     
  32. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    If I made this statement, I was not clear in my meaning. I think at this point I have made myself perfectly clear on this subject.


    Romero did report that a 3mm shim underneath the 1st met had attenuates (gravity drive) pronation. But they did not state what pathology they were treating. Gravity drive pronation is a symptom. Many different foot aberrations can result in gravity drive pronation.

    Yes, Their findings are almost identical to my research findings. However, my research deals exclusively with RFS and PCFD.

    You point would be well taken if Romero had stated that he used a 3mm shim underneath the 1st met head in treating RFS (or PCFD) and he was able to reduce gravity drive pronation.

    In my clinical experience, using a 3mm shim solely underneath the 1st met head to treat either RFS or PCFD results in an exacerbation of symptoms.
     
    Last edited: Feb 19, 2024 at 4:23 PM
  33. scotfoot

    scotfoot Well-Known Member

    You did make this statement Brian and its meaning is perfectly clear. If you want to change your mind about what constitutes Rothbart's foot I don't think anyone really cares, sorry .

    Yes they did .

    Taking these statements together you seem to be saying their results are almost identical to your research findings whilst being totally different.
     
  34. Brian A. Rothbart

    Brian A. Rothbart Well-Known Member

    22,000 plus readers on Researchgate are interested. But I do understand that you have no interest in my research.
     
  35. scotfoot

    scotfoot Well-Known Member

    Your research seems to be all about toe flexor muscles and their importance in posture and gait mechanics. This is an area that is of interest to me . I suspect strengthening will have a greater effect than your insoles for many types of foot. Do you have any research to the contrary? Published research that is, not " experience".
     
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