Don't ask me why but suddenly, upon reading the phrase, "maximally pronated patient" I had the feeling that the language was too far from describing what was going on. What does it mean to have a 'patient' who is maximally everted, abducted and dorsiflexed? Why is the phrase so far away from describing what's going on?
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If the idea of a maximally pronated patient is difficult for me is the much used "pronated foot" that much better?
Is the "foot" everted, dorsiflexed and abducted?
As the term is commonly used to describe the foot of a person who is standing with their foot/feet flat on the ground it seems to me that the answer to the above questions is no?
If the "foot" is not pronated what is pronated and why isn't it stated clearly?
Bill
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Insomuch as one believes in the theory of what you have just quoted, the answer is that "the joint" is pronated. Since these things happen at a joint, not a functional unit such as a foot, one must go back to basics; it is the joint. Having said that, one assumes that we are talking about the subtalar joint; there is, of course, no such thing in terms of structural entities. It amuses/bemuses (choose your own adjective) that vast numbers of pods fail to understand this. The subtalar joint, as I am quite sure that you understand, is a composite of two separate joints, one part of which is also a part of the so-called midtarsal joint. Easy? No. Nothing about foot anatomy is easy. Rob -
Bill -
Eric -
But to stay on topic my study is the reflexes that occur in one part of the body to compensate for movement in another part of the body. Therefor is the client chronically in a posture that inhibits the supinators and or facilitates the pronators.
So in my discipline I would say the client has a maximum loss of the capacity to supinate the medial arch. -
In the online User Guide and Manual August 2005 the following definition of the FPI is given in the introduction.
"The foot posture index (FPI) is a diagnostic clinical tool aimed a quantifying the degree to which the foot can be considered to be in a pronated, supinate or neutral position."
As "All observations are made with the subject standing in a relaxed angle and base of gait, double limb support, static stance position" it seems that Podiatric biomechanical definitions of supinated and pronated, with respect to foot posture cannot easily be applied?
As you say Eric, a number of different things contribute to foot posture but hey, so far we haven't got a definition of the word posture.
Let me try this one, I've just made up, on for size. "Posture is a position of a body or part of a body and is dependent upon both structural and functional characteristics of the body or part of the body."
The FPI by using the words pronated, supinated and neutral seems to ignore the structural aspect of posture or at least by not clearly stating the structural contribution to posture encourages others to ignore the structural/functional relationship.
It seems to me that, with respect to the FPI, when using Podiatric definitions of pronated and supinated the 'foot' is not in a supinated or pronated position. Whatever supination or pronation has taken place is at at some specific joint/s within the foot and the other part of the posture is due to structural features affecting things like, the angles and positions of axes of motion and the relative positions of bones to one another and the relative position of bones to their axes of motion plus movements that have taken place at other joints in the foot and lower limb allowing the plantar aspect to rest on the ground.
I am now asking myself how the description of the FPI would have to be modified to more clearly identify what it is describing and what value there would be in confining terms like "pronated" to describing the everted, abducted, dorsiflexed position of a foot resulting from motion at joint of the foot having supinatory/pronatory axes of motion.
Then again maybe nothing needs to be changed? Maybe the current popular use of the terms pronated patient, pronated foot and supinated foot are good enough? Oops I need to stop I'm losing my conviction.
Bloody hell did I write all that! I think I need to lie down for a little while to recover.
Bill -
The terms "pronation" and "supination" should be reserved only for discussing the motions of the subtalar joint in the lower extremity. The terms "pronation" and "supination" should not be used to describe the motions of the midtarsal joint since the midtarsal joint does not have a discrete or constrained joint axis, that the subtalar joint seems to have. In other words, it is very easy for the midtarsal joint to dorsiflex, abduct and invert which is not a true pronation range of motion (i.e. pronation is dorsiflexion, adbuction and eversion).
I defined subtalar joint rotational position as being the position of the subtalar joint within the subtalar joint's range of motion (e.g. maximally pronated, neutral position, maximally supinated, 2 degrees from maximally pronated, etc). I defined subtalar joint axis spatial location as being the three-dimensional of the subtalar joint axis relative to another point of reference (e.g. medially deviated, laterally deviated). Therefore, it is very possible for a foot with a high degree of "rearfoot varus deformity" and a limited subtalar joint range of motion to be "maximally pronated" but still have "supination instability" during weightbearing activities (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001).
Therefore, one must not confuse "maximally pronated at the subtalar joint" to indicate that the individual may have increased risk of symptoms caused by excessive subtalar joint pronation moments, since excessive subtalar joint pronation moments are more likely caused by an abnormally medially deviated subtalar joint spatial location than are caused by a maximally pronated subtalar joint. Hope that makes sense. -
OK, here goes. The single plane motions we have are abduction/adduction, dorsiflexion/plantarflexion, inversion/eversion. If I contract that to ab/ad, do/pl, in/ev it's still clear? In fact do/pl could be contracted to d/p and in/ev to i/e and still contain no inherent confusion?
So the motions involved in pronation could be written as "abed" and the movements involved in supination could be written as "padi". Then midtarsal joint motion could be described as "abid" and "adep".
To differentiate between a posture/position resulting from structure (s) or function (f). Hallux valgus or hallux abductovalgus would then become hallux fadse. In a situation where a posture has both structural and functional components sf could be added as a prefix, e.g. Calcaneal sfe or in the case of uncertainty sf?e.
It sounds nonsensical at the moment and I am sure would need a bit/ lot more consideration but there might be something in it?
Bill -
Oh you word smith you!
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Eric -
But seriously, for someone writing off the top of his head even I was surprised by the emergence of the nice little mnemonics "abed" and "padi".
All I have to do now is remember them?
Bill -
Whenever I here the word "index" with respect to linear dimensions my alarm bells go off. And this is for two fundamental, though unconnected reasons. First is the relationship of size and shape; any attempt to remove the "quantity of size" by indexing is naive to say the least. It assumes a Y=MX+C relationship (ie a straight line) which simply does not exist in biology, though many issues may closely approximate to it. The real issue is that bivariate relationships equate to Y=BX to the K (exponent) as in Julian Huxley's bivariate allometry equation. That is, there are no straight lines in biology. The other issue is that the indexing of data frequently buggers up the distribution profile. That is, even if the two (or more than two) data groups may have been normally distributed before, the indexing process may may stuff that up. Normal distribution is an assumed critera for much of standard statistics such and t test or any of its multivariate progressions such as principal components analysis and canonical variates analysis.
Those people using the foot posture index should be well aware of these two issues, and recognise there shortcomings. I have never heard this referred to.
References available for those that want. Rob
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