I'd love more time but in reality, I generally have about 10 - 15 minutes of my consult time to perform a concise but thorough biomechanical assessment.
Members do not see these Ads. Sign Up.
Given the time constraints, exactly what tests/assessments are the most important?
Thanks for your thoughts.
<
Determination of the amount of leg length inequality that alters spinal posture
|
The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic
>
Page 1 of 2
-
-
I suppose a good place to start is by asking "why do we perform a biomechanical assessment?"
My answer would probably be that in most cases we are looking for information to (a) help us diagnose any pathology or deformity and (b) gain useful information to assist with orthotic design.
Am I on the right track here?? If so, what tests should be at the top of my list?
Thanks. -
-
What measures do I feel that are most important for writing my prescription
STJ axis position
Maximum eversion height
Medial arch height in stance
Relative length 1st and 2nd met
Promenent plantar fascia
Ankle max dorsiflexion
Gait
Tibial varum in stance
The results of each of those measures will potentially alter my prescription.
Eric -
Hi Eric
Sorry to the OP for diverting the thread but how does tibial angle and 1st met length vary your prescription?
Thanks -
-
What about the 10 second biomechanical assessment:
1. What is the structure/tissue under load that is damaged?
2. How can that load be reduced
3. What (if any) foot orthotic prescription variables can reduce that load?
4. What design features can deliver those prescription variables? -
Sorry for my ignorance but what is "max eversion height?" and how do you measure it? and also do you measure arch height in "relaxed" stance or "STJ neutral" stance?
Thanks. -
Or does the assessment you do depend entirely on the structure/tissue under load?
Thanks. -
Tibial angle
In a patient with high tibial varum and pronation related problems there is a concern when adding a varus wedge effect to increase supination moment that you will also increase external knee adduction moment. This will increase compression forces in the medial compartment of the knee. If I want to add supination moment, I will usually add less in the presence of tibial varum. I will also add another return visit to check on them.
Eric -
http://www.podiatry-arena.com/podiatry-forum/showthread.php?p=226745
I measure arch height in relaxed stance position. There are some feet that will feel disomfort in the arch if you make the arch of the orthotic the height of neutral stance position. When I measure arch height I press gently into the arch and measure the height of my finger off of the ground. I've found I get very few complaints of too much pressure in the arch from the orthotic with this technique. There's a nice little project for someone. Do this measurement and make 3 orthotics, one lower arch, one at standing arch height, one higher. You could look at comfort and symptom relief and patient preference. STJ axis deviation or supination resistance might be a variable to add as well.
Eric -
Eric -
Berms is this 10 minutes just for the hands on assessment ?
or history taking and discussing of treatment options etc etc.
in 10 minutes of assessment time you could do a full Root assessment if you wanted to, palpate the STJ axis weight bearing and none weightbearing, dorsiflexion stiffness at the MTJ´s , supination resistance Eric tests, none weightbearing ankle dorsiflexion testing, lunge test.
if it is for history taking etc as well then re-organise you appointment times imo -
Thanks for the list of assessments you suggested, very helpful. Although I am curious as to why you included a "full Root assessment"?? What exactly do you mean by a full Root assessment and I thought that biomechanics of today had evolved beyond Roots theories and the measurements he advocated?
Thanks. Berms. -
Up 'til now I have been placing the weightbearing foot in close to STJ neutral and then measuring arch height. I do this because that's the joint position and arch height of the foot I (think) I want to achieve when the foot is on the orthotic device. Have I got it wrong? -
ie 10 mins is a lot of time to take measurements - Also a lot of the Root stuff will give you important info as long as you don´t take measure . Forefoot to rearfoot - Supinatus-flat or Valgus, Position of the 1st MTPJ plantarflexed -flat and Dorsiflexed.
Great for ROM and QOM of the joints of the foot - again without taking measurment - eye ball and feel.
So a Root exam without degrees if you will.
People will argue that measurements are only needed if it will change your prescription, but some times a good look and feel will give you information. -
Thanks, Berms -
Dorsiflexion stiffness of the 1st ray ( I never mentioned but) Would/could be used to look at MLA stiffness - ie a ray with greater resistance to dorsiflexion would indicate a arch which would have greater resistance to elongation without increased pressure on the plantar fascia. Would also help to determine where the GRF moments are coming from as COP move distally.
Got me thinking re ray dorsiflexion stiffness :drinks -
It's all in your history taking, the key thing ;)
-
Eric -
-
-
-
So with your foot as an example, if your device arch height is lower than your STJ neutral arch height.... then how does your orthotic address your medially deviated STJ axis and your FnHL?
Thanks. -
Cheers, Berms. -
Thanks. -
-
I appreciate you and others taking the time to respond to my posts as I am trying to evolve my understanding and the way I practice. -
-
Eric -
Simon is right, you have a great learning opportunity here. You have started to question the validity of the measurements you take because that is all you know.
We've all been there. You want to know what measures are important/worthwhile but more crucially, you need to know why they are important.
I measure almost nothing. Occasionally, I quantify numerically an ankle lunge test. Why do I not measure anything? Because it is unlikely make any difference to what I prescribe.
Craig does a great section in his bootcamps that state that there is only point in testing something if it is likely to affect your prescription. So if I measure forefoot to rearfoot angulation, what can I do with that information? Not much
The biggest thing, in my opinion, is to understand the difference between performing kinetic tests and kinematic tests.
Good luck -
This old thread may be of interest:
Do you take measurements during orthopaedic examination? -
-
-
OK ...what do I do if I don't measure? Good Question;)
Well, as most of the people posting on this thread have mentioned, the assessment that you perform needs to be appropriate to the presenting complaint. So you're history taking is critical to the process.
You then need to identify the injured structure(s). Now, I am a fan of having a diagnosis prior to treatment. That doesn't mean to say that if I don't have a definitive diagnosis, I will not embark upon treatment. As long as I don't feel that treatment will be contraindicated based on the differential diagnosis, I will treat based on a "working diagnosis" whilst further investigations are being performed.
So based on the injured structures and the diagnosis I have arrived at, I will look at potential biomechanical causes of the tissue stress
Unfortunately for you, I cannot give you a list of tests to perform as it depends on the tissue under consideration. However, given that the majority of things that come through my clinic are probably going to be pronation related problems(eg PTTD, plantar fasciitis/MTSS) I am probably reliant on just a few tests to determine the caused of the tissue stress.
Here's the bit that is important. If I perform a supination resistance test. What information does it give me and why is it important. Moreover, what difference does it make to what I prescribe? -
-
-
PS - Im not trying to be a dick... :p -
So lets say I have a patient with typical plantar fasciosis.... Now that I have the diagnosis, what particular tests or assessments are most valid in determining the biomechanical causes of the tissue stress in this case? What tests will give me the information I need to prescribe an effective orthotic device, and why?
I have a basic list of examinations that I would generally perform, such as:-
> Leg Length discrepancy
>Ankle joint dorsiflexion (not exactly sure what to do with this information)
>Subtalar jt range and quality of motion
>Midtarsal jt range and quality of motion
>First Ray dorsiflexion stiffness (not exactly sure what to do with this information)
>First MTP jt range and quality of motion (not exactly sure what to do with this information)
>foot posture in resting stance
>Medially deviated STJ axis?? (I don't measure, I just take an educated guess)
>Arch height
So as you can see I am a bit confused with the whole deal.... I would like to hear what assessments other wiser and more experienced practitioners like yourself would do in this case, and why....
Cheers, Berms -
Eric
Page 1 of 2
<
Determination of the amount of leg length inequality that alters spinal posture
|
The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic
>
Loading...
- Similar Threads - min Biomechanical assessment
-
- Replies:
- 30
- Views:
- 23,975
-
- Replies:
- 0
- Views:
- 159
-
- Replies:
- 1
- Views:
- 1,204
-
- Replies:
- 0
- Views:
- 359
-
- Replies:
- 11
- Views:
- 2,098
-
- Replies:
- 7
- Views:
- 927
-
- Replies:
- 0
- Views:
- 377