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FIX FOOT PROBLEMS WITHOUT ORTHOTICS Donald McDowall, DC, DIBAK Macquarie Chiropractic Clinic 4 Weedon Close, Belconnen, ACT, Australia, 2617 Ph. 61262515477 Fax 61262531773 [email protected] www.chiroclinic.com.au ABSTRACT A new approach to supporting the functional movement of the foot without the use of orthotics is discussed. A short review of myo-tendinous attachments of the foot is presented with associated treatments. INTRODUCTION Epidemiologic Studies provide strong support for the clinical advantages of orthoses, yet explanations of foot orthotic mechanisms remain elusive. Researchers await a more complete theoretical understanding of the mechanisms of foot orthotics(1). Some studies are considering the 3-dimensional effects of subtalar joint motion on the entire kinetic chain (2). Chiropractors and other manipulators have developed techniques to treat a variety of foot conditions. Some even propose using this area of skill as a bridge to working with physical therapists (3). Probably the most often a chiropractor looks at the feet is indirectly when checking for a leg length discrepancy. At this time the most common observation is usually of foot rotation (4). Walther describes a variety of approaches to resolving foot problems (5). I will not discuss existing techniques in this paper. I will use the graphics of Netter to illustrate the attachments of the lower leg muscles at both their origin on the femur, tibia and fibula and their insertion on the foot. I will demonstrate testing the integrity of these muscles quickly and efficiently for diagnostic purposes and a treatment procedure for rapid correction. DISCUSSION Persistent foot pain can represent a multitude of disorders. One study of “Burning feet syndrome” found that nerve related treatment was not effective. Treatment for rheumatism also failed. However uric acid retention was causing the problem. A B vitamin deficiency discovered during the 2nd world war observing suffering POW’s was prescribed and immediately resolved the problem (6). Chronic ankle instability can slow down weight transfer from heel strike to toe off reducing the impact at the end of the stance phase of walking and restrict the lateral shift of body weight (7). Evidence now shows that the weight distribution of the body through the foot is not according to the “tripod” theory but that the peak pressure of weight in the normal person is 2.6 times greater under the heel than on the forefoot. In fact, load distribution was measured as 60% at the heel, 8% at the mid foot and 28% at the forefoot. Toe weight was almost unmeasurable (8). Other studies show that there is a lack of a relationship between peak foot pronation and the rotation of the tibia and femur contrary to the clinical hypothesis that increased pronation results in greater lower extremity rotation (9). The authors made the recommendation that each patient should be individually assessed because the dynamics can be so different case to case. The benefits of biomechanical correction of the foot can assist in more rapid healing of diabetic foot ulcers (10) to playing better golf (11, 12, 13, 14, 15, 16,). Most biomechanical correction is either serendipitous secondary to spinal alignment or by direct intervention using orthotics. The days of inflexible, forceful orthotics and the pain they induced in attempts at correction are numbered. Today research is supporting the use of comfortable more flexible supports to encourage better muscle function (17, 18). Recent evidence suggests that proprioceptive influences play a large, and perhaps largely unexplored, role in resolving foot problems (19). DIAGNOSES OF FOOT MUSCLE ATTACHMENTS 1. Test all foot muscles in bent knee positions. Prone for popliteus, hamstrings, gastrocnemius, plantaris, soleus, posterior tibial, toe flexors and adductors. Supine for the peroneus group, anterior tibial, popliteus, quadriceps, toe extensors 2. Observe and note weaknesses. 3. Therapy localise attachments where appropriate using an upper body indicator muscle while the patient sits or lies (whichever is most comfortable). 4. Challenge the muscle attachment and retest the muscle to observe response. 5. Remember to post check the Patella movement and straight leg quadriceps test for final lower leg stability. 6. Check full single leg weight bearing with indicator muscles to observe any residual irritation. TREATMENT 1. Using a firm heavy digital pressure, adjust the muscle attachment in the direction that produces strength in the previously weak muscle. 2. Be sure to check both origin and insertion. 3. Check for ligament nutrition and octocasonal support. 4. Review results in 24 hours and if stable then in 1 week after normal sport and activity. PATIENT MANAGEMENT 1. Encourage the patient to use the golf ball, marbles, belt and towel exercises each night. 2. After exercise have the patient use a foot bath with mineral salts for 10 minutes. Some evidence shows that essential oil of lavender is associated with small but significant changes in autonomic activity producing relaxation ( 3. Then encourage the patient to massage emu or crocodile oil into the foot. 4. This should be done for 1 week after treatment SUMMARY My observations are an application of Goodheart’s work regarding origin-insertion technique recorded in his 1964 manual. I have applied these observations in regard to the effect of micro avulsion of the periosteal attachments of the tendons being the first initial injury of most foot problems. These are easily fixed leaving the use of orthotics to chronic pathologies of the foot. REFERENCES: 1. Ball, K.A., Afheldt, M.J, “Evolution of foot orthotics-Part 1: coherent theory or coherent practice? JMPT, Vol 25, No 2, Page 116 (Feb 2002). 2. Ball, K.A., Afheldt, M.J, “Evolution of foot orthotics-Part 2: Research reshapes long-standing theory. JMPT, Vol 25, No 2, Page 125 (Feb 2002). 3. Lawrence, DJ, “Chiropractic manipulation for the foot: diversified chiropractic techniques. Manual Therapy, Vol 6 No 2, Page 66, (May 2001). 4. Knutson, GA, “Incidence of foot rotation, pelvic crest unleveling, and supine leg length alignment asymmetry and their relationship to self-reported back pain. JMPT, Vol 25 No 2, Page 110 (Feb 2002). 5. Walther, DS, “Orthopedic conditions” Page 446-469 in Applied Kinesiology Synopsis 2nd edition, Systems DC, Colorado (2000). 6. Nutrition News, “Burning feet syndrome”, June/July 1985. 7. Nyska, M. et al., “Dynamic force distribution during level walking under the feet of patients with chronic ankle instability, BjofSMed. Vol 37, No 6 (Dec 2003). 8. Cavanagh, PR, et al. “Pressure distribution under symptom-free feet during barefoot standing” in (“Foot Ankle” 1987: 7: 262-76). JMPT, Vo1 1, No 1, Page 63, (Feb 1988). 9. Reischl, SF, et al. “Relationship between foot pronation and rotation of the tibia and femur during walking”. JMPT Vol, 23, No 4, Page 305, (May 2000). 10. Medscape, “Correcting biomechanical abnormalities greatly reduces risk of diabetic foot ulcers”. Mar 1, 2002. 11. Stude, DE, Gullickson, J. “The effects of orthotic intervention and 9 holes of simulated golf on gait in experienced golfers”. JMPT, Vol 24, No 4, Page 279 (May 2001). 12. Stude, DE, Gullickson, J. “Effects of nine holes of simulated golf and orthotic intervention on club-head velocity in experienced golfers”. WWW.footlevelers.com. Jul 10, 2001. 13. Stude, DE, Gullickson, J. “Effects of nine holes of simulated golf and orthotic intervention on gait in experienced golfers”. WWW.footlevelers.com. (July 10, 2001). 14. Stude, DE, Gullickson, J. “Effects of nine holes of simulated golf and orthotic intervention on balance and proprioception in experienced golfers”. WWW.footlevelers.com. (July 10, 2001). 15. Stude, DE, Gullickson, J. “Effects of orthotic intervention and nine holes of simulated golf on club-head velocity in experienced golfers”. JMPT, Vol 23, No 3, page 168. (Mar/apr 2000). 16. Stude, DE, Gullickson, J. “Effects of nine holes of simulated golf and orthotic intervention on balance and proprioception in experienced golfers”. JMPT, Vol 20, No 9, Page 590. (Nov/Dec 1997). 17. Mundermann, A. et al. “Orthotic comfort is related to kinematics, kinetics, and emg in recreational runners”. Med and Sci in Sp and Exercise. Vol 35, No 10, (Oct 2003). 18. Kuhn, DR, et al. “Radiographic evaluation of weight-bearing orthotics and their effect on flexible pes planus”. JMPT. Vol 22 No 4, Page 221. (May 1999). 19. Ball, DA, Afheldt, MJ, “Evolution of foot orthotics-Part 2: Research reshapes long-standing theory”. JMPT Vol 25, No 2, Page 125. (Feb 2002). 20. Saeki, Y, “The effect of foot-bath with or without the essential oil of lavender on the autonomic nervous system: A randomised trial”. Comp. Ther. In Med. Vol 8, No 1, Page 2. (Mar 2000).