Download FIXING FEET WITHOUT ORTHOTICS

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).