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Rothbart Proprioceptive Therapy: The Research

Excerpts from over 40 years of research that led to the discovery of a previously unknown source of chronic muscle and joint pain and a solution to permanently eliminate it without drugs or surgery. To learn more go to http://www. RothbartSite.com

PreClinical Clubfoot Deformity vs Clubfoot Deformity

In 2002 I published a paper that described a previously unrecognized embryological foot structure, the PreClinical Clubfoot Deformity. In that paper, I suggested that the PreClinical Clubfoot Deformity is a milder form of the Clubfoot Deformity in which the heel supinatus (inward twisting of the foot) and talipes equinus (downward position of the foot) is not as severe as seen in the Clubfoot Deformity.

Even though the PreClinical Clubfoot Deformity is a milder form of the Clubfoot Deformity, the treatment for these two embryological foot structures is entirely different:

Non-surgical treatment of the Clubfoot Deformity - The Ponseti Method

The Ponseti Method (named after Dr Ignacio Ponseti, 1914 - 2009) advocates treating the Clubfoot Deformity with serial casts (See Photos below) starting within the first two to three months after birth.Typically this incorporates a series of four to six casts over a period of one to two months to reposition and hold the foot in its correct position. In some cases, a microscopic incision into the Achilles tendon is required toward the end of the serial casting.

Ponseti Serial Casting - Courtesy of University of Missouri, School of Medicine, Department of Pediatric Orthopedics

Maintenance therapy is usually required for up to four years after casting. This involves using a foot abduction splint. The reported rate of success is upwards of 95% if the casting and post splinting are applied correctly.

The Ponseti Method is not used for treating the PreClinical Clubfoot Deformity.

Clubfoot Deformity - Courtesy of

WikiPedia

Non-surgical treatment of the PreClinical Clubfoot Deformity - Rothbart Proprioceptive Therapy

Rothbart Proprioceptive Therapy (named after Professor/Dr. Brian A. Rothbart, 1943 - ) advocates treating the PreClinical Clubfoot Deformity using a specific type of proprioceptive therapy, starting no earlier then four years of age. Typically this involves a series of tests, computer postural analyses, specific prescriptive proprioceptive insoles and ongoing monitoring, for a period of 12-18 months. After this time, the patient uses the prescriptive insoles as needed, for the rest of their life.

Rothbart Proprioceptive Therapy is not indicated nor used for treating the Clubfoot Deformity.

PreClinical Clubfoot Deformity - Courtesy of

Professor/Dr. Rothbart

For information on the embryology of the Clubfoot Deformity and the PreClinical Clubfoot Deformity, go the my Technical Blog on these two foot structures

Reference

Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot and PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

Posted by rothbart at 4/18/2011 3:39 PM | Add Comment

Postural Distortions - Mechanical Model vs Neurophysiological Model

It is becoming widely accepted that postural distortions (poor posture) are a major determinant in the development of musculoskeletal pain. However, there are two entirely different postural models that describe the sequence of events that lead to a poor posture: the Mechanical Model and the Neurophysiological Model.

The Mechanical Model for the Development of Postural Distortions

The mechanical model can be best understood by evaluating the kinetics of motion and the impact that gravity has on the body. Because the body is connected from head to toe, what affects one part of the body affects every other part - a compensatory concept of body mechanics.

Because human beings exist on a planet with gravity, this fundamental principle of physics cannot be overlooked. In every moment, with every movement, the body makes every attempt to balance itself from top to bottom, side to side, and front to back.

How this relates to Rothbarts Foot

If Rothbarts Foot is present, when the body’s weight is over the front part of the foot, the foot must twist inward and fall downward (pronate excessively) in order to attain full foot-to-ground contact (foundational stability).

As the body's center of gravity is shifted to the inside of the foot, the knees are forced to roll inward and closer together, producing an oblique patellar tracking pattern and genu valgum (knock knees).

The collapsing feet drive the sacroiliac joints forward, inward and downward because the body's center of gravity is anterior to the sacroiliac joints.

This rotation in the sacroiliac joint carries the lumbar spine with it, producing lumbar lordosis with a compensatory thoracic kyphosis, seen visually as "sway-back" and "hunched" shoulders.

When the shoulders protract (hunch), the cervical spine loses its normal curvature, and the head is thrust forward.

The end result is a postural distortional pattern (kyphotic Posture).

The Neuro-Physiological Model for the Development of Postural Distortions – The Foot to Brain Connection

The Neuro-Physiological Model (which I first described in my book, Forever Free From Chronic Pain), can best be understood by elucidating the role that the Pacinian and Meissner corpuscles (touch mechanical receptors) play in the Foot to Brain Connection.

All feet have millions of mechanical receptors dispersed across the bottom of both feet. As one walks these touch receptors are being stimulated. The position and quantity of receptors that are being stimulated is referred to as a Pattern of Stimulation.

An entirely different pattern of stimulation is seen in a ‘normal’ (non-twisting) foot than in a Rothbarts Foot (a foot that twists when standing or walking). That is, a non-distorted pattern of stimulation is seen in a ‘normal’ foot, whereas a distorted pattern of stimulation is seen in a Rothbarts Foot.

This distorted pattern of stimulation has a dramatic and devastating impact on posture:

According to the Neuro-Physiological Model, patterns of stimulation coming from the feet send information (signals) to the cerebellum on the current position of the body in space (e.g., its posture). Acting on this information, the cerebellum makes continuous micro adjustments in the posture to maintain an upright posture.

If these patterns of stimulation are normal, the cerebellum maintains an erect and stable posture.

If these patterns of stimulation are abnormal (e.g., distorted resulting from a Rothbarts Foot) the cerebellum distorts the posture (e.g., kyphotic posture).

For more information on the Neuro-Physiological Model, read Chapter 5 - The Foot to Brain Connection in my book, Forever Free From Chronic Pain

Posted by rothbart at 1/15/2011 11:51 AM | Add Comment

What is Proprioception?

Throughout my patient and research websites you will find me continually using the terms proprioception and proprioceptive: proprioceptive therapy, proprioceptive insoles, etc. What exactly do these terms mean?

Proprio comes from the latin word proprius, meaning “one’s own” and perception is the sense of the relative position of neighboring parts of the body.

Proprioception is a distinct sensory feedback mechanism that provides information to the brain on the internal status of the body. The sense of proprioception determines whether the body is moving, and where the various parts of the body are located in relation to each other (e.g., the body’s posture).

The body’s sense of proprioception was originally described in 1557 by Julius Scaliger. In 1826 Charles Bell expounded the idea of proprioception to include a ‘muscle sense’. Bell suggested that commands (move here, lift this, etc) are transmitted from the brain to the muscles. And that the muscles, in return, send information to the brain on their state of elasticity (e.g., are they stretched or are they contracted). That is, Bell described the body’s sense of proprioception as a two-way avenue of communication.

Now let’s look at the terms Proprioceptive Therapy and Proprioceptive Insoles

Proprioceptive Therapy

Proprioceptive Therapy and more specifically, Rothbart Proprioceptive Therapy, is a type of therapy that improves the body’s overall posture, which in turn, eliminates or greatly reduces chronic muscle and joint pain.

Rothbart Proprioceptive Therapy involves:

(1) A complete medical history, body system review and foot to head examination to determine if the patient has one of the two inherited, abnormal foot structures (the Rothbarts Foot or the PreClinical Clubfoot Deformity) that causes bad posture and leads to chronic muscle and joint pain.

(2) Extensive Computerized Postural Analyses to determine which of the two foot structures the patient has.

(3) Design and fabrication of prescriptive proprioceptive insoles to correct the patient’s posture, which will permanently eliminate or greatly reduce their chronic musculoskeletal pain.

(4) Ongoing Treatment and Monitoring to address issues that can arise, which may impede the healing process.

Proprioceptive Insoles

Proprioceptive insoles change the body’s global posture by sending signals from the feet to the cerebellum. The cerebellum acts on these signals and automatically makes a global correction in the body’s posture.

I invented and patented Rothbart Proprioceptive Insoles to change the body’s posture in a specific and predetermined fashion, in order to eliminate chronic musculoskeletal pain. Rothbart Proprioceptive Insoles are custom designed (prescriptive) based on the results of extensive computer analyses of the patient’s posture.

For more information on Rothbart Proprioceptive Therapy, go to Rothbart’s Therapy

For information on the difference between Rothbart Proprioceptive Insoles and orthotics, read Rothbart Insoles And Orthotics Are Totally Different In Design And Function

For more information on proprioception, go to Kosmix Health Kosmix Health

Posted by rothbart at 12/23/2010 5:43 PM | Add Comment

Determining the Presence of Rothbarts Foot

In 2002, I published a paper (Medial Column Foot Systems: An Innovative Tool for Improving Posture) in the Journal Bodywork and Movement Therapies, describing a previously unreported embryological foot structure which I linked to the failed or an incomplete torsional development of the talar head. Technically referred to as Primus Metatarsus Supinatus (or Rothbarts Foot), this foot structure is characterized by an elevated first metatarsal and hallux (big toe) when the foot is placed in its anatomical neutral position.

This research was part of a series of discoveries that ultimately led to a therapy that, in many cases, permanently eliminates chronic musculoskeletal pain without the use of drugs or surgery. This therapy is called Rothbart Proprioceptive Therapy, in which I use a series of tests, proprietary computer analyses, custom designed Rothbart Proprioceptive Insoles and ongoing monitoring to address all of the changes in the patients condition and necessary changes in prescriptions, until the chronic muscle and/or joint pain is eliminated.

A deep first webspace, positive Knee Bend Test (See photos below) and uneven heel wear patterns, provide a 70-75% level of confidence that you are dealing with a Rothbarts Foot.

Positive Knee Bend Test

Microwedge Measurements

However, a definitive diagnosis for the Primus Metatarsus Supinatus (PMs) foot type is made by measuring the PMs values (See Figures Below). PMs values between 10mm and 25mm (approximately ½ to 1 inch) are pathognomonic of the PMs foot type (Rothbarts Foot).

Microwedge Measurement

A double blind ramdomized trial was conducted by George Cummings and Elizabeth Higbie at Georgia State University, School of Health Sciences (1996) to determine the accuracy and reliability of the PMs values. They concluded that Microwedge Measurements (referred to in their paper as the weight bearing method of measurement), when used to determine PMs values, is accurate and reliable.

Reference

Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot and PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

Sign Up Now to get your free chapter from Professor Rothbart's book, Forever Free From Chronic Pain

Posted by rothbart at 11/11/2010 5:58 PM | View Comments (3) | Add Comment

Hammertoes

A Hammertoe (aka mallet or claw toe) is an abnormal bending in the toes joints (See Figure 1 below).

Figure 1 - Hammertoeing of the 2nd, 3rd, 4th and 5th toes.

Hammertoes usually start out as a mild bending in one or more toes, but over time the bending tends to become more severe. This abnormal bending can result in pressure on the top of the toes when wearing enclosed shoes, which can lead to inflammation and pain in and around the afflicted joints. If ignored, the hammertoe(s) can become rigid and inflexible.

Symptoms of a Hammertoe:

Contracture (bending) of the toe
Pain on the top of the bent toe when wearing enclosed shoes
Inflammation, redness and burning sensation in the bent toe (See Figure 2 below).

Figure 2 - Inflammation of the 2nd, 3rd and 4th toes resulting from hammertoeing.

Traditional Viewpoint of Etiology (cause) and Treatment of Hammertoes

Podiatrists concur that hammertoes are caused by either foot twist or improper (tight) fitting shoes with inadequate room in the toe box. Traditionally, they view hammertoes as a problem with symptoms that are localized in the foot only. That is; a problem that does not affect other parts of the body. Because of this, they just treat the foot pain. For example:

Padding to shield the corn from shoe irritation
Changing the shoe wear; avoiding shoes with pointed toes, shoes that are too short or shoes with high heels
Corticosteriod injections and/or oral nonsteroidal anti-inflammatory drugs (i.e., ibuprofen) to reduce the inflammation and pain
Splinting/strapping the toe in an attempt to realign the bent toe
Orthotic devices to help control the muscle/tendon imbalance

If all of the conservative interventions fail, surgery is then advocated to straighten the toe by fusing the bent toe joint(s).

In my clinical experience, I see hammertoes as being a symptom of a much larger problem. This problem starts as a structural alteration in the foot, present at birth (i.e., the Rothbarts Foot or the PreClinical Clubfoot Deformity), which forces the foot (when standing or walking) to twist. This foot twist leads to not only hammertoes, but also to other symptoms in the entire body, including pain in the knees, hips, back and jaw.

I believe that you must treat the larger problem (the abnormal foot structure) not just the hammertoes (which are just a symptom of the larger problem).

A more logical approach in treating hammertoes would be to effectively treat the cause of the foot twist.

In 2002, I published a major paper (Journal of Bodyworks and Movement Therapy) in the medical journals that described two previously unrecognized, but very common, embryological (present at birth) foot structures that force the foot to twist when standing or walking. I then described a very effective therapy (Rothbart Proprioceptive Therapy) that attenuates or completely eliminates the symptoms developing from foot twist.

Reference:

Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46

Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot Structure and the PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Inventor and Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

Posted by rothbart at 11/5/2010 3:28 PM | View Comments (2) | Add Comment

Headaches Can Be Caused by a Mal-Position in the Atlas

If the Atlas (1st cervical vertebrae) is twisted either in a clockwise or counterclockwise rotation, the four paired small muscles on either side of the neck (that insert into the skull) are affected.

The oblique superior, rectus capitis posterior major and minor muscles become stretched and tight (See Animation below). The stretching of these muscles places tension on the attachment points of their tendons into the occipital bone. This tension can cause micro tears within these tendons.

The counterclockwise rotation of the Atlas can produce the following symptoms:

Headaches (resulting from the entrapment of the greater occipital nerve) radiating from the back of the head to above the left eye
Inflammation where the tendons are being torn
Crepitation (crackling sound) where the head is rotated or extended
Buldging and tenderness along the transverse spinal process of the Atlas (left side of the neck)
Mild to severe tenderness along the nucheal line (at the base of the skull)

The above symptoms come from the Atlas rotation, which can be the result of a PreClinical Clubfoot Deformity (a severe, inherited, abnormal foot structure). Proprioceptive therapy is indicated to reduce the torsion of the Atlas; which in turn, reduces or eliminates the painful symptoms.

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot and PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

Posted by rothbart at 10/4/2010 2:24 PM | Add Comment

BioImplosion – a gravity induced distortion in posture

In 1988 I coined the word BioImplosion as a gravity induced postural distortion, frequently originating in the feet (Journal Manipulative Physiological Therapeutics). There are four distinct patterns of postural distortions resulting from BioImplosion; the most common being the Kyphotic Pattern. In the Kyphotic Pattern the:

hips are rotated forward
shoulders are protracted
head is shifted anteriorly relative to the cervical spine (forward head position)

A Kyphotic Posture places the ankles, knees, hips, back and neck in a mal-aligned position, which results in uneven joint wear patterns and poor posture. In time, these mal-aligned joints become swollen and painful (e.g., osteodegenerative arthritis).

Frequently, a kyphotic posture (See Animation Above) is observed in patients who have the Rothbarts Foot.

However, there are other patterns of postural distortions that can result from BioImplosion:

Flatback Pattern
Lordotic Pattern
Swayback Pattern

In understanding BioImplosion, you will find that addressing and effectively treating its' underlying cause (frequently Rothbarts Foot or the PreClinical Clubfoot Deformity), you will be able to permanently improve the articular alignments (e.g., improve the posture). This is an important prerequisite when treating chronic musculoskeletal pain patients.

For more information on the patterns of postural distortion resulting from BioImplosion, read The Four Postural Distortional Patterns on my research blogsite.

Reference:

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.

Posted by rothbart at 9/3/2010 1:07 PM | Add Comment

What is Rothbarts Foot?

Rothbarts Foot is an abnormal embryological foot structure. It is the result of the incomplete ontogenetic torsional development of the neck and head of the talus (the bone that sits on top of the heel bone) that occurs approximately between the eighth and ninth week post ovulation.

The result of this incomplete development of the talus is that when the rear foot is placed in its anatomically neutral (correct) position, the big toe and its adjoining metatarsal are elevated off the ground (See photo below).

Rothbarts Foot. The white arrow points to the supinatus (elevated and inverted) of the hallux and first metatarsal when the foot is placed into its anatomical neutral position (subtalar joint congruity).

Functionally, the Rothbarts Foot is an unstable foot structure. If one has a Rothbarts Foot, functionally, as the body’s weight is shifted from the rearfoot to the forefoot, gravity forces the supinatus (elevated and inverted) hallux and 1st metatarsal to roll inward, forward and downward until they rest on the ground.

This twisting motion of the foot is referred to as abnormal pronation. Abnormal pronation results in postural distortions, which lead to chronic musculoskeletal pain.

For a more in depth explanation of the Rothbarts Foot, read my book Forever Free From Chronic Pain .

To access information on objective signs for Rothbarts Foot, go to Determining the Presence of Rothbarts Foot

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot and PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

Sign Up Now to get your free chapter from Professor Rothbart's book, Forever Free From Chronic Pain.

Posted by rothbart at 8/5/2010 1:44 PM | View Comments (2) | Add Comment

The Evolution of Foot Biomechanics

Biomechanics is the study of motion in organic systems. Foot biomechanics is the study of foot motion.

Biomechanics and foot biomechanics are relatively new areas of investigation that have resulted in significant inroads into the understanding of musculoskeletal pain.

Following is the progression of the science of foot biomechanics and discoveries made, resulting in effective interventions in eliminating chronic muscle and joint pain.

In the 1960s, podiatrists were amongst the first medical professionals to write about foot mechanics. That is, podiatrists linked abnormal foot motion to pathology in the feet and ankles.

In the early 1970s, I was one of the first researchers to publish papers on abnormal foot pronation and how it is linked to foot pain [1-8]. At the same time, I (and other researchers) started looking at how abnormal foot motion (pronation) can lead to pain in the knees.

In the 1980s and 1990s, I published clinical studies that linked abnormal foot pronation to chronic knee and lower back pain [9-11].

In 2002 [12], I published a paper describing two common, but previously unknown foot structures, that I linked to the development of postural distortions, which in turn, I linked to the development of chronic musculoskeletal pain, foot to jaw.

In 2006 [13], I was the first to publish on the link between scoliotic and kyphotic curves in the spines (spinal mechanics) and abnormal foot biomechanics. I also suggested that abnormal foot biomechanics can result in increased tension in the postural muscles in the body.

In 2008 [14], I was the first person to determine that abnormal pronation can lead to abnormal dental mechanics and can actually change the position of the cranial bones (craniomechanics).

As a result of these discoveries our understanding of biomechanics has dramatically increased, which has led to the development of innovative interventions that effectively eliminate chronic musculoskeletal pain.

As it turns out, the study and effective use of biomechanics and foot biomechanics hold the key to resolving chronic muscle and joint pain!

Professor/Dr. Brian A. Rothbart

Chronic Pain Elimination Specialist

Discovered the Rothbarts Foot Structure and the PreClinical Clubfoot Deformity

Developer of Rothbart Proprioceptive Therapy

Inventor and Designer of Rothbart Proprioceptive Insoles

Founder of International Academy of Rothbart Proprioceptive Therapy

Author of Forever Free From Chronic Pain Forever Free From Chronic Pain

As you learn more about my innovative therapy, you may find that addressing and effectively treating your foot structure may be the missing link to ending your long time battle with unrelenting muscle and joint pain.

If you would like to make an appointment with me to see if I can help you to permanently eliminate your constant foot pain or chronic musculoskeletal pain, go to: Schedule a Consultation Schedule a Consultation

If you would like more information on resolving foot pain, go to: How The Foot Can Create Muscle And Joint Pain In The Entire Body How The Foot Can Create Muscle And Joint Pain In The Entire Body

For technical information on hyperpronation, read my research blog post: Defining Excessive Foot Pronation - Hyperpronation Defining Excessive Foot Pronation - Hyperpronation

References:

1. Rothbart BA 1971. Heel spur and heel spur syndrome. Journal American Podiatric Medical Association(JAPMA), 61(5):186-9.

2. Rothbart BA 1972. Clinical treatise on transverse plane dysplasias of the femur and tibia. Journal American Podiatric Medical Association, 62(1):1-14.

3. Rothbart BA 1972. Metatarsus adductus and its clinical significance. Journal American Podiatric Medical Association, 62(5):187-190.

4. Rothbart BA 1972. Nomenclature and its importance in modern podiatry. Journal American Podiatric Medical Association, 62(8):298-302.

5. Rothbart BA 1973. Phasic activity of muscles within the lower extremity. Journal American Podiatric Medical Association, 63(4):129-137.

6. Rothbart BA 1973. Part I. Biomechanical analysis of a normal gait pattern. Journal Canadian Podiatry Association, (3):3-7.

7. Rothbart BA 1973. Part II. Biomechanical analysis of a normal gait pattern. Journal Canadian Podiatry Association, (4):1-12.

8. Rothbart BA 1974. Flexible Vertical Talus Syndrome: Its Relationship to Talipes Equinus, Journal American Podiatric Medical Association, 64(9):697-700.

9. 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.

10. Rothbart BA, Yerratt M. 1994. An Innovative Mechanical Approach to Treating Chronic Knee Pain: A BioImplosition Model. The Pain Practitioner (formerly American Journal of Pain Management) 4(3): 13-18.

11. Rothbart BA, Liley P, Hansen, el al 1995. Resolving Chronic Low Back Pain. The Foot Connection. The Pain Practitioner (formerly American Journal of Pain Management) 5(3): 84-89

12. Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46

13. Rothbart BA 2006. Asymmetrical Pronation Patterns linked to Thoracic Curves. Biomechanics – The Foot Blog. PICOMM/PIJ Editors, Oct.

14. Rothbart BA 2008. Vertical Facial Dimensions Linked to Abnormal Foot Motion. Journal American Podiatric Medical Association, 98(3):01-08, May.

Posted by rothbart at 7/3/2010 9:07 AM | Add Comment

Defining Excessive Foot Pronation - Hyperpronation

In order to define foot hyperpronation, one must first define foot pronation:

Pronation is a normal rotation that occurs in the feet, in which the subtalar joint moves inward, forward and downward when we walk. This inward rotation is such a small amount of movement, that as one looks at the foot (while walking), the rotation cannot be seen.

When the foot normally pronates, one will see a well formed inner longitudinal arch in the footprint, similar to the one in Figure A below.

It is important for normal foot pronation to occur because this movement allows the entire foot to adapt to uneven ground surfaces (such as stones, slanted or uneven surfaces) when one walks.

Figure A – Normal foot pronation imprint in sand.

Note the well formed inner longitudinal arch (white arrow)

Hyperpronation is an abnormal (excessive) rotation that occurs in the feet. That is, the inward rotation of the subtalar joint is of such a magnitude that it allows the inner longitudinal arch to move downward towards the ground. If the hyperpronation is severe enough, the inner longitudinal arch may actually reach the ground (See Figure B).

Figure B – Hyperpronation. Note the flattened inner longitudinal arch (white arrow).

One can observe the degree of foot pronation by doing a ‘sand or wet foot test’:

Wet the bottom of your feet and walk on compacted sand or pavement

Look at the footprints

Normal foot pronation will leave foot imprints similar to the one in Figure A. Excessive foot pronation (hyperpronation) will leave foot imprints similar to the one in Figure B.

Please note – In this post, I am talking about the two extremes of foot motion – normal pronation and hyperpronation. However, most people fit in the grey zone. That is, their pronation pattern is neither normal, nor so excessive that their inner arch reaches the ground.

In these people (the grey zone- the majority of people), when they are sitting they have a well-formed arch. But when they walk, their arch is lower than when they are sitting, but is not flat. Frequently this can only be observed and recorded by a healthcare provider when they run a gait analysis.

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot Structure and the PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Inventor and Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

Posted by rothbart at 6/2/2010 2:22 PM | Add Comment

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