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PreClinical Clubfoot Deformity vs Clubfoot Deformity

2011-04-18T14:39:00Z

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

Postural Distortions - Mechanical Model vs Neurophysiological Model

2011-01-15T10:51:00Z

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

What is Proprioception?

2010-12-23T16:43:00Z

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

Determining the Presence of Rothbarts Foot

2010-11-11T16:58:00Z

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

Hammertoes

2010-11-05T14:28:00Z

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

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

2010-10-04T13:24:00Z

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

BioImplosion – a gravity induced distortion in posture

2010-09-03T12:07:00Z

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.

What is Rothbarts Foot?

2010-08-05T12:44:00Z

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.

The Evolution of Foot Biomechanics

2010-07-03T08:07:00Z

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

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.

Defining Excessive Foot Pronation - Hyperpronation

2010-06-02T13:22:00Z

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.

Why Your Hips Need to be Replaced

2010-05-27T14:28:00Z

Physiologically and anatomically, hip joints are constructed to last 100 or more years. But many people must have their hips replaced because their own hips have become arthritic and painful and often, these artificial joints need to be replaced every 10 to 15 years.

A commonly used hip joint prosthesis (implant)

Unfortunately, the underlying cause that is producing the degenerative changes in the hip is also affecting all the other weight-bearing joints in the body. Even if you have a hip replacement surgery to eliminate the pain in your hips, frequently the degenerative joint changes start becoming apparent in other parts of the body, such as your knees. When this happens, the surgeon often advises the patient to have a knee replacement surgery. This brings to mind the woodman in ‘The Wizard of Oz’, who - piece by piece - had his body parts replaced with tin.

Does it make sense to replace joint by joint (as they become painful)? Or does it make more sense to find the real cause of the degenerative changes in the joints and effectively treat it, thus preventing the need for joint replacement surgery?

What is the cause of joint degeneration? One explanation is that as we get older, the hip joints become worn with use and therefore it’s not surprising that they need to be replaced and re-replaced. But if this is true; why doesn’t every octogenarian require hip replacement surgery?

What is the real reason that hips need to be replaced?

Bad posture results in mal-alignment of the weight-bearing joints (and specifically the hip joint). The mal-alignment of the hip joint produces changes in the hip similar to a car alignment problem that produces changes in the tires. That is, both the hip and the tires wear unevenly and eventually require replacement.

Just as your tires will last much longer and wear more evenly if you are diligent about maintaining a good alignment in the suspension of the car, your hip joints will remain healthy, mobile and pain free if you maintain a good posture.

Some people naturally maintain a good posture, but others do not. A common reason for bad posture is being born with an inherited foot structure that produces postural distortions. Many people have one of the two abnormal foot structures (that I have discovered). They are known as the Rothbarts Foot and the PreClinical Clubfoot Deformity.

These common foot structures are successfully treated by Rothbart Proprioceptive Therapy, an innovative treatment that permanently corrects the postural distortions resulting from these two abnormal foot structures.

When the postural distortions are corrected, the alignment of the postural joints (including the hips) is dramatically improved. By improving the hip alignment, the hip joint does not wear out as quickly (or not at all) thus negating the need for hip replacement surgery.

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 hip pain, go to: Schedule a Consultation

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

About Bunions

2010-04-27T16:33:00Z

A bunion is a swelling of tissue and/or an enlargement of bone around the joint at the base of the big toe (1st metatarsophalangeal articulation). The big toe may turn towards the second toe (displacement), and the tissues surrounding the joint may be swollen and tender (See Animation below). Today, the term bunion is usually used to refer to the abnormal (pathological) bump on the inside of the big toe joint. The bump is the swollen bursal sac and/or an osseous (bony) deformity that has grown on the inside of the big toe joint.

The term ‘hallux valgus’ or hallux abducto valgus’ are the most commonly used medical terms to describe the bunion deformity, where ‘hallux’ refers to the big toe, ‘valgus’ refers to the abnormal rotation of the big toe, and ‘abducto’ refers to the abnormal drifting or leaning of the big toe towards the second toe.

The symptoms associated with a bunion deformity include swelling of the bunion joint, irritation and redness of the skin surrounding the bunion joint, joint pain, and a possible shift of the big toe toward the other toes.

In most cases, two factors must be present before a bunion deformity can develop: (1) foot twist, and (2) out toeing (abducted) foot position. The interplay between these two factors and the development of a bunion deformity are discussed below.

Foot twist (technically referred to as pronation), when excessive, disrupts the structural stability of the entire foot (Zitzlesperger, Elftman). In essence, foot twist allows the big toe to float towards the second toe. Typically this only happens if the foot is excessively abducted (pointing outwards).

This outward pointing of the foot, in the presence of foot twist, can dramatically distort the structure of the 1st metatarsophalangeal articulation. That is, the metatarsal bone shifts inward and the hallux (big toe) shifts outward (e.g., the classic bunion deformity). Wearing tight shoes with pointed toes can rapidly accelerate these shifts in the metatarsal and hallux.

Bunions are frequently treated in a variety of ways including changes in shoe gear, padding and shielding the bunion joint, rest, ice, anti-inflammatory medications, steroid injections and surgery . However, all of these therapies only treat the symptoms of the bunion (pain or joint misalignment) and not the cause. In order to effectively treat the bunion and eliminate the pain, the cause of the excessive foot twist must be addressed.

The two most common causes of foot twist are the Rothbarts Foot and the PreClinical Clubfoot Deformity. The only effective therapy to eliminate foot twist resulting from either of these foot structures is termed Rothbart Proprioceptive Therapy .

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

References:

Zitzlesperger S 1960. The mechanics of the foot based on the concept of the skeleton as a statically indetermined space framework. Clinical Orthopedics (American) 16:47-63

Elftman H 1960. The transverse tarsal joint and its control. Clinical Orthopedics (American) 16:41.

Your Foot Pain Can Increase After Foot Surgery

2010-03-24T10:10:00Z

Surgical intervention on the feet is frequently done for bunions, heel spurs, hammertoes and post tibial nerve entrapments. In some cases the surgery is very successful in correcting the subjective complaint and eliminating the foot pain. However, if you have one of two inherited, abnormal foot structures (the Rothbarts Foot or the PreClinical Clubfoot Deformity); the surgical intervention can actually end in failure and exacerbate the pain.

Let’s look at two surgical interventions - for nerve entrapments and bunions - and see why surgery for these problems is not a solution.

Let’s start with some information about the Rothbarts Foot and the PreClinical Clubfoot Deformity:

If you were born with the Rothbarts Foot or the PreClinical Clubfoot Deformity, your bunion or nerve entrapment is frequently a symptom of these foot structures. That is, having one of these abnormal foot structures can result in the formation of a bunion or a nerve entrapment. This is why:

Post Tibial Nerve Entrapment: Both the Rothbarts Foot and PreClinical Clubfoot Deformity force the foot to excessively pronate (twist) during stance phase of gait (walking). This foot twist can compress the post tibial nerve between the surrounding connective tissue and the medial malleolus (inner ankle bone). This nerve entrapment can produce a sharp, lancinating and debilitating pain.

Surgery for Nerve Entrapments: Frequently this nerve entrapment is surgically treated by releasing (cutting) the soft connective tissue around the entrapped post tibial nerve in an attempt to reduce the compression on the nerve. However, cutting this soft connective tissue can result in scarring and hardening of this tissue. If this occurs, the post tibial nerve is now being pushed up against the inner ankle bone by hard connective tissue instead of soft connective tissue. This results in more pain.

The solution: In order to eliminate the pain produced by an entrapment of the post tibial nerve you must eliminate the cause, and not merely treat the symptom of the entrapment (your pain). And that cause is the foot twist being generated by either the Rothbarts Foot or the PreClinical Clubfoot Deformity.
Eliminating this foot twist is accomplished by Rothbart Proprioceptive Therapy, a non invasive treatment that naturally decompresses the nerve. As a result, the nerve is eliminated.

Bunions: Both the Rothbarts Foot and PreClinical Clubfoot Deformity force the foot to excessively pronate (twist) during stance phase of gait (walking). This foot twist destabilizes the 1st metatarsal phalangeal joint, which can distort this joint’s alignment. The distortion of this joint's alignment is referred to as a bunion.

Surgery for Bunions: Frequently the alignment of the 1st metatarsal phalangeal joint is surgically corrected by remodeling the joint. However, the foot twist resulting from either the Rothbarts Foot or the PreClinical Clubfoot Deformity continues. The surgically corrected bunion is weaker than the joint was before surgery. The result is that the continuing foot twist can reproduce the bunion within several years. You now have a weaker foot, more prone to be destabilized by the foot twist.

The solution: In order to eliminate the pain produced by bunions you must treat the cause, and not merely treat the symptom of the bunions (your pain).

If you have a Rothbarts Foot or PreClinical Clubfoot Deformity, you must eliminate the foot twist caused by these foot structures, as it is this foot twist that is responsible for the formation of the bunion.

Eliminating the foot twist coming from the Rothbarts Foot or PreClinical Clubfoot Deformity is done by Rothbart Proprioceptive Therapy. If done early enough, this therapy can stop the bunions from getting larger and more disfiguring, and in some cases can actually diminish the size of the bunion.

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 read more information about the Rothbarts Foot and the PreClinical Clubfoot Deformity, go to: How Chronic Pain Resulting From The Rothbarts Foot And The PreClinical Clubfoot Deformity Can Be Eliminated.

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

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

Your Back Pain May be Worse after Having Back Surgery

2010-02-12T11:25:00Z

Are you thinking about undergoing the knife to eliminate your back pain? Before you make such an important decision which will affect the rest of your life, it’s important to read the experiences of other back pain sufferers who have had this invasive surgery.

Below are four posts, taken from the Spine Health Forum, of people whose pain is worse after their back surgery:

Martyjo

Here I’m again posting. 15 months post L3-S1 fusion with iliac bone graft. I just can't get past the pain and spasms. I thought I'd be walking around and enjoying life. Instead, I have to take pain pills just to do normal daily living tasks.

Straker

I myself am still in considerable pain post operation {18 months now}. My first operation in 1996 was a laminectomy L4/L5. My second operation was in 2007, a bilateral discectomy S1 and redo of L4/L5 laminectomy to release scar tissue from my first back surgery.

sun2

I am three years post anterior double fusion L3-SI. I am in the same boat. I also need medications just to do normal things.

Meydey321

I went through a fusion on L5-S1 10 months ago and it was my second back surgery. The first time around was a bust since I suffered a recurrent herniation among other problems. These two surgeries were supposed to make me feel a whole lot better and get me on my feet again. It didn't go that way in either case!

The failure rate for back surgery is deplorable. In fact, in many cases the surgery actually makes the pain worse then before the surgery was done.

Why do back surgeries fail?

The answer lies in first understanding the cause of the back pain. In almost all cases, the herniation (a pathology in the spinal discs) and resulting back pain is caused by an underlying problem. And surprising enough, frequently that underlying problem is the way your feet function when you walk.

A direct link has been documented between back pain and bad posture resulting from foot twist (abnormal foot motion). When the posture is improved by eliminating the foot twist, the back pain quickly dissipates, without the need for surgery.

Rothbart Proprioceptive Therapy has been proven to be a very effective therapy that eliminates back pain by reprogramming the cerebellum (brain) to automatically improve posture.

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

Therapies That Only Manage Chronic Pain - Drugs

2010-02-03T10:17:00Z

Pain medication is one of the top 10 treatments traditionally used to treat chronic muscle and joint pain.

This has had some pretty devastating effects for chronic pain sufferers. For example, lately the news has been flooded with untimely celebrity deaths as a result of taking prescriptive pain medication(s). But, this problem does not lie merely with the rich and famous. In fact, taking prescriptive painkillers has become more common than street drug abuse.

The dangers of pain medication have been documented everywhere. Why is it that billions of people still reach for their pill bottle to suppress their pain?

One very good reason is that many pain sufferers have not yet found anything else that actually eliminates their pain and so they just live with pain management. In other words, the cause of their pain has not been found and effectively treated.

Let’s take a closer look at how pain medication works and its side effects. These two factors alone will hopefully convince you that it’s a better idea to find a therapy that actually addresses the source of your pain, thereby eliminating it for good.

What is pain medication?

Pain medication, commonly referred to as painkillers, include over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin and/or acetaminophen, anti-depressant drugs and prescription pain medications such as opioids, morphine and methadone.

How does pain medication work?

Non-prescriptive pain medication such as NSAIDs (Ibuprofen®, Motrin®, aspirin (Bayer® and acetaminophen (Advil®, Tylenol® inhibits the production of prostaglandins, which are hormone-like substances which increase sensitivity to pain.

Prescription anti-depressants such as the tricyclic drugs (Elavil®, Prozac®, Zoloft®, etc.) increase the level of serotonin (a neurotransmitter), which suppresses the pain circuit to the brain.

Opioids (codeine, Alfenta®, Subutex®, Stadol®, etc.) are chemical substances that have a morphine-like action in the body.

* Please note that all of the above suppress pain in one way or another. But none of the above addresses the reason why you have pain in the first place. It stands to reason, that if the drug doesn’t address and effectively treat the cause, you will have to continue to take it for the rest of your life – pain management.

What are the side effects?

Painkillers must be taken continuously to be effective and have many documented side effects. The side effects of non-prescription pain medications includes: ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation, heartburn and unexplained weight gain. They can increase bleeding after an injury and cause ulcerations in the stomach. They reduce blood flow to the kidneys and can impair or cause acute kidney failure. Heart attacks, high blood pressure and heart failure have also been associated with the use of these non-prescription drugs.

The side effects of prescription anti-depressants include: liver dysfunction (jaundice), confusion, muscle rigidity and heart and kidney failure leading to death.

The well-known side effects of chronic opioid therapy include dependence or addiction, aberrant drug behaviors and respiratory depression (which can lead to death). It is important to note that over one million Americans are currently addicted to opioids.

To make matters worse, additional drugs are often prescribed to handle the side effects of the above medications. It is not uncommon for patients to take 10 to 15 different drugs a day for this very reason. The cumulative effect of taking so many drugs over a period of time is unknown.

When looking at the facts, it’s pretty obvious why painkillers are not the preferable way to treat your muscle and joint pain. Yes, they suppress your pain as long as you take them, but because they don’t treat the source of your chronic pain problem, they must be taken continually for the rest of your life. Besides being a very expensive habit, you could easily become another victim of (legal) drug addiction.

To find out the potential source of your chronic pain, go to the Rothbarts Questionnaire page.

To read about healthy alternatives to pain medication, go to Non Drug Alternatives for Resolving Chronic Pain.

Non Drug Alternatives for Resolving Chronic Pain

2010-01-25T18:32:00Z

Millions of people worldwide suffer with chronic muscle and joint pain. After trying countless therapies and even surgery, all to no avail, people often turn to prescription painkillers to eliminate their suffering.

Each year, pharmaceutical companies spend billions in promoting pain medication as a ‘solution’ for managing chronic pain. This propaganda (often based on false or misleading claims) is partly responsible for the multitude of persons using pain medication long-term in order to manage their pain.

Unfortunately, many prescriptive painkillers are addictive and lethal. As a result, the use of prescriptive drugs, such as opioids, has become an epidemic. In fact more people are killed by prescription opioids than all those killed by heroin and cocaine combined.

Many people reach for their pill bottle with little thought or awareness of what it might do to their health. But the side effects of using pain medication over a prolonged period of time cannot be ignored, as they can be worse than the pain itself. Such side effects include liver dysfunction, fueling of existing cancer malignancies and respiratory depression (which can lead to death).

Sometimes we have to take medication as there may be no other way to get short term relief from the agony of chronic muscle and joint pain. But pain medication only interrupts the pain signal to the brain so that the pain is not felt and relief lasts only as long as one continues to take the pain killers. Don’t confuse this temporary relief with healing.

There are natural options to prescription pain medication which will not only reduce or even eliminate pain, but also promote healing throughout the body and enhance your health for the rest of your life. Some of these are:

1. Cleansing your digestive tract

Pain medications cause a toxic digestive tract by suppressing the contraction of the stomach muscles. This causes constipation, and as a result small amounts of toxins and waste begin to accumulate along the lining of your intestines. If the toxins penetrate the lining of the stomach and enter the blood stream, they will circulate throughout the body, deposit into your joints and cause pain. With a good cleansing program you can heal your digestive tract and break up the accumulated toxins.

2. Cleansing your liver

The liver’s job is to remove toxins from the body. Help it do its job by drinking plenty of pure water with fresh lemon juice added, which will flush away pain inducing toxins.

3. Eating ‘live’ foods

Reducing your intake of meat and animal products and eating a plant-based, ‘living’ foods diet will help eliminate toxins in your muscles, joints, tissues and nerves.

4. Getting enough sleep

While you sleep, the body carries on important functions to restore and maintain wellness. Your body simply cannot get well if it is deprived of sleep, due to pain.
There are many non-drug solutions that promote a good night’s sleep, thereby giving pain relief. A few of them are:

Eating your largest meal early in the day and your lightest meal early in the evening.

Using sleep inducing, pure therapeutic grade essential oils in the bath, dabbed on the body or massaged into the feet before bedtime.

Closing your eyes and ‘feeling’ a pleasant experience, such as walking on the beach and feeling warm sand under your feet and the sun on your head. This will calm down an overactive mind.

Following the above recommendations, one through four; will help you reduce or get off pain medication and greatly improve your overall health. But in addition, there is another step that is crucial to successfully eliminating your muscle and joint pain, once and for all. You must:

5. Address and effectively treat the source of your pain.

Lately, there has been much written about treating the source of chronic muscle and joint pain and there are numerous therapies that claim to do so. But the truth is; if the source of chronic muscle and joint pain was being addressed and effectively treated, there wouldn’t be so many people worldwide still suffering!

A previously unknown, yet very common source of chronic muscle and joint pain is in the feet.

Many people are born with an abnormal foot structure (that is frequently undiagnosed) that creates bad posture and predisposes them to a lifetime of muscle and joint pain. If you have this foot structure, this source must be addressed and effectively treated in order to permanently eliminate your chronic pain. How to identify this foot structure and the method that I have developed to effectively treat it; is fully explained in my book, Forever Free From Chronic Pain.

My wish for you is that 2010 be a New Year of health and happiness. A good first step toward making this a reality is to make a commitment to reducing pain medication or disposing of it altogether. In its place, use healthful alternatives such as a natural health regimen to clean out and rejuvenate your body. For permanent pain elimination; look for the source of your pain. It may be in your feet.

Resolution of Chronic Knee Pain

2010-01-19T11:01:00Z

In 1993, a three year study was completed at the Bellevue Foot and Ankle Center in Bellevue, Washington, on 128 patients who suffered with chronic knee pain.

Prior to this study, these patients had been treated with various therapies including physical therapy, osteopathic and/or chiropractic manipulation, anti-inflammatory medications and in some cases, surgery. All of these patients were to some degree disappointed with the therapies they had received and were committed to permanently eliminating their knee pain.

I ran an initial evaluation, testing and analysis on each patient and found that all 128 patients all had foot twist and bad posture. A therapy (which later evolved into what is now known as Rothbart Proprioceptive Therapy) was then initiated to permanently improve their posture.

One year after therapy was completed, the patients completed a questionnaire. The results were:

78 patients reported that their chronic knee pain lessened 70% or more

14 reported that their knee pain lessened by 50-60%

8 reported that their knee pain lessened 10 to 40%

25 reported a definite decrease in their knee pain, but percentage of improvement was given

1 reported no change in their knee pain

2 reported an increase in their knee pain

Objective Outcomes (what I noted):

Of the 92 patients who reported a decrease in their level of knee pain of 50% or greater, all had a dramatic improvement in their posture.

Of the 8 patients who reported a decrease in their level of knee pain of 10 – 40%, all had a slight improvement in their posture.

The 1 patient who reported no lessening in her level of knee pain, no improvement in her posture was noted.

Of the 2 patients who reported an increase in their level of knee pain, all 2 demonstrated a deterioration in their posture.

Conclusion

A direct correlation was observed between bad posture and chronic knee pain. When the therapy improved the posture, the chronic knee pain diminished. However, when the posture did not improve, or deteriorated, the knee pain either remained the same or increased.

This study suggests that a viable, effective way to eliminate or dramatically reduce chronic knee pain is by permanently improving posture.

Reference:

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.