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What is Rothbarts Foot?

rothbartsfoot@yahoo.com (rothbart) — Thu, 05 Aug 2010 12:44:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Sat, 03 Jul 2010 08:07:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Wed, 02 Jun 2010 13:22:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Thu, 27 May 2010 14:28:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Tue, 27 Apr 2010 16:33:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Wed, 24 Mar 2010 10:10:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Fri, 12 Feb 2010 11:25:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Wed, 03 Feb 2010 10:17:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Mon, 25 Jan 2010 18:32:00 GMT

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

rothbartsfoot@yahoo.com (rothbart) — Tue, 19 Jan 2010 11:01:00 GMT

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.

The Foot can Create Muscle and Joint Pain in the Entire Body

rothbartsfoot@yahoo.com (rothbart) — Sat, 09 Jan 2010 10:27:00 GMT

An estimated 80% of the world population has one of the two inherited, abnormal foot structures that Professor Rothbart has discovered. These foot structures are known as the Rothbarts Foot and the PreClinical Clubfoot Deformity.

These common, abnormal foot structures create multiple effects in the body; which over time, can affect some or all of your weight-bearing joints and muscles (such as the neck, back, hips, knees and ankles) and cause pain.

If you have tried everything to eliminate your muscle and joint pain, but nothing has permanently resolved your problem, there is a good possibility that you have a Rothbarts Foot or PreClinical Clubfoot Deformity, and no one has identified and correctly treated your foot structure (the probable source of your pain).

How the feet can lead to pain throughout the body:

1. All feet have mechanical receptors on the bottom, which are stimulated through touch, as in standing or walking. This stimulation produces a signal which is sent to the brain.

If the foot structure is normal, correct signals are sent to the brain. The brain acts on these correct signals by maintaining good posture.

If the foot structure is abnormal (such as in a Rothbarts Foot or PreClinical Clubfoot Deformity), distorted signals are sent to the brain. The brain acts on these distorted signals by maintaining bad posture.

2. Posture affects the health of all the weight-bearing joints and muscles in your body (e.g., the neck, back, hips, knees and ankles). If you have bad posture, your joints become misaligned. This can lead to joint and muscle inflammation, which results in pain throughout the body.

3. If your bad posture is not permanently corrected, your muscle and joint pain can become severe and chronic.

If you have a Rothbarts Foot or PreClinical Clubfoot Deformity, the only way to permanently correct your posture (and thus eliminate your chronic pain), is by correcting (normalizing) the distorted signals coming from your feet.

After many years in research, I developed a therapy which does just that! Rothbart Proprioceptive Therapy corrects the distorted signals coming from the Rothbarts Foot and PreClinical Clubfoot Deformity. The brain receives these corrected signals and automatically improves your posture.

Through a series of postural corrections, your posture becomes straighter and straighter, allowing the weight-bearing joints to re-align into their proper position. As a result, the chronic inflammation in your joints and muscles can now heal and so the musculoskeletal pain in your entire body is eliminated for good.

For more in-depth information on the contents of this article, read my book, Forever Free From Chronic Pain.

Professor/Dr.Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot 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

Sign Up Now to get a free chapter from my book, Forever Free From Chronic Pain

Scoliosis - Rothbart Proprioceptive Therapy vs Surgical Intervention

rothbartsfoot@yahoo.com (rothbart) — Mon, 04 Jan 2010 13:31:00 GMT

The most progressive spinal (scoliotic) curve is the right thoracic curve. Its growth velocity is the fastest at skeletal ages 12-13, but frequently continues moderately after the age of 16 (Yrjones,20006).

Rothbart Proprioceptive Therapy has proven to be very effective in reversing scoliotic curves in adolescents.

Case # 1 – Right Thoracic Scoliotic Curve – 13 year old male

The parents of a 13 year old boy brought their son to see their family doctor, concerned over the progressive worsening of the son’s scoliosis. The doctor suggested a back brace. The brace was uncomfortable and difficult for the boy to use in school, so the parents decided to seek the advice of an orthopedist.

The orthopedist took two sets of Xrays (a year apart) of the boy’s spine. The first set of Xrays showed a right thoracic curve of 17 degrees. One year later, when the second set of Xrays was taken; the right thoracic curve had increased to 31 degrees.

The orthopedist explained that right thoracic curves are the most unstable type of scoliotic curves. When patients in their pre-teens and early pubescence have a right thoracic curve, this requires immediate attention. The orthopedist strongly advised surgical intervention (fixation of the thoracic vertebra) before the thoracic curve deteriorated even further.

Before subjecting their son to such an invasive and painful surgery, the parents decided to seek a third opinion and brought their boy to see me at my office in Rome.

After initially examining the boy, I determined that he had a Rothbarts Foot. I then tested him using proprioceptive stimulation under his feet in order to determine if any changes would occur in his thoracic curve. I noted that the boy’s posture looked straighter, his shoulders were more level and his head was more centered over his spine (See Right Thoracic Curve below).

Right Thoracic Curve. Before proprioceptive stimulation vs immediately after proprioceptive stimulation

Based on this immediate improvement in the boy’s posture using proprioceptive stimulation, I determined that his Rothbarts Foot was the cause of his right thoracic curve. Rothbart Proprioceptive Therapy was then initiated in order to stabilize the patient’s right thoracic curve.

Results

Using Rothbart Proprioceptive Therapy, the progression of the thoracic curve was not only stabilized, but also reversed. There was no longer any need for bracing or surgical intervention.

Reference

Yrjonen T, Ylikoski M 2006. Effect of growth velocity on the progression of adolescent idiopathic scoliosis in boys. Journal Pediatric Orthopaedics; 15(5):311-315.

Case 2 – Right Thoracic/thoracolumbar Scoliotic Curve – 15 year old female

The parents of a 15 year old girl were concerned over the visual appearance of their daughter’s back and that it might be getting worse and brought her to see an orthopedist.

The orthopedist’s initial exam and evaluation revealed a well compensated (stable) right thoracic colubar double curve. Initial Xrays taken at the hospital revealed a right thoracic curve of 32 degrees and a left thoracolumbar curve of 28 degrees (See Xray A below).

Xray A Xray B Xray C

The orthopedist diagnosed the girl as having adolescent idiopathic (cause unknown) scoliosis. He told the parents that the right thoracic curves are most unstable around the time of the beginning of menstruation and that these curves are prone to worsening if not surgically stabilized. Based on the orthopedist’s recommendation, the parents consented to the surgery.

Immediately after the surgery was done, Xrays demonstrated that the right thoracic curve had not changed, but that the left thorocolumbar curve had been decreased (by the surgery) from 28 degrees to 22 degrees (See Xray B above).

Six months after the surgery, the parents brought their daughter to see the orthopedist, anxious over the cosmetic appearance of their daughter’s back, which appeared to be worse than it was before the surgery. The orthopedist advised the parents not to be concerned; that the ‘appearance’ of worsening was only a temporary situation and the appearance of the girl’s back would improve as she completed her growth.

One year after the surgery, the appearance of their daughter’s back was still deteriorating. The parent’s concern continued to escalate. They sought another opinion and were referred to a radiologist for another set of Xrays.

The radiology report stated that the right thoracic curve was 52 degrees (a 20 degree increase compared to before the surgery was done). The left thoracolumbar curve had lost its surgical correction and was now measuring 28 degrees (the same as prior to the surgery) (See Xray C above).

Results

Prior to the surgery, the 15 year old female had a stable (not worsening) double curve pattern. One year post surgically, the spinal curves were unbalanced, unstable and getting worse. The girl’s cosmetic appearance had deteriorated (See Photos below).

What these two case studies suggest

When the cause of the abnormal spinal curve is determined and then correctly treated, as in Case 1, the spine is stabilized.

When the cause is not determined and not correctly treated, as in Case 2, the spine becomes unstable and the curves further deteriorate.

Reference

Weiss HR 2007. Adolescent Idiopathic Scoliosis - case report of a patient with clinical deterioration after surgery. Patient Safety in Surgery Journal, 1(7) Online at www.pssjournal.com/content/1/1/7

Professor/Dr.Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot 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

Sign Up Now to get a free chapter from my book, Forever Free From Chronic Pain

Resolution of Chronic Low Back Pain

rothbartsfoot@yahoo.com (rothbart) — Thu, 24 Dec 2009 16:23:00 GMT

In 1994, I completed a four year study at the Bellevue Foot and Ankle Center in Bellevue, Washington, on 208 patients who suffered with chronic low back pain. This study, which I published in the American Journal of Pain Management (1995), is described below.

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 low back pain.

I ran an initial evaluation, testing and analysis on each patient and found that they 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.

Of the 208 patients who started this therapy, 203 completed it. One year later, the 203 patients filled out a questionnaire rating the effectiveness of their therapy by how they now felt. The results were:

170 patients reported that their chronic low back pain lessened 50% or more

24 reported that their low back pain lessened 10 to 40%

6 reported no change in their low back pain

3 reported an increase in their low back pain

Objective Outcomes (what I noted):

Of the 170 patients who reported a decrease in their level of low back pain of 50% or greater, all had a dramatic improvement in their posture.

Of the 24 patients who reported a decrease in their level of low back pain of 10 – 40%, all had a slight improvement in their posture.

Of the 6 patients who reported no lessening in their level of low back pain, no improvement in their posture was noted.

Of the 3 patients who reported an increase in their level of low back pain, all three demonstrated a deterioration in their posture.

Conclusion

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

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

Reference:

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

Professor/Dr. Brian A Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot 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

Sign Up Now to get a free chapter from my book, Forever Free From Chronic Pain

Using Proprioceptive Stimulation to Improve Level of Performance in Sports

rothbartsfoot@yahoo.com (rothbart) — Tue, 15 Dec 2009 12:07:00 GMT

Using Proprioceptive Stimulation to Improve Linear Mechanics and Level of Performance in Competitive Sports
Level of performance in all sports, to a large degree, depends on the mechanical efficiency and linearity of movement. By this we mean the joints in the human body must function around their anatomical neutral position in order to generate maximum power and postural stability.

A good example of this principle is observed in power lifting (See photo below). The power lifter is concerned with (1) establishing a solid foot to ground position (e.g., "the sweet spot" where the foot functions around its anatomical neutral position) and (2) preventing any torsion or twisting in his legs, hips or shoulders while lifting (e.g., linearity of movement). If either of these two principles is compromised, the weight lifters level of performance dramatically suffers.

Courtesy of Gorilla Pack Power Lifting Club
in Johnstown, N.Y. Mike Miller, 6'5", 385 lbs.

Several years ago, at a workshop for power lifters at Gold's Gym in St. Petersburg Florida, I noticed one particular athlete having great difficulty with his lifts. First, he would spend several minutes before each lift trying to find “the sweet spot” between his feet and the ground, where he felt most stable. Then as he started to lift, I saw that he had great difficulty keeping his right shoulder from rotating forward as he power lifted 500 lbs (the maximum amount he could lift). I also noted a counter clockwise torsion in his thoracic spine as his feet abnormally twisted (pronated).

Basically, this athlete was having problems because his feet were twisting as he lifted the weights. This resulted in torsional mechanics. With the athlete’s permission, I placed a specific proprioceptive insole under his feet, which would decrease his foot twist, which in turn, would take the athlete from torsional mechanics into linear mechanics. He then repeated his power lift of 500 lbs.

The Result: (1) He found his "sweet spot" within several seconds (instead of minutes) (2) I saw a more linear motion in his mechanics, e.g. his right shoulder was not as forward, as he lifted. His foot alignment improved (e.g., less pronation), and (3) he lifted 500 lbs with considerably less effort.

The athlete then immediately increased his lifting weight to 525 lbs and was able to power lift this weight for the first time in his life!

What does this show?

Torsional Mechanics = fatigue, weakness and loss of endurance.

Linear Mechanics = power, strength and endurance.

The use of the correct proprioceptive insole takes the athlete from torsional to linear mechanics.

This is just one example of using proprioceptive stimulation to improve linear mechanics and resulting performance.

Professor/Dr. Brian A Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot 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

Sign Up Now to get a free chapter from my book, Forever Free From Chronic Pain

A forward head position can lead to central nervous system (CNS) dysfunction

rothbartsfoot@yahoo.com (rothbart) — Sat, 05 Dec 2009 08:13:00 GMT

Investigators at Northwestern University's School of Medicine (Baliki et al 2008) discovered an alteration in brain function in people suffering from chronic pain. They feel that this alteration in brain (CNS) function may explain how chronic pain can trigger such symptoms as insomnia, depression, anxiety and/or mental sluggishness.

Baliki et al further explained that the front region of the brain, in a person suffering from chronic pain, is consistently active. This, they suggest, will prematurely wear out the neurons, altering their connections to one another. They believe this may lead not only to the symptoms above, but also to permanent brain damage.

Based on nearly 40 years of clinical research, what I have suggested is that focal areas of hyperactivity within the cerebral cortex (CNS) may result from ischemia (decreased blood flow) due to a positional compression of the carotid arteries on either side of the neck.

Compressing these carotid arteries can diminish the flow of blood to the brain much like a kink in a water hose can diminish the flow of water through the water hose (Rothbart 2009. Forward head position can lead to debilitating symptoms within the brain). Diminished blood flow can lead to cellular death in the brain. The end result are symptoms such as insomnia, depression, anxiety and/or mental sluggishness and finally, permanent brain damage.

The question is, what causes a positional compression of the carotid arteries? My research suggests that this compression can result from a forward head position (See Diagrams below). The impact a forward head position has on the blood flow to the brain is clinically observable by taking the carotid pulses:

When the head is in a forward position, the carotid pulses are weaker

When the head is over the spine, the carotid pulses are stronger

A forward head position is part of apostural distortional pattern caused by an abnormal embryological footstructure, now known as the Rothbarts Foot.

Forward Head Position (adapted from Ventura Publications). This forward head position is frequently part of a postural distortional pattern resulting from a Rothbarts Foot

Rear View of the Head and Neck. The red arrows point to the carotid arteries. When the head is in a forward position, the carotid arteries are more susceptible to being compressed. This compression can dramatically decrease the blood flow to the brain.

All feet have mechanical receptors on their plantar surfaces, which send signals from the feet to the brain. The brains responds by adjusting the posture. But the Rothbarts Foot sends distorted signals to the brain. The brain responds by distorting the posture. Part of this postural distortion is a forward head position, which is seen in most chronic musculoskeletal pain patients.

This forward head position can be effectively reversed using a type of therapy that now bears my name (e.g., Rothbart Proprioceptive Therapy). Rothbart Proprioceptive Therapy provides a stimulation underneath the feet. This stimulation sends a corrected signal to the brain. The brain, in turn, automatically corrects the posture and brings the forward head back over the spine. When this takes place, the compression on the carotid arteries is diminished. This allows the blood to flow more freely to the brain. The brain cannow function optimally.

In summation, I suggest that:

when the head is forward over the spine, the brain may not be receiving sufficient blood flow and oxygen due to compression of the carotid arteries. If this compression is severe enough, it can result in cerebral ischemia (CNS dysfunction). Clinically what we see is disturbed sleeping patterns, increased anxiety and mental sluggishness.

when the head is in its correct position over the spine and the brain is receiving sufficient blood flow and oxygen, brain function improves. Clinically, what we see is improvement in sleeping, anxiety abating, mental alacrity improving and a greater sense of wellbeing.

References

     Baliki MN, Geha PY, Apkarian V, et. Al. 2008. Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics. Journal Neuroscience. 28(6):1398-1403.
     Rothbart BA 2009. A forward head position can lead to debilitating symptoms in the brain. Heal Yourself Magazine, July 25
     Rothbart BA 2009. Chronic Pain Changes How the Brain Functions. Research Blog, August.

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot 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

Sign Up Now to get a free chapter from my book, Forever Free From Chronic Pain

The Four Postural Distortional Patterns

rothbartsfoot@yahoo.com (rothbart) — Sat, 05 Dec 2009 08:06:00 GMT

In 1988, I published a paper in the Journal of Manipulative and Physiological Therapeutics in which I linked foot twist (pronation) to torsional changes within the knees and pelvis. This study was based on 97 chronic pain patients in whom I correlated oblique patella (knee) tracking patterns and dysfunctional positioning of the pelvis to foot twist.

In 1994 and 1995 I published two papers in the American Journal of Pain Management in which I linked a distortion in posture (referred to as BioImplosion) to foot twist. The results of these two clinical studies, which involved nearly 300 patients, also supported my theory that poor posture was one of the major causes in the development of chronic knee pain (1994) and chronic low back pain (1995). (Foot twist leads to poor posture, poor posture leads to chronic pain in the knees and low back)

However, the cause of foot twist still remained a mystery until 2002, when I published a paper in the Journal of Bodywork and Movement Therapies in which I described two previously unknown embryological foot structures that resulted in foot twist: the Rothbarts Foot and the PreClinical Clubfoot Deformity.

Since 2002, I have been classifying the various postural distortional patterns that can result from either the Rothbarts Foot or the PreClinical Clubfoot Deformity. Four distinct patterns became apparent:

Flatback Postural Pattern
Kyphotic Postural Pattern
Lordotic Postural Pattern
Swayback Postural Pattern

Interesting enough, the Kyphotic and Lordotic Postural Patterns are most frequently seen in patients with the Rothbarts Foot. Whereas the Flatback and Swayback Postural Patterns are more frequently seen in patients with the PreClinical Clubfoot Deformity.

The classification of these four postural distortional patterns are based on the:

Position of the innominates on the sagittal plane,
Curves in the lower and upper back
Position of the head relative to the cervical spine

Below is a brief description of each of the four postural distortional patterns and the Normal or Ideal Pattern.

(1) - Flatback Postural Pattern

Flatback Postural Pattern is Characterized by:

Posteriorly positioned innominates
Decrease in the sacral (lower back) curve
Slight Increase in the thoracic (upper back) curve (convex backwards)
Forward head position

(2) - Kyphotic Postural Pattern

Kyphotic Postural Pattern is Characterized by:

Anteriorly positioned innominates
Increase in the sacral (lower back) curve (convex forwards)
Increase in the thoracic (upper back) curve (convex backwards)
Forward head position

(3) - Lordotic Postural Pattern

Lordotic Postural Pattern is Characterizied by:

Anteriorly positioned innominates
Increase in the sacral (lower back) curve (convex forward)
Normal thoracic (upper back) curve
Head in neutral position (auricle over outer ankle bone)

(4) - Swayback Postural Pattern

Swayback Postural Pattern is Characterized by:

Posteriorly positioned innominates
Decrease in the sacral (lower back) curve (flatten)
Increase in the thoracic (upper back) curve (convex backwards)
Head forward position

The Ideal (Normal) Postural Pattern

Ideal Postural Pattern is Characterized by:

Innominates in neutral position
Normal sacral (lower back) curve (slight convex forward)
Normal thoracic (upper back) curve (slight convex backward)
Head in neutral position (auricle over outer ankle bone)

References:

   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.
   Rothbart BA, Yerratt M. 1994 An Innovative Mechanical Approach to Treating Chronic Knee Pain: A BioImplosion Model. The Pain Practitioner (formerly American Journal of Pain Management) 4(3): 13-18.
   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
   Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
   Cordova N, Cordova PV 2009. Posture Confidence

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot and the 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 a free chapter from my book, Forever Free From Chronic Pain

A special thanks to Natalie and Philip Cordova for granting me permission to use the above photographs that were published in their e-book: Posture Confidence. Their e-book contains a wealth of information on postural exercises; highly recommended.

Plantar Fasciitis - What is it and How do you treat it

rothbartsfoot@yahoo.com (rothbart) — Wed, 18 Nov 2009 18:16:00 GMT

Plantar Fasciitis is an inflammation of the plantar aponeurosis, a thick fascia located underneath the foot than spans from the heel bone (medial and lateral calcaneal tubercles) to the toes (plantar tubercles of the proximal phalanges) (See Figures 1 and 2 below).

Figure 1 - Plantar Aponeurosis (Long Plantar Ligament). A thick fascia that runs from the bottom of the heel bone to the toes.

Figure 2 - medial view of the foot demonstrating the insertion of the plantar aponeurosis into the heel bone.

Plantar Fasciitis is characterized by pain across the inside of the ankle (medial malleolus) and under surface of the heel bone (medial calcaneal tubercle) (See Figure 3 below). Plantar Fasciitis is the most common foot symptom seen in chronic pain patients.

Figure 3 - location of pain associated with Plantar Fasciitis; inside of the ankle and the under surface of the heel bone.

In 1971, I published a paper in the Journal American Podiatric Association that challenged the then current thought that Plantar Fasciitis was frequently due to a heel spur irritating the long plantar ligament. I suggested that Plantar Fasciitis (heel pain syndrome) was the result of excessive foot twist. My paper was based on my findings that:

Many of my patients with heel pain (Plantar Fasciitis) did not have heel spurs
Many of my patients with heel spurs did not have heel pain
All of my patients with heel pain had foot twist

In this paper, I described the step by step process in which foot twist can culminate in heel pain (Plantar Fasciitis):

Foot twist expands the foot (longer and wider)
As the foot becomes longer, the long plantar ligament is stretched
As the long plantar ligament is stretched, micro tears occur in the attachment of the ligament into the heel bone
These micro tears result produce an inflammatory reaction, culminating in heel pain

My research remained controversial for approximately 20 years until the early 1990s when other research teams came to the same conclusions.

However, the question that still needed to be answered was: what causes the foot to twist?

This question was answered in a paper I published in 2002 in the Journal Movement Bodyworks Therapy, in which I linked foot twist to two embryological foot structures, the Rothbarts Foot and the PreClinical Clubfoot Deformity. I theorized that these two foot structures force the foot to twist due to the incomplete osseous development of the calcaneal (heel) and/or talar bones.

Therapy

Traditionally, Plantar Fasciitis is treated with arch supports. The rationale of this therapy is to reduce the stretch on the long plantar ligament (plantar aponeurosis), thereby allowing the inflammation at its insertion points to heel (See Figure 4 below). However, a randomized trial published by Landorf et al (2006) concluded that this approach resulted in only “small reductions in pain for people with Plantar Fasciitis”. In my practice, I have found that arch supports frequently increase the pain in patients suffering from Plantar Fasciitis.

Figure 4 - Therapy using arch supports which actually increase the tension of the plantar aponeurosis, which in turn, predisposes this ligament to further micro tears.

Rothbart Proprioceptive Therapy

Rothbart Proprioceptive Therapy has proven to be very effective in eliminating heel pain associated with Plantar Fasciitis. The reason this therapy is so effective is that it treats the underlying cause of foot twist, which in turn, decreases the elongation of the long plantar ligament (and resulting inflammation of its insertion points as it is being torn away from the bone) (See Figure 5 below).

Figure 5 - Proprioceptive Therapy reduces foot twist, which in turn, decreases the tension on the long plantar ligament (plantar aponeurosis).

For more information on Rothbart Proprioceptive Therapy, go to: What is Rothbart Proprioceptive Therapy or Does Rothbart Proprioceptive therapy reduce foot twist? A technical presentation.

References

    Landorf KB, Keenan AM, Herbert RD, 2006. Effectiveness of Foot Orthoses to Treat Plantar Fasciitis. Archives Internal Medicine, 166:1305-1310.
    Rothbart BA 1971. Heel spur and heel spur syndrome. Journal American Podiatric Medical Association (JAPMA), 61(5):186-9.
    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 the 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 a free chapter from my book, Forever Free From Chronic Pain