Medial column foot systems: an innovative tool for improving posture

Abstract

Intuitively we know feet affect posture. Engineers use this concept daily: as goes the foundation (foot), so goes the building (posture). Rothbart describes the foot–posture relationship dynamically, e.g. the impact the walking foot has on posture. Morton (1932) asserts a short 1st metatarsal (relative to the 2nd and 3rd metatarsals) prevents it from fully participating in weight bearing. While this concept appears correct, it is only a partial explanation of the pathodynamics engaging hyperpronators. Embryologically the foot goes through a series of torsional changes (Streeter 1945, Lash et al. 1997, Aiton et al. 1995, McLachlan et al. 1997, O’Rahilly et al. 1987, Smith 1999, Jirasek & Keith 2001, Gasser 1975, Patten 1946). If these torsions end prematurely (Tabibzadeh & Pettersson 1995), the 1st metatarsal and big toe (proximal phalanx and hallux) remain structurally elevated and inverted (in elevatus) relative to the lesser metatarsals and phalanges (Straus 1927, Olivier 1962). It is this retained elevatus that forces the walking foot into hyperpronation (Rothbart & Esterbrook 1988, Rothbart & Hansen 1995, Filner 1996, Liley 1996). It is hyperpronation that draws the posture forward (Rothbart et al. 1992, Rothbart & Hansen 1995, Schneider et al. 1995, Filner 1996, Liley 1996). And it is this forward posture and ensuing compensations that lead the patient into chronic pain (Rothbart & Esterbrook 1988, Rothbart et al. 1992, Rothbart & Hansen 1995, Petersen 1995, Schneider 1995, Filner 1996, Liley 1996). The embryology section briefly outlines [1] the normal ontogenetic stages within the lower limb bud and [2] the abnormal ontogenetic events that result in either the Clubfoot deformity (Cfd) or Rothbart foot structure (RFS). (This paper does not deal with the positional or structural deformations that can occur postnatally, e.g. rearfoot varum from massive trauma to the heel bone, leg length discrepancy from sepsis of the femoral growth plate, etc) Section 2 (RFS, clinical significance of PME) discusses RFS impact on posture and gaiting, and provides a methodology for diagnosing RFS in the adult foot. Section 3 (stabilizing RFS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Journal of Bodywork and Movement Therapies (2001) 6(1), 000^000 r 2002 Harcourt Publishers Ltd Brain A. Rothbart DPM,LEd,PhD