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Biomechanics of F t and Podiatry Physical Therapy
Huei-Ming Chai, PT PhDSchool of Physical Therapy
National Taiwan University, Taipei, TaiwanJune 21, 2008
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孟子曰 : 人之异于禽兽者几希,庶民去之,君子存之。舜明于庶物,察于人伦,由仁义行,非行仁义也 。 -- 离娄下第十九
• plantigrade of foot
• widening of pelvis
• erect spine
• delicate function of hand
孟子曰 : 人之异于禽兽者几希
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Plantigradeplanta = sole gradi = walk
bipedal quadripedal
ankle
ankle
MP joints
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Biomechanics of Foot and Podiatry Physical Therapy
Biomechanics of Foot– Bony structure and joints of foot– Types of foot
• Foot Orthotic Therapy
• Podiatry Physical Therapy
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Medial Aspect of Foot
subtalar joint
Forefoot Midfoot Rearfoot
medial longitudinal arch
calcaneus
talus
navicular
1st metatarsalphalanx
1st cuneiformMT head
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Superior Aspect of Foot
calcaneus
talus
navicularmetatarsals
phalanges
Forefoot Midfoot Rearfoot
cuneiforms
cuboidmidtarsal joint
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fibula
talus
tibia
mediallateral
Anterior Aspect of Foot
subtalar jointcalcaneus
MTHs
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anterior aspect
Neutral Foot ( 正中足 )
• Subtalar joint is placed at the neither pronated nor supinated position
• subtalar neutral position– calcaneus ground– tibia ground– metatarsal heads // ground
subtalar joint neutral
tibial bisecting line
calcaneual bisecting lineplantar surface
of MTHs
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Pronated Foot ( 內旋足 )
non-weight-bearing weight bearing
forefoot varus STJ
pronated
(plantigrade)
Talus shiftsmedially +inferiorly
STJ neutral
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Pronated Foot
• pronation of rearfoot with respect to forefoot (decreased arch) as foot is loaded
• NOT structural flat foot
• resulting in pain or dysfunction of foot or other WB joints
NWB
4.6 cm
WB
3.0 cm
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Wearing Pattern in Pronated Foot
pronated foot
medial side wearing
內
外
normal wearing pattern
neutral stance
WBstance
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Problems Related to Pronated Foot
• Plnatar faciitis
• Achilles tendinitis
• Arch pain
• Metatarsalgia
• Tibialis posterior tendinitis
• Chondromalacia patella
• Low back pain
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Supinated Foot ( 外旋足 )
non-weight-bearing weight bearing
forefoot valgus
STJ neutral
STJsupinated
(plantigrade)
Talus shiftslaterally +superiorly
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Supinated Foot
• supination of rearfoot with respect to forefoot (increased arch) as foot is loaded
• NOT structural high-arch foot
• resulting in pain or dysfunction of foot or other WB joints
NWB
5.5 cm
WB
6.2 cm
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Three Foot Types at Stance
外旋足supinated foot
10%
正中足neutral foot
60%
內旋足pronated foot
30%
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Biomechanics of Foot and Podiatry Physical Therapy
• Biomechanics of Foot
Foot Orthotic Therapy– Concept I: plantigrade– Concept II: total contact– Concept III: neutral foot
• Podiatry Physical Therapy
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Concept I: Plantigrade
• to provide plantigrade by 3-point contact to the ground
• examples– therapeutic exercises– orthopedic surgery– shoe modifications 5th MTH
heel
1st MTH
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Concept II: Total Contact
• to provide even distribution of WB onto whole foot by total plantar surface of foot contacting ground
• Increase area of contact to decrease pressure since P = F /A
• examples:– filling stuff into shoes to support the arch– total contact orthoses
transverse arch
medial longitudinal
arch
lateral longitudinal
arch
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Concept III: Neutral Foot
• to provide balance of soft tissues by control subtalar joint in neutral position
• examples:– functional foot orthoses
STJ neutral
tibial bisecting
line
calcaneual bisecting lineplantar surface
of MTHs
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Functional Foot Orthosis
• to maintain the foot in the subtalar neutral position
• to disperse the body weight as even as possible
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Neutral Cast -- Prone Technique
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Making A Positive Mold
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Fabrication
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Various Posting
heel liftmetatarsal pad
medial post
lateral post
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Benefits from Using Functional Foot Orthosis
• To re-align foot structure for malalignment – to control excessive motion– to change weight bearing pattern– to equalize leg length– to support deformed structure
• To relieve pain for painful foot
• To re-distribute weight bearing for insensitive foot
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Biomechanics of Foot and Podiatry Physical Therapy
• Biomechanics of Foot
• Foot Orthotic Therapy
Podiatry Physical Therapy– Example I: pronated foot– Example II: one pronated and another supinated
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Podiatry Physical Therapy
• Podi = foot
• DPT: one kind of physical therapy intervention to assess, treat, and prevent foot and ankle problems– movement – manual– modality– assistive device
– podiatrist (DPM) vs. certified pedothist (CPED)
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Indications of Podiatry PT
• utilization of functional foot orthosis as a component of the total treatment program for– back and hip pain related to foot dysfunction– patellofemoral syndrome– shin splint– plantar fasciitis– foot sprain or deformities– heel pad syndrome– ……
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Case #1
• A 22 year-old male was unable to stand longer than 10 minutes. He felt lateral knee pain during walking.
• diagnosis: severe pronated feet due to forefoot varus
• prescription: functional foot orthoses with forefoot medial postings
• pain decreases immediately
• changes orthoses every 3-4 yrs
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Case #2• A 38 year-old male stands with one foot pronated
and another foot supinated. His chief complaints are low back and currently treated by PT.
natural stance stance c/ pelvis leveled