Biomechanics of F t and Podiatry Physical Therapy

1. Biomechanics of F t and Podiatry Physical Therapy Huei-Ming Chai, PT PhD School of Physical Therapy National Taiwan University, Taipei, Taiwan June 21, 2008

2. 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 孟子曰:人之异于禽兽者几希 • plantigrade of foot • widening of pelvis • erect spine • delicate function of hand

3. ankle MP joints ankle bipedal quadripedal Plantigradeplanta = sole gradi = walk

4. 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

5. 1st cuneiform subtalar joint MT head navicular talus 1st metatarsal phalanx calcaneus medial longitudinal arch Medial Aspect of Foot ForefootMidfootRearfoot

6. midtarsal joint Superior Aspect of Foot phalanges cuboid talus calcaneus navicular metatarsals cuneiforms Forefoot MidfootRearfoot

7. tibia fibula lateral medial talus subtalar joint MTHs Anterior Aspect of Foot calcaneus

8. tibial bisecting line calcaneual bisecting line plantar surface of MTHs 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

9. Talus shifts medially + inferiorly forefoot varus STJ neutral STJ pronated non-weight-bearing weight bearing (plantigrade) Pronated Foot (內旋足)

10. 4.6 cm 3.0 cm 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 WB

11. Wearing Pattern in Pronated Foot pronated foot normal wearing pattern medial side wearing 內 neutral stance WB stance 外

12. Problems Related to Pronated Foot • Plnatar faciitis • Achilles tendinitis • Arch pain • Metatarsalgia • Tibialis posterior tendinitis • Chondromalacia patella • Low back pain

13. Talus shifts laterally + superiorly STJ supinated STJ neutral forefoot valgus non-weight-bearing weight bearing (plantigrade) Supinated Foot (外旋足)

14. 5.5 cm 6.2 cm NWB WB 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

15. 外旋足 supinated foot 10% 正中足 neutral foot 60% 內旋足 pronated foot 30% Three Foot Types at Stance

16. 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

17. 1st MTH 5th MTH heel Concept I: Plantigrade • to provide plantigrade by 3-point contact to the ground • examples • therapeutic exercises • orthopedic surgery • shoe modifications

18. transverse arch medial longitudinal arch lateral longitudinal arch 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

19. tibial bisecting line STJ neutral calcaneual bisecting line plantar surface of MTHs Concept III: Neutral Foot • to provide balance of soft tissues by control subtalar joint in neutral position • examples: • functional foot orthoses

20. Functional Foot Orthosis • to maintain the foot in the subtalar neutral position • to disperse the body weight as even as possible

21. Neutral Cast -- Prone Technique

22. Making A Positive Mold

23. Fabrication

24. lateral post medial post metatarsal pad heel lift Various Posting

25. 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

26. 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

27. 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)

28. 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 • ……

29. 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

30. 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

31. 请支持人类智慧资源共享理念 柴惠敏 hmchai@ntu.edu.tw http://www.pt.ntu.edu.tw/hmchai/ 谢谢您耐心听讲