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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 Slide 2 : -- plantigrade of foot widening of pelvis erect spine delicate function of hand : Slide 3 Plantigrade planta = sole gradi = walk bipedal quadripedal ankle MP joints Slide 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 Slide 5 Medial Aspect of Foot subtalar joint Forefoot Midfoot Rearfoot medial longitudinal arch calcaneus talus navicular 1 st metatarsal phalanx 1 st cuneiform MT head Slide 6 Superior Aspect of Foot calcaneus talus navicular metatarsals phalanges Forefoot Midfoot Rearfoot cuneiforms cuboid midtarsal joint Slide 7 fibula talus tibia mediallateral Anterior Aspect of Foot subtalar joint calcaneus MTHs Slide 8 anterior aspect Neutral Foot ( ) 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 line plantar surface of MTHs Slide 9 Pronated Foot ( ) non-weight-bearing weight bearing forefoot varus STJ pronated (plantigrade) Talus shifts medially + inferiorly STJ neutral Slide 10 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 Slide 11 Wearing Pattern in Pronated Foot pronated foot medial side wearing normal wearing pattern neutral stance WB stance Slide 12 Problems Related to Pronated Foot Plnatar faciitis Achilles tendinitis Arch pain Metatarsalgia Tibialis posterior tendinitis Chondromalacia patella Low back pain Slide 13 Supinated Foot ( ) non-weight-bearing weight bearing forefoot valgus STJ neutral STJ supinated (plantigrade) Talus shifts laterally + superiorly Slide 14 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 Slide 15 Three Foot Types at Stance supinated foot 10% neutral foot 60% pronated foot 30% Slide 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 Slide 17 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 Slide 18 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 Slide 19 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 line plantar surface of MTHs Slide 20 Functional Foot Orthosis to maintain the foot in the subtalar neutral position to disperse the body weight as even as possible Slide 21 Neutral Cast -- Prone Technique Slide 22 Making A Positive Mold Slide 23 Fabrication Slide 24 Various Posting heel lift metatarsal pad medial post lateral post Slide 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 Slide 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 Slide 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) Slide 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 Slide 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 Slide 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 Slide 31 hmchai@ntu.edu.tw http://www.pt.ntu.edu.tw/hmchai/