Dear TPD Postulators:
   I've read most of your posts and my question to you all is what is truly
causing the TPD.  None of you seem to quite get to that point.  In a minute
I will give you my explanation for what I feel is the true Root - Sorry
Jeff- of TPD.  First though I must admit that you all explain the function
of TPD after it is end stage quite well.  I will admit that Kevins medial
heel skive and the blake inverted orthotic are excellent treatments as well.
I do feel that you are all missing the boat in the true cause of the TPD.
None of you are thinking along the line of what these patients usually look
like before they present in end stage form.  I know we have all seen stage
1 and 2 TPD patients in our offices and we put them on NSAIDS and get them
orthotics and they do great and probably never progress to end stage unless
they give up the orthotics.  What I have seen though is that many of these
30-40 y.o. women present with pain at the insertion of the TPD and pain on
one legged toe standing.  There strength is still usuall decent to down
right remarkable inthe TP though.  I have then checked the peronal strenght
in these patients and guess what?  The peroneal strenght 9/10 times is
weak. Try it and keep track for yourselves.  Jeff told me his dad called
this Peroneal spasticity -- which we now call TPD.  I now submit to you all
that Jeff's Dad was correct again.  Except in my opinion the peroneals are
not spastic, but non functioning.  Why would this be in a normal young
women.  What could possible cause the peronels to weaken so that the TP
could become excessively strong, indeed strong enough to idiopathically
rupture and cause an end stage TPD just as you  have all described in your
own ways.  My belief is that Functional Hallux Limitus is the true culprit,
coupled with LLD and ankle equinus.  Think about it, if the 1st mpj cannot
function as it should and the 1st met does not plantarflex as it should
then the peroneal tendons are not being used.  This also causes the
insertion of the peroneal tendons - the fibula - to not move as much as
usual because of the lact of activity of the peroneals at their insertion.
I know this is a least partially true because I have used Howards Technique
of manipulating the proximal fibular head and the ankle joint many times
and seen each and everyone of these women flip out by there reduction in
pain, and the near complete return of their strength in their peroneal
tendons.  I'm not kidding, i've seen 70-100% reduction in the pain just
from the manipulation and the reactivation of the peroneal tendon.  Think
about it some more, it all makes sense. The FHL causes inactivity of the
peroneus longus which causes inactivity at the fibula which causes an AJ
equinus as well.  You know if you measure it often the TPD patients that
are unilateral usu have LLD on the TPD side.  It all makes sense guys --
just think it through.  OK I've opened myself up now and since I'm a newbie
I know it can be even worse.  My only request is that you not talk about we
all know to be true about end stage TPD and talke about the patients I've
described abouve.  Good talking to you all.
Regards;
Bruce Williams
[log in to unmask]
www.knowyourfeet.com

-----------------------------------------------------------------
This message was distributed by the Podiatry JISCmail list server

to leave the Podiatry email list send a message containing the text
leave podiatry
to [log in to unmask]

Please visit http://www.jiscmail.ac.uk for any further information
-----------------------------------------------------------------