Hello List Members -
I recently replied to a query from an orthotist regarding the availability
of literature or resources on the issue of forefoot posting in AFOs
intended for "tone reduction". I recommended TC Michaud's text: Foot
Orthoses and Other Forms of Conservative Foot Care, as the best-written,
best-illustrated, clearest and most comprehensive text I've ever found on
the topics of foot and ankle biomechanics and function, compensation and
intervention using plantar orthotic inserts. (The author took over
publication when Williams & Wilkins stopped printing it. Michaud
Chirporactic, Newton, MA : PH/FAX 617/969-2225.)
As the clientele is neurologically involved, and scope of my need for
orthotic options is much broader than Michaud's, we differ at times on
posting principles. I've also refined the assessment techniques that add to
the decision-making body of data pertaining to orthotic design and posting.
I'm wondering if any members of this list know of other such resources?
By the way, "tone'' is defined as a state of resistance to passive
elongation. It is not a state of activation of the neuromuscular system,
though a hyperactive stretch reflex ('spasticity") might be a component of
hypertonus. Inappropriate or excessive recruitment of muscle groups, in
synergy, or of antagonistis (coactivation) is not "tone". It is evidence of
injury to the CNS neuromotor regulation system.
Anyway, back to the topic -
I use forefoot posting routinely in managing foot alignment and function
problems in children and adults with CNS dysfunction, as they are generally
unable to make any selective or subtle adjustments to malalignments or
imbalances of foot joint configuration or ROM.
The foot is our body-ground interface. In my experience, addressing its
management is fundamental to optimizing its function in load-bearing
circumstances. Considering that we (hopefully) load it 10,000 times/day on
average, the attention to details of foot and orthotic configuration, to
reduce mechanical stresses (through the closed chain) and the related
muscle recruitment problems and the discomfort that ensues, is essential to
effective care of anyone with LE muscle imbalances, orthopedic problems at
the knee and hip joints, and those with CNS dysfunction, many of whom
existed with orthopedic problems relating to foot function prior to
enduring a head injury or stroke.
I'm sure that varus posting is where the most common errors in forefoot
posting occur. Either the post is terminated too proximal on the foot - the
met heads must be included as they are the only part of the foot that is
loaded at early propulsion - or the post is excessive in magnitude, or the
first ray (of normal length) is prohibited from plantarflexing at early
propulsion.
Would any of you have other points of view or experience with this aspect
of orthotic intervention?
I discuss this issue in detail inmost of my courses, to which orthotists,
biomechanists, podiatrists, and kinesiologists are invited along with PTs
and other rehab clinicians. www.gaitways.com/bcsked.html .
Thanks in advance for your thoughts.
Regards -
Beverly (Billi) Cusick, PT, MS
>Hello List members
>Does any one have some literature on forefoot posting and on tone reducing
>AFOs?
>thanks
>Vikram Choudhary
>
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Beverly Cusick, MS, PT [log in to unmask]
http://www.gaitways.com
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