Dear Bruce

I am writing in reply to your query.

The gentleman's name is Dr. C. Nester from Ireland.

In his paper using cadarvic material he attempted using computer driven
equipment to copy the walking motion of the human foot and ankle.

He came to the conclusion that the calcaneous and cuboid had very little
to do with the motion of walking. He also stated that the model was far
from perfect.

One of the reasons why the model did not work well at heel strike was
because the action of the biceps femoris via the fibula was left out of
the experiment.

The action of the biceps femoris muscle via the fibula is to produce
eversion of the calcaneous at heel strike.(while the superior aspect of
the talus is not loaded by bodyweight). This in turn causes the cuboid to
externally rotate and produce a locking motion. This in turn at heel
strike causes the 5th and 4th metatarsals to lock to produce a rigid
lateral foot.

That is why when one is walking or running and happens to stand on a rock
on the lateral foot, the foot is likely to roll as it hits the rock or
even be injured. A very acute, uncomfortable message is sent to the brain.

This foot position is for standing upon. The standing foot.
This is seen as a the first 'bump' in GRF in walking vs running. In
walking the body assumes it is going to stop (at the end of each step)
within the gravity field, the basic action of all muscles acting
individually.

Indivually all muscle action is to protect the joint 'look after' and thus
stop motion. This can be proven very easily with lengthening a joint eg.
elbow passively, while an EMG needle is in the muscle.

When the muscle is relaxed there is no electrical activity.
 As you approach end range of motion, that is the joint end range of
normal motion (depending on the individuals flexibility)the muscle begins
to fire (as seen on the EMG screen) ready to protect the elbow joint from
injury.

The rest of the foot (remaining bones) is for self preservation. Walking,
running, climbing basically getting out ot the way of the tiger that is
chasing you.

aside:
A patient of mine from the Pacific Islands climbed many a coconut tree in
his life time. He has size 18 feet and nearly as wide!. He can lie supine
and totally invert his feet so that they oppose each other and then clap.
It is a sight to be hold!
He has a passive dorsiflexion of 15+ degrees (at 5Kg pressure). His feet
are normal.

The standing foot is all the other bones, toes 1,2 and 3, cunieforms,
navicular and talus.

Thus patients who complain about foot pain on walking are walking on their
standing foot. This often is seen as shoe wear on the lateral side
especially along the side of the long bones.

While those who complain about pain when standing are standing on their
walking foot.

You may say that patients do not complain about such things. I can
guarantee you when you query them they soon will tell you what is
happeneing.

The navicular stress fracture is produced by a patient (athlete usually)
who is running on their standing foot and attempts at each pace to get to
their great toe in time for heel off. This produces a rearfoot to forefoot
compression situation.

This rotation (in the normal foot) occurs at moving the talus upon the
navicular and then to the medial and mid cunieform bones and down to the
base of the great toe.

The navicular (very much like the scaphoid in the wrist) cannot rotate
naturally to accommodate this compressive force (it is designed to look
after rotational forces)and thus suffers this compressive force and after
enough repetitive compressions fractures.

I have seen over 25 patients who despite having the normal bone scan still
have their pain. Simply put the problem that caused their fracture is
still there.

There is nobody that looks at joint motion or lack there of, and here the
problem begins and ends.

I have been told that the short muscles cause the problem. The answer is
the other way around.

It would be useless for the muscles to have a lenght that allowed a
passive dorsiflexion of 15+ degrees if the joint is 20 degrees plantar
flexed. This is an incredibly common finding in my practice, especially
with foot pain and so called plantar fasciitis.

The vast majority of near heel pain in my practice is due to immobility of
the mid and lateral cunieform bones. The mid cunieform controls neutral
subtalar joint and the lateral cunieform along with the cuboid control
adduction and pronation.

The other foot pain that is so common is a very shortened flexor hal.
longus. Easily diagnosed, easily fixed.

When one learns how to individually test and 'feel for joint motion' these
observations will become obvious.

Hopefully I have made myself clear.

I will be showing all these to all and sundry when both sane and myself
come over in Jan-Feb 2005. www. musmed.com.au

The whole process does not end here. Cervical motion, hip motion, scapula
distances are all controlled by the talus. You name it will change AND
stay changed.

 Once you have learnt the foot and ankle your whole outlook on how much
control the foot/ankle has will astound you.

I have been doing this for 15 years and I am still astounded on
occassions. I havew treated over 80,000 feet according to my records.

Regards,

Paul. Conneely

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