Thanks Stanley, David and Colin,  when I've digested your comments and done some further reading I'll come back with any questions

 

Regards

 

Neville

Neville Parker

Senior I Poditrist

Podiatry Department

Therapy Unit

Royal Bolton Hospital

Minerva Road

Farnworth

BL4 0JR

 



	-----Original Message----- 

	From: A group for the academic discussion of current issues in podiatry on behalf of Dr. Stanley Beekman 

	Sent: Sat 11/12/2004 05:58 

	To: [log in to unmask] 

	Cc: 

	Subject: Re: Orthoses and Lumbar mechanics

	

	

	Neville, 

	

	The answer to your question is a two hour lecture. But I will condense it down to a few paragraphs. Hopefully I can give you the tools to learn it for yourself. 

	

	Evaluation 

	Standing: PSIS (Posterior superior iliac spine)to the ground and ASIS (Anterior superior iliac spine) to the ground in both neutral and relaxed calcaneal position. 

	Gait: Watch for hip drop coming and going. Watch the path of the head. If the head raises when the side with the hip drops is in midstance, there is a primary scoliosis, and you may have to use a lift on the side with the high hip. 

	

	When the PSIS is lower on the same side that the ASIS is higher, this is a posterior innominate. 

	When the ASIS is lower on the same side that the PSIS is higher, this is an anterior innominate.

	A  primary posterior innominate will occur in a runner with a tight hamstring. (The patient requires unilateral hamstring stretching) 

	A  primary posterior innominate will occur in a weightlifter with a weak quadricep. (The patient requires unilateral quadricep strengthing)

	

	A posterior innominate will give a pain pattern of: pain in the buttocks and/or pain in the groin and/or pain down the lateral side of the thigh. 

	

	Lumbar disc pathology tends to occur on the short side. A secondary posterior innominate occurs on the long side (shortening compensation via posterior innominate)

	Pronation can cause an anterior innominate. This is the conformation that usually occurs when the chiropractors cannot help the patient. When you tape the patient's foot, they say it feels like there is a girdle stabilizing the back. But watch out for the equinus that seems to be the major pronatory factor on the side with the anterior innominate.  

	Here is something interesting. Pronation can cause a lengthening of a leg. This is mediated through the sacroiliac joint. A short leg in a good runner is compensated by developing an equinus. Eventually there is a decompensation (pronation of the midtarsal joint to compensate for the equinus). This will shorten a leg. This should result in some major hip drop. But you tend to see this large hip drop in a minority of cases. Instead an anterior innominate secondary to the pronation develops, and the leg is lengthened. The top of the lower extremity is the ilium where the sacrum rests on it. 

	

	As you can see a podiatrist can add a lot to the treatment of the back. If you have any specific questions, I'd be happy to help. 

	

	Respectfully, 

	

	Stanley

	 

	

	

	At 02:31 PM 12/10/04 +0000, you wrote:

	



		Colleagues, 

		 

		I have been receiving referrals recently from a ESP physiotherapist to treat patients with Lumbar and Sacral conditions.  These range from trapped nerve roots to 'mechanical LBP' and poor core stability.

		 

		Whilst I recognise that external leg rotation from supinating the foot may externally rotate the hip and affect the pelvis, I am struggling to assess the appropriateness of this refferal as a primary treatment or after the failure of courses of physiotherapy.

		 

		I do not want to remove this category of conditions from our scope of practice, but as podiatrists can we profess to be able to treat the Lumbar-sacral region and know what effect we are having on the to the skeletal system in this area?  Is this type of patient more appropriate is all else has failed?

		 

		From what reading I have done I am unable to find evidence as to the effect that orthoses (not unilateral heel raises) have at the lumbar-sacral level.  Does anyone know of good studies on this topic to allow me to make a better judgment?

		 

		Anecdotal comments and experience would be most welcome.

		 

		Should add the title of back specialist to our remit????!

		 

		Regards

		 

		Neville

		 

		Neville Parker

		Senior I Poditrist

		Podiatry Department

		Therapy Unit

		Royal Bolton Hospital

		Minerva Road

		Farnworth

		BL4 0JR

		 

		



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