Hi Shane,

 

Thanks for the insightful comments.  

You wrote: /I mentioned how the forefoot function may alter with midtarsal joint mobilising and
 for me particularly, the intermediate cuneiform. I think some of the others need to be 
mobilised to allow this one which is the key in the end. 
/

I agree with the mobilization will change the function of the midtarsal joint. I am not so sure
about the intermediate being the key. I find a lot of lateral cuneiforms need attention(I only 
find one that needs to be manipulated) and less often the intermediate cuneiform. But I am not 
rechecking right after I attend to it. I’ll look for it. I find that you have to go outside the 
foot to get a more permanent stabilization of these joints. A lot of times the cuneiform 
subluxation is where I start my assessment.  

You wrote: /I also find it tricky having the engineering discussion when it seems to me that the 
properties and the function of the joints and other tissue may vary considerably from one moment 
to another depending on interventions such as mobilising and the release of intrinsic muscle
trigger points and I'm sure neurological changes./ 

I agree. The changing of the muscles and joints change the input to the nervous system, and 
therefore the output is changed. 

You wrote: /Nevertheless, mechanical therapy, with an engineering formulation is required for 
long term maintenance, more so, in the more extreme foot types. So, my perspective is practical 
and is expressed daily in my clinic and that has changed enormously over the past few years. I'd 
like to be on another thread, maybe parallel.// /

Again I agree mostly. May I add that as you change the foot, the correction that is require from 
your orthotic is lessened.  

You wrote: /You mentioned the ASIS being used for a postural test, which is new to me and very 
interesting. You said that allowing the feet to relax from a neutral calcaneal position to a 
relaxed position will not cause the ASIS to drop on either side if the cuneiforms are 
unrestricted. Hence any movement indicates that mobilising is required and stability indicates 
good function is available. The test then will also show the success or otherwise of the 
mobilising. I'm surprised about this as logic would tell me that going through that range in the 
foot would entail internal rotation of the tibia and I'd expect that to transfer through the hip 
causing the pelvis to drop anteriorly always if there was significant movement in the foot./

You misinterpreted what I wrote. I reread what I wrote and I can see why the misinterpretation. 
To be more clear: One ASIS drops when in relaxed position compared to neutral calcaneal stance 
position for both sides. You would normally think (without a manipulative background) that 
pronation is causing either and anterior innominate dysfunction or a functional short leg 
(depending on what the PSIS is doing). Now that you understand subluxations of the cuneiforms, 
the dropping of the ASIS is a sign usually of cuneiform dysfunction (once in a rare while it 
could be a calcaneus or a metatarsal-cuneiform joint). Also interesting is that you can see an 
equinus on the side with the cuneiform dysfunction. Manipulate and recheck the dorsiflexion and 
the ASIS to the ground in relaxed position. Tell me what you find. Don’t believe a word I say 
until you check it for yourself, and tell me what you find. 

 

Regards, 

 

Stanley





Shane Toohey wrote:
> Hi Stanley,
>
> I appreciate your response (5th May)to my note of agreement with
> Kevin Kirby about factors other than the STJ function being
> responsible for the 'stiffness' or lack in forefoot function. Sorry,
> I've had one of those hectic periods and wanted to be relaxed when
> responding but am trying to be succinct. I mentioned how the forefoot
> function may alter with midtarsal joint mobilising and for me
> particularly, the intermediate cuneiform. I think some of the others
> need to be mobilised to allow this one which is the key in the end. 
>
> I also find it tricky having the engineering discussion when it seems
> to me that the properties and the function of the joints and other
> tissue may vary considerably from one moment to another depending on
> interventions such as mobilising and the release of intrinsic muscle
> trigger points and I'm sure neurological changes. Nevertheless,
> mechanical therapy, with an engineering formulation is required for
> long term maintenance, more so, in the more extreme foot types. So,
> my perspective is practical and is expressed daily in my clinic and
> that has changed enormously over the past few years. I'd like to be
> on another thread, maybe parallel.
>
> You mentioned the ASIS being used for a postural test, which is new
> to me and very interesting. 
> You said that allowing the feet to relax from a neutral calcaneal
> position to a relaxed position will not cause the ASIS to drop on
> either side if the cuneiforms are unrestricted. Hence any movement
> indicates that mobilising is required and stability indicates good
> function is available. The test then will also show the success or
> otherwise of the mobilising. I'm surprised about this as logic would
> tell me that going through that range in the foot would entail
> internal rotation of the tibia and I'd expect that to transfer
> through the hip causing the pelvis to drop anteriorly always if there
> was significant movement in the foot.
>
> Cheers
> Shane
>
> Could you explain how the when the midfoot is not restricted, the
> ASIS will not move with that movement. It doesn't on myself, but I'm
> probably not restricted.
>
> ---- Original Message ----
> From: [log in to unmask]
> To: [log in to unmask]
> Subject: Re: Midtarsal Joint Biomechanics and Interaction of
> Tension/Compression Elements During Stance Phase
> Date: Sat, 5 May 2007 23:48:55 -0400
>
>   
>> Shane,
>>
>> Good point. Also I find the lateral cuneiform should be included.
>>
>> Here's the postural test for these dysfunctions:
>> Put the feet in neutral position and palpate the ASIS's. Now let the 
>> feet go into relaxed calcaneal stance position. If the ASIS drops on 
>> either side, it is usually a sign of a restriction of movement for
>> the 
>> cuneiforms.
>> Part of the function as a mobile adapter is to allow the foot to go
>> to 
>> either an inverted of everted position without the upper body getting
>>
>> affected. Any restriction of the foot joints interferes with the 
>> interdependence of these joints It would not be in primitive man's
>> best 
>> interest to run after prey (or away from predators), and because he 
>> steps on angled ground, have his direction changed just prior to
>> propulsion.
>>
>> Regards,
>>
>> Stanley
>>
>>
>>
>> Shane Toohey wrote:
>>     
>>> Dear Kevin et al,
>>>
>>> I've struggled keeping up with this discussion other than in a
>>> general sense and than you wrote:
>>>
>>> What I really wanted to know was what you think of my idea that you
>>> don't need pronation of the STJ to cause the foot to be a "mobile
>>> adaptor" and supination of the STJ to cause the foot to be a "rigid
>>> lever" since this is dependent on the architecture of the foot and
>>> arrangement of posterior musculature, foot bones and plantar soft
>>> tissue supporting structures, not just on STJ rotational position
>>>       
>> or
>>     
>>> motion.
>>>
>>> As one who plays with feet, I agree with that comment. Mostly, I
>>>       
>> find
>>     
>>> that mobility and or lack of mobility for adapting is a function of
>>> the mid tarsal environment, particularly how 'free' the
>>>       
>> intermediate
>>     
>>> cuneiform and the cuboid are.
>>> When they are changed then the feet function differently.
>>> Unfortunately, I can't ever imagine putting that to any scientific
>>> testing!
>>>
>>> Cheers
>>> Shane
>>>
>>>
>>>
>>>
>>> ---- Original Message ----
>>> From: [log in to unmask]
>>> To: [log in to unmask]
>>> Subject: Re: Midtarsal Joint Biomechanics and Interaction of
>>> Tension/Compression Elements During Stance Phase
>>> Date: Sat, 5 May 2007 06:33:42 -0700
>>>
>>>   
>>>       
>>>> <!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
>>>> <html>
>>>> <head>
>>>>  <meta content="text/html;charset=ISO-8859-1"
>>>> http-equiv="Content-Type">
>>>> </head>
>>>> <body bgcolor="#ffffff" text="#000000">
>>>> <font face="Arial">Dave:<br>
>>>> <br>
>>>> </font><font face="Arial" size="2">You wrote:<br>
>>>> <br>
>>>> &lt;&lt;As I&nbsp;do not regularly correspond and&nbsp;not feel
>>>> familiar with Dr
>>>> Dananberg I used that form of address. It seemed a little
>>>>         
>> disingenuos
>>     
>>>> to use the form of title Dr Dannanberg and not be respectful
>>>>         
>> enough
>>     
>>>> to
>>>> include that&nbsp;form when addressing both Doctors.&gt;&gt;<br>
>>>> <br>
>>>> Sorry about that, I&nbsp; was just giving you a "bad time"
>>>> Dave.&nbsp; Your
>>>> postings are extremely helpful and informative and I really like
>>>>         
>> the
>>     
>>>> engineering perspective you bring to these topics.&nbsp; What I
>>>> really
>>>> wanted to know was what you think of my idea that you don't need
>>>> pronation of the STJ to cause the foot to be a "mobile adaptor"
>>>>         
>> and
>>     
>>>> supination of the STJ to cause the foot to be a "rigid lever"
>>>>         
>> since
>>     
>>>> this is dependent on the architecture of the foot and arrangement
>>>>         
>> of
>>     
>>>> posterior musculature, foot bones and plantar soft tissue
>>>>         
>> supporting
>>     
>>>> structures, not just on STJ rotational position or motion.<br>
>>>> </font><br>
>>>> Sincerely,<br>
>>>> &nbsp;<br>
>>>> Kevin<br>
>>>> &nbsp;<br>
>>>>
>>>>         
>> *********************************************************************
>>     
>>>> *******<br>
>>>> Kevin A. Kirby, DPM<br>
>>>> Adjunct Associate Professor<br>
>>>> Department of Applied Biomechanics<br>
>>>> California School of Podiatric Medicine at Samuel Merritt
>>>>         
>> College<br>
>>     
>>>> &nbsp;<br>
>>>> Private Practice:<br>
>>>> 107 Scripps Drive, Suite 200<br>
>>>> Sacramento, CA&nbsp; 95825&nbsp; USA<br>
>>>> &nbsp;<br>
>>>> Voice:&nbsp; (916) 925-8111&nbsp;&nbsp;&nbsp;&nbsp; Fax:&nbsp;
>>>>         
>> (916)
>>     
>>>> 925-8136<br>
>>>>
>>>>         
>> *********************************************************************
>>     
>>>> *******<br>
>>>> <br>
>>>> <br>
>>>> David Smith wrote:
>>>> <blockquote
>>>>         
>> cite="mid001001c78f08$bccfbdf0$eed10250@acervfr9okf50t"
>>     
>>>> type="cite">
>>>>  <meta http-equiv="Content-Type"
>>>> content="text/html;charset=ISO-8859-1">
>>>>  <meta content="MSHTML 6.00.6000.16414" name="GENERATOR">
>>>>  <style></style>
>>>>  <div><font face="Arial" size="2">Dear Kevin K</font></div>
>>>>  <div>&nbsp;</div>
>>>>  <div><font face="Arial" size="2">As I&nbsp;do not regularly
>>>> correspond
>>>> and&nbsp;not feel familiar with Dr Dananberg I used that form of
>>>> address. It
>>>> seemed a little disingenuos to use the form of title Dr Dannanberg
>>>> and
>>>> not be respectful enough to include that&nbsp;form when addressing
>>>> both
>>>> Doctors. </font></div>
>>>>  <div>&nbsp;</div>
>>>>  <div><font face="Arial" size="2">Cheers Dave</font></div>
>>>>  <div>&nbsp;</div>
>>>>  <blockquote
>>>> style="border-left: 2px solid rgb(0, 0, 0); padding-right: 0px;
>>>> padding-left: 5px; margin-left: 5px; margin-right: 0px;">
>>>>    <div
>>>> style="font-family: arial; font-style: normal; font-variant:
>>>>         
>> normal;
>>     
>>>> font-weight: normal; font-size: 10pt; line-height: normal;
>>>> font-size-adjust: none; font-stretch: normal;">-----
>>>> Original Message ----- </div>
>>>>    <div
>>>> style="background: rgb(228, 228, 228) none repeat scroll 0%;
>>>> -moz-background-clip: -moz-initial; -moz-background-origin:
>>>> -moz-initial; -moz-background-inline-policy: -moz-initial;
>>>> font-family: arial; font-style: normal; font-variant: normal;
>>>> font-weight: normal; font-size: 10pt; line-height: normal;
>>>> font-size-adjust: none; font-stretch: normal;"><b>From:</b>
>>>>    <a title="[log in to unmask]"
>>>> href="mailto:[log in to unmask]">Kevin Kirby</a> </div>
>>>>    <div
>>>> style="font-family: arial; font-style: normal; font-variant:
>>>>         
>> normal;
>>     
>>>> font-weight: normal; font-size: 10pt; line-height: normal;
>>>> font-size-adjust: none; font-stretch: normal;"><b>To:</b>
>>>>    <a title="[log in to unmask]"
>>>> href="mailto:[log in to unmask]">[log in to unmask]</a>
>>>> </div>
>>>>    <div
>>>> style="font-family: arial; font-style: normal; font-variant:
>>>>         
>> normal;
>>     
>>>> font-weight: normal; font-size: 10pt; line-height: normal;
>>>> font-size-adjust: none; font-stretch: normal;"><b>Sent:</b>
>>>> Saturday, May 05, 2007 6:34 AM</div>
>>>>    <div
>>>> style="font-family: arial; font-style: normal; font-variant:
>>>>         
>> normal;
>>     
>>>> font-weight: normal; font-size: 10pt; line-height: normal;
>>>> font-size-adjust: none; font-stretch: normal;"><b>Subject:</b>
>>>> Midtarsal Joint Biomechanics and Interaction of
>>>>         
>> Tension/Compression
>>     
>>>> Elements During Stance Phase</div>
>>>>    <div><br>
>>>>    </div>
>>>>    <font face="Helvetica, Arial, sans-serif">Dave and
>>>> Colleagues:<br>
>>>>    <br>
>>>> Dave wrote:<br>
>>>>    <br>
>>>> &lt;&lt;</font><font face="Helvetica, Arial, sans-serif">Is it
>>>> possible
>>>> for true tensegrity to be maintained with mobility and changing
>>>>         
>> load
>>     
>>>> patterns? Long bones usually snap with bending stress and not from
>>>> direct tension or compression. (even tho bending stress is
>>>> tensional&nbsp;at
>>>> the microscopic level) However most joints can only transmit
>>>>         
>> moments
>>     
>>>> thru the tensional forces&nbsp;of the soft tissues. Due the nature
>>>>         
>> of
>>     
>>>> muscle
>>>> and ligament arrangement it is very unusual for one muscle and or
>>>> ligamnet to be entirely reponsible for a single plane rotation
>>>>         
>> about
>>     
>>>> the axis of a joint. Instead each tissue has an oblique pull on
>>>>         
>> the
>>     
>>>> joint and so it is necessary for several muscles to be active at
>>>>         
>> one
>>     
>>>> time to stabilise a limb thru a single plane RoM. This arrangement
>>>> both
>>>> enables redundancy and allows muscle tension to be dissapated to
>>>>         
>> many
>>     
>>>> secondary rigid structures IE bone, which in turn reduces local
>>>> stress
>>>> at what could be called the primary site of load. If this were not
>>>>         
>> so
>>     
>>>> then lifting relatively small loads would cause the spine to crush
>>>>         
>> or
>>     
>>>> tear apart. The trunk itself acts very much like a
>>>> tensegrity&nbsp;structure
>>>> where increasing the tension in the chest and abdomen increases
>>>>         
>> the
>>     
>>>> overall siffness of the structure centered around the spine.
>>>>         
>> Whereas
>>     
>>>> I
>>>> would say the arms are more like a conventional lever system
>>>>         
>> acting
>>     
>>>> like a crane. I think that the foot is a combination of the two.
>>>>         
>> As a
>>     
>>>> whole unit it is a lever that propells us, about&nbsp;the ankle
>>>> joint,&nbsp; thru
>>>> gait but&nbsp;can also be adaptable to ground contours (or
>>>>         
>> whatever
>>     
>>>> is under
>>>> the foot eg a tree branch). The untensioned bag of bones can adapt
>>>> and
>>>> the&nbsp;propelling foot becomes less compliant as tensegrity or
>>>> internal
>>>> tension increases.&nbsp;Due to the redundancy factor however if
>>>>         
>> the
>>     
>>>> individual segments and muscles are not operating at their optimum
>>>> then
>>>> another segment or muscle must increase its work load which may
>>>>         
>> cause
>>     
>>>> damage to that structure or tissue or may unbalance the whole
>>>> internal
>>>> tension system, r</font><font face="Helvetica, Arial,
>>>> sans-serif">esulting
>>>> in pathologies various and many. Perhaps as the balanced internal
>>>> tension is disrupted then the foot experiences more internal
>>>>         
>> bending
>>     
>>>> moments that more easily cause trauma.&gt;&gt;<br>
>>>>    <br>
>>>> Excellent posting, Dave.&nbsp; You are now addressing me
>>>> formally..................................Dr.
>>>> Kirby?............................&nbsp; ;-) <br>
>>>>    <br>
>>>> Let's look at the biomechanics of the foot without the need to use
>>>> the
>>>> term "tensegrity" (so I can ensure that JISCmail will light up
>>>>         
>> over
>>     
>>>> the
>>>> weekend with postings from the lovers of tensegrity that inhabit
>>>>         
>> this
>>     
>>>> list). ;-)<br>
>>>>    <br>
>>>> The passive mechanical structure of the human foot is composed of
>>>> both
>>>> compression load-bearing elements, known as bones, that are held
>>>> together and attached to each other by&nbsp; tension load-bearing
>>>> elements
>>>> known as ligaments and fascia.&nbsp; It is the combination of the
>>>> specific
>>>> geometric arrangements of these passive structural elements of the
>>>> foot
>>>> along with the mechanical interaction of these elements during
>>>> weightbearing activities that is very important in allowing the
>>>>         
>> foot
>>     
>>>> to
>>>> both assume the function of a mobile adapter during early stance
>>>> phase
>>>> and a rigid lever during late stance phase.<br>
>>>>    <br>
>>>> Ground reaction force (GRF) acting on the forefoot will cause a
>>>> compression force on the metatarsal heads and digits and will, in
>>>> turn,
>>>> also cause a forefoot dorsiflexion moment.&nbsp; In early stance
>>>> phase, the
>>>> magnitude of forefoot GRF will be relatively low causing decreased
>>>> metatarsal head and digital compression forces and low forefoot
>>>> dorsiflexion moments.&nbsp; The relatively small magnitudes
>>>>         
>> forefoot
>>     
>>>> dorsiflexion moments seen in early stance phase causes only small
>>>> increases in the magnitudes of passive tensile forces within the
>>>> plantar ligaments and plantar aponeurosis that will, in turn,
>>>>         
>> cause
>>     
>>>> relatively small magnitudes of forefoot plantarflexion moments to
>>>> counterbalance the forefoot dorsiflexion moments.&nbsp; Therefore,
>>>> due to
>>>> the relatively small magnitudes of passive plantar ligament and
>>>> plantar
>>>> fascia tensile forces in early stance phase, there will be
>>>>         
>> relatively
>>     
>>>> small interosseous compression forces within the midfoot and
>>>> midtarsal
>>>> joints during early stance phase.&nbsp; The combination of smaller
>>>> plantar
>>>> ligament tensile loads and smaller interosseous compression forces
>>>> within the midfoot and midtarsal joints allow greater dorsiflexion
>>>> compliance of the individual metatarsal rays that will, in turn,
>>>> ensure
>>>> that the plantar forefoot has sufficient compliance&nbsp; to
>>>>         
>> optimize
>>     
>>>> surface contact of all the metatarsal heads with any uneven
>>>> weightbearing surfaces that may be encountered by the individual
>>>> during
>>>> the early stance phase of gait.<br>
>>>>    <br>
>>>> During late stance phase, this unique geometric arched structure
>>>>         
>> of
>>     
>>>> compression and tension load-bearing elements that constitute the
>>>> human
>>>> foot will allow passive sagittal plane stiffening of the
>>>>         
>> longitudinal
>>     
>>>> arch and metatarsal rays of the foot so that the more compliant
>>>> forefoot in early stance is then rapidly converted into a more
>>>>         
>> stiff
>>     
>>>> forefoot to allow for greater efficiency of force transfer during
>>>> propulsion.&nbsp; In late midstance, GRF acting on the plantar
>>>> forefoot will
>>>> rapidly increase that will </font><font
>>>> face="Helvetica, Arial, sans-serif">cause an increased compression
>>>> force on the metatarsal heads and digits and will also cause
>>>>         
>> rapidly
>>     
>>>> increasing forefoot dorsiflexion moments.&nbsp;&nbsp; The
>>>>         
>> relatively
>>     
>>>> large
>>>> magnitudes of forefoot dorsiflexion moments seen in late stance
>>>>         
>> phase
>>     
>>>> will cause relatively large magnitudes of passive tensile forces
>>>> within
>>>> the plantar ligaments and plantar aponeurosis that will, in turn,
>>>> cause
>>>> relatively large magnitudes of forefoot plantarflexion moments to
>>>> counterbalance the forefoot dorsiflexion moments.&nbsp; In turn,
>>>> these large
>>>> magnitudes of passive plantar ligament and plantar fascia tensile
>>>> forces in late midstance phase will cause large magnitudes of
>>>> interosseous compression forces within the midfoot and midtarsal
>>>> joints
>>>> during late stance phase. As a result, these rapidly increasing
>>>> counteropposing forefoot dorsiflexion and forefoot plantarflexion
>>>> moments in late stance cause significant increases in forefoot
>>>> dorsiflexion stiffness which will, in turn, reduce the capacity of
>>>> the
>>>> individual metatarsal rays to conform to uneven surfaces (i.e.
>>>>         
>> will
>>     
>>>> reduce their compliance) but will have the positive mechanical
>>>> benefit
>>>> of significantly increasing the dorsiflexion stiffness of the
>>>> forefoot
>>>> to allow for more efficient propulsion. <br>
>>>>    <br>
>>>> This above mechanism is dependent only on the passive integrity of
>>>> the
>>>> ligaments and fascia of the foot, on the passive integrity of the
>>>> bones
>>>> of the foot and on the specific geometric arrangement of the
>>>> structural
>>>> elements into an arched dorsally-oriented series of compression
>>>> load-bearing elements that are supported by linear arrangements of
>>>> plantarly-oriented tension load-bearing elements.&nbsp; And,
>>>>         
>> contrary
>>     
>>>> to
>>>> universally taught and widely-accepted podiatric biomechanics
>>>>         
>> dogma,
>>     
>>>> this mechanism of early stance phase compliance (i.e. mobility)
>>>>         
>> and
>>     
>>>> late stance phase stiffness (i.e. rigidity) will occur independent
>>>>         
>> of
>>     
>>>> subtalar joint rotational position or subtalar rotational motions
>>>>         
>> as
>>     
>>>> long as the forefoot is plantigrade to the ground during stance
>>>> phase.&nbsp;
>>>>    <br>
>>>>    <br>
>>>> I have previously published this alternative theory of early
>>>>         
>> stance
>>     
>>>> phase mobility and late stance phase rigidity previously in my
>>>>         
>> May,
>>     
>>>> June and July&nbsp; 2006&nbsp; Precision Intricast Newsletters
>>>>         
>> titled
>>     
>>>> "Transmission of Forces and Moments Within the Foot - Volume I, II
>>>> and
>>>> III".<br>
>>>>    </font><font face="Helvetica, Arial, sans-serif"><br>
>>>>    </font>Sincerely,<br>
>>>>    <font face="Helvetica, Arial, sans-serif">&nbsp;<br>
>>>> Kevin<br>
>>>> &nbsp;<br>
>>>>
>>>>         
>> *********************************************************************
>>     
>>>> *******<br>
>>>> Kevin A. Kirby, DPM<br>
>>>> Adjunct Associate Professor<br>
>>>> Department of Applied Biomechanics<br>
>>>> California School of Podiatric Medicine at Samuel Merritt
>>>>         
>> College<br>
>>     
>>>> &nbsp;<br>
>>>> Private Practice:<br>
>>>> 107 Scripps Drive, Suite 200<br>
>>>> Sacramento, CA&nbsp; 95825&nbsp; USA<br>
>>>> &nbsp;<br>
>>>> Voice:&nbsp; (916) 925-8111&nbsp;&nbsp;&nbsp;&nbsp; Fax:&nbsp;
>>>>         
>> (916)
>>     
>>>> 925-8136<br>
>>>>
>>>>         
>> *********************************************************************
>>     
>>>> *******</font><br>
>>>>    <br>
>>>>    <blockquote
>>>> cite="mid000701c78e82$b91f7e10$61500150@acervfr9okf50t"
>>>>
>>>>         
>> type="cite">--------------------------------------------------------
>>     
>>>> ----
>>>>    </blockquote>
>>>> -----------------------------------------------------------------
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