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Rediscovering better posture – a foot-related personal saga

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I have always been slightly hypermobile – a genetic ‘double-jointed’ state. However this not been a problem – except in relation to my feet  – where sagging arches (hyperpronation) periodically made themselves felt – both locally and at a distance!

Approximately 15 years ago – details are lost in the fog of memory  I developed plantar fasciitis (or more likely fasciosis) … and I don’t recall how, or via whom, was introduced to a remarkable company  Posture Dynamics  and one of their products  ProKinetics® Natural Body Balance™ Insoles – that sorted out the problem extremely rapidly – NOT by offering crutch-like support, but via their unique design which reeducates the foot

DISCLOSURE: I have absolutely no financial interest in this product – or this company

Once pain-free again after a matter of weeks, I did what so many of my patients also do, I neglected to continue applying what had been helpful, and stopped using these ‘educational insoles’. And  of course you know what happened next!?

Following an injury to my left leg a few years ago that altered my gait pattern for a while, I slowly began to notice foot, and knee and hip related symptoms. I dealt with these (semi-successfully) with piecemeal, self-applied stretching and exercise……until the last few months when my ancient body started to complain more than usual. Fortuitously I was able to locate the manufacturers of the product that had helped me so much in the past…..and after carrying out a simple self-evaluation test that’s on their website I made contact – and via the somewhat clunky USPS “express” mail service, these arrived in Corfu yesterday  – 2 weeks after leaving Olympia, WA. They are now safely inserted into my shoes.

This picture from Clinical Applications of Neuromuscular Techniques (Volume 2, lower body) shows the postural effects of inversion….my problem was eversion, so all the rotations would be reversed from this image…..

My reason for this rambling introduction is twofold….

  1. I want as many practitioners/therapists as possible to be aware of the company and its’ many products (REPEAT: I HAVE NO FINANCIAL INTEREST IN IT)
  2. It reminded me of details of “Morton’s Toe”, from a chapter Judith Delany and I wrote in our Clinical Applications of Neuromuscular Techniques (Volume 2, lower body)….extracts from which which I am including in this post:

EXTRACT FROM CHAPTER 14: Clinical Applications of Neuromuscular Techniques (Vol.2 – Lower Body)

PES PLANUS (FLAT FOOT)

“If the medial longitudinal arch is lost this is known as pes planus or flat footed, and can be either flexible or rigid. Flexible flat foot, which is marked by the reappearance of the arch when the foot is non-weight-bearing, may be correctable, whereas rigid flat foot does not usually respond to manual therapies or exercise. Mechanically, collapse of this arch may occur because of hyperpronation or from increased eversion of the subtalar joint. This leads to the calcaneus lying in valgus and external rotation relative to the talus. It is most noticeable in the midfoot region where associated sagging or medial excursion of the midfoot occurs when the talus moves anteriorly, medially and inferiorly, the navicular slides inferiorly, and the calcaneus pronates. (Levangie & Norkin 2005)”

“The incidence of pes planus is approximately 20% in adults, the majority of which are flexible. Flat feet are not necessarily uncomfortable, as long as there is no heel cord contracture, but flat feet associated with heel cord contracture may limit function and lead to discomfort when walking. Heel cord contracture is associated with lateral deviation of Achilles when weight bearing (Staheli et al 1987).”

“Evidence suggests that flat feet protect against metatarsal stress fractures but the feet offer poor shock absorption with regard to the lower back, leading to a higher incidence of low back pain. In contrast, a cavus foot (high arch) may actually be somewhat protective of stress-related low back pain (Ogon 1999).”

“It is important to distinguish between flexible flat foot and rigid (or spastic) flat foot. Surgical intervention is only called for if there is a rigid flat foot (seldom in flexible flat foot) and only when pain, deformity (midfoot breakdown) or severe contracture are factors. A small number of flexible flat feet do not correct with growth and eventually become rigid due to adaptive changes (Lau & Daniels 1998).”

Conservative treatment

“Wenger et al (1989) suggest that, since flexible flat foot is generally a benign condition, it rarely requires treatment. If there are problems associated with heel cord shortening, stretching should be the main treatment. It is important when stretching to ensure that the foot is supinated in order to avoid worsening midfoot collapse.”

REFERENCES

  • Lau J, Daniels T: Effects of tarsal tunnel release and stabilization procedures on tibial nerve tension in a surgically created pes planus foot, Foot Ankle Int 19(11):770, 1998

  • Levangie C, Norkin P: Joint structure and function: a comprehensive analysis, ed 4, Philadelphia, 2005, F A Davis.

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  • Ogon M: Does arch height affect impact loading at the lower back level in running? Foot Ankle Int 20(4):265, 1999.

  • Staheli L, Chew D, Corbett M: The longitudinal arch. A survey of eight hundred and eighty-two feet in normal children and adults, J Bone Joint Surg 69A:426–428, 1987.

  • Wenger D, Mauldin D, Speck G: The influence of footwear on the prevalence of flat foot. A survey of 2300 children, J Bone Joint Surg 71A:800–810, 1989

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