Extraosseous talotarsal stabilization improves hyperpronation

In a paper recently published (Oct 2013) in the Journal of Craniomandibular and Sleep Therapy, a direct linke was demonstrated (using radiographs) between hyperpronation (resulting from the PreClinical Clubfoot Deformity) and frontal plane divergencies in the cranial bones and atlas.

Rothbart BA 2013. Prescriptive Insoles and Dental Orthotics Change the Frontal Plane Position of the Atlas (C1), Mastoid, Malar, Temporal and Sphenoid Bones: A Preliminary Study. Journal of Cranio Manidibular and Sleep Practice, Vol 31(4):300-308.

On May 20th, 2008, in a thread on a Podiatry forum, David Simons MD (co-author of the preeminent textbook on trigger points, myofascial pain and related dysfunctions) wrote:

"The association between your observations [abnormal foot motion changing the facial dimensions - Rothbart BA 2008, JAPMA] is no surprise to me. What is not clear is the chicken and egg relationship. [That is,] Are they both the result of a common cause or does the foot influence facial proportions....."

It saddens me that Dr Simons did not live long enough to read my radiographic study published in the October 2013 issue of Cranio - Craniomandibular and Sleep Practice (the dental journal on craniomandibular orthodontic interventions). On of the purposes of this current study was to determine if insoles could affect the position of the cranial bones and/or atlas. Below is the abstract of my paper.  The published paper is available online.

Abstract

The purpose of this Series of Case Studies was to determine if the frontal plane position of the cranial bones and atlas could be altered using dental orthotics, prescriptive insoles, or both concurrently.

Methods: The cranial radiographs of four patients were reviewed in this study. Three of the patients were diagnosed as having a TMJ dysfunction and a PreClinical Clubfoot Deformity. The fourth patient was diagnosed as having a TMJ dysfunction, a PreClinical Clubfoot Deformity and a Class II Sacral Occipital Subluxation.

Each patient had a series of 4 cranial radiographs taken by a board certified D.C. radiologist in atlas divergency, using a modified orthogonal protocol. The first cranial radiograph was taken with the patient using neither the dental orthotic nor proprioceptive insoles were used (baseline measurement). The second cranial radiograph was taken with the patient using only the dental orthotic. The third cranial radiograph was taken with the patient only using the proprioceptive insoles. The final cranial radiograph was taken with the patient using both the dental orthotic and proprioceptive insoles concurrently.

The degree of change in angle between the various specified cranial landmarks and atlas were measured directly off of these radiographs and compared to one another.

Results: In two patients, improvement towards orthogonal was achieved when using both prescriptive dental orthotics and prescriptive insole concurrently. Improvement towards orthogonal was less apparent when using only the prescriptive dental orthotic. And no improvement or a negative frontal plane shift was noted when using only the prescriptive proprioceptive insoles.

In the third patient, the frontal plane position of the cranial bones and atlas increased (away from orthogonal) when using the generic proprioceptive insoles alone or in combination with a prescriptive dental orthotic.

In the fourth patient, the frontal plane position of the cranial bones improved using the dental orthotic. However, the proprioceptive insoles when used alone, or in combination with the dental orthotic, increased the frontal plane position of the cranial bones and atlas.

Conclusion: This study demonstrates that changes in the frontal plane position of the cranial and atlas bones can occur when using proprioceptive insoles and/or dental orthotics.

This paper provides compelling radiographic data demonstrating why we must be cognizant of the impact (both positive and negative) insoles can have on the cranium. For example:

One of the patients in my retrospective study (patient A.D.) developed debilitating 'squeeze like' headaches several months following the successful use of insoles for her heel pain. (generic insoles purchased from an internet vender). She consulted several healthcare providers (including, if my memory serves me right, a neurosurgeon) in an attempt to isolate the cause of her ongoing headaches, with no success.

During her initial evaluation, I ran a series of computerized tests and then sent her in for a series of cranial radiographs. The radiographs revealed an increase in the Pls (absolute sum of the planar line shift) while wearing her insoles (greater divergence from orthogonal) suggesting an increase in pressure between the cranial sutures.

Removing the insoles from her shoes, immediately dissipated her headaches.

Coincidence? Most likely not. On several occasions A.D. tried using her insoles again. On each occasion her headaches returned.

For nearly a decade now I have suspected a link between orthotic intervention and cranial topography.

Rothbart BA 2008. Vertical Facial Dimensions Linked to Abnormal Foot Motion. JAPMA, Vol 98, No 3.
Rothbart BA 2006. Cranial lesions initiated by abnormal foot motion. Price-Pottinger Foundation, Journal Health and Healing Wisdom 30(1):6-7

This current radiographic study demonstrates that link.

Postural distortional patterns are not linear (chicken and the egg).  Rather they are multifactorial and can be initiated by distorted signals generated from the eyes, inner ear, occlusion and feet (which are sent to the cerebellum for processing).

My area of research has been principally restricted to the ascending distortional patterns (e.g., coming from the feet).  I have mapped out the pure (textbook) descriptions of the distortional patterns resulting from either the PreClinical Clubfoot Deformity or the Primus Metatarsus Supinatus (aka Rothbarts) Foot.

However, rarely do we clinically see pure textbook pathologies (e.g., pure ascending or descending distortional patterns). Usually chronic pain patients have a mixed postural distortional patterns (concurrently ascending and descending patterns) resulting in a skewed postural distortional pattern.

To understand these skewed patterns, we must first understand the pure patterns.  Then we can make sense of the mixed patterns.

In my Cranio paper, you can see the divergencies resulting from treating only one of the skewed postural patterns (they increase, which clinically manifests as increased symptomatology).  That is why it is so important to maintain a global perspective when reversing the postural distortions