When I evaluate feet and ankles and note very different function side to side, and see 2 identical orthotics, I am puzzled. When I see the same but 2 very different orthotics; I am pleased. Before getting for for orthotics it is ideal to have all of the joints of the foot and ankle evaluated and treated. There are several movement restrictions that are treatable and can distinctly improve the function of these joints. Long ago I learned that the orthotics do not make much change in the transverse plane, (where rotation occurs) they do affect frontal (front and back view of foot) and sagittal planes (lateral view). These joints are very strong, so they can take some abuse, and in fact do. They may or may not have local pain, but the body reflexively compensates elsewhere and this distal area over time may become symptomatic. It is not unusual to find muscle imbalances in the presence of joint restrictions, and these reflexively restore when the joint, ligament, tendons and muscle are balanced. Treat all. Per above, rotation in the transverse plane must be treated, especially at the subtalar joint. It can be very rewarding, one treatment, and the clinet should then know self management. Terms like pronation can be misued, most clients I see have been told they pronate (too much) and I find they do so only at the forefoot. Why? Because the rear foot and mid foot supinates excessively, in fact remain in supination. So the joint mobilization addressthe supination and restores functional pronation of the rear foot and mid foot, and then the forefoot pronates, less, now normally. If foot and ankle joint dysfunbction persists it can alter forces and movements at the knee, the hip, the pelvis and reflexively; as far as the neck. If "whole-body" is important, incorporating foot care in the paradigm provides a good foundation, literally and figuratively. Happy Friday! Jerry
This was a very remarkable presentation. A poker player cam to see me for headache and neck pain and low back pain. I was astonished at how very tight and unyielding his upper cervical spine was (occipito-atlantal) where the head and neck connect. Nothing I did there was effective so I knew to find the cause elsewhere. His hip were extremely tight bilaterally and I previously thought that this was simply the way they developed; concluded on a false positive for a hard bone-on-bone end-feel. Nothing else seemed to explain his presentation. This was the tightest upper cervical I had seen for some time, and sitting at the poker table and at his business computer would only compound the problem as the posture induces flexion throughout the spine but hyper-extension in the upper neck.
I treated both hips for 10 minutes, using a fulcrum to induce a very gentle force.
His neck released and in 2 visits, neck was normal with more hip range of motion, much less pain and muscle tightness. He was taught self-treatment, so he will be able to keep these gains, does not need to "keep coming back...".
Releasing the hips released the neck.
This is an example of the Hesch Method; treating the cause, not "the pain". Or perhaps worded better; treating the pain very effectively and efficiently by treating far away, treating the source.
Rule: When you cannot achieve gains in one part of the body, go elsewhere, typically below. If unilateral, go to the opposite side, below.
Thanks for visiting my blog.
Dr. Jerry Hesch, DPT, MHS, PT
Married with 4 grown kids. Earned my Doctorate at A.T. Still University in Tempe, AZ, MHS at the University of Indianapolis and my BS PT at University of New Mexico. I enjoy working with my hands and particularly making glass objet d'art.