In 2002, I published a paper in the Journal of Bodywork and Movement Therapy describing a previously unrecognized embryological foot structure, the PreClinical Clubfoot Deformity, which occurs when the talus and calcaneus do not complete their normal ontogenetic development (e.g., Calcaneal and Talar Supinatus).
Clinically, Calcaneal and Talar Supinatus maintains the calcaneus and entire medial column of the foot in supinatus, observed as an elevated and inverted calcaneus, first metatarsal and hallux when the foot is placed into its anatomical neutral position (e.g., subtalar joint congruity).
The PreClinical Clubfoot Deformity is one of the most common causes of abnormal pronation. This occurs because gravity forces the gaiting foot to rotate inward and downward until the elevated and inverted calcaneus, first metatarsal and hallux rest on the ground (referred to as Gravity Drive Pronation).
Fluoroscopy of the Rearfoot. Laxity of the spring ligament predisposes the head of the talus to slip downward and forward. This can result in the partial or total collapse of the inner longitudinal arch.
Protocol for recording Preimus Metatarsus Supinatus value
Posterior tibialis Syndrome (Acquired Adult Flat Foot)
The Posterior Tibialis Muscle is a major stabilizer of the rearfoot. Rupture or chronic stretching of this muscle, beyond its normal limit of excursion, can lead to a functional flatfoot. This acquired adult flat foot must be differentiated from the PreClinical Clubfoot Deformity which also results in a functional flatfoot.
Typical rupture point of this muscle is either at or within 6cm proximal to its navicular insertion.
Xray (See Below) frequently demonstrate:
Spring Ligament Laxity - can result in a functional flatfoot
Anatomy: The Spring Ligament is a strong, thick ligament which covers part of the articular surface of the talar head. It is attached to the (1) anterior border of the sustentaculum tali and (2) plantar surface of the navicular.
Function: The Spring Ligament helps maintain the inner longitudinal arch by supporting the head of the talus. Laxity of the Spring Ligament (as occurs in Ehlers-Danlos Syndrome and Marfan Sydrome) can result in a forward, downward and inward displacement of the talar head (See Fluoroscopy below)
Differential Diagnosis - Rothbarts Foot vs PreClinical Clubfoot Deformity
Knee Bend Test
Cummings GS, Higbie EJ 1997. A weight bering method for determining forefoot posting for orthotic fabrication. Physio Research International, 2(1). Whurr Publishers Ltd.
Functional Flatfooted Gait Associated with a Preclinical Clubfoot Deformity: foot motion is driven by Gravity Drive observed from heel contact to heel lift
Note the atypical heel contact in which the entire foot lands on the ground (as opposed to a distinct heel contact). This same atypical motion occurs at heel lift where the entire foot is raised off the ground (as opposed to a distinct push off by the hallux). This gait pattern, often described as a functional flatfooted gait, is frequently observed in the PreClinical Clubfoot Deformity (PMSv greater than 15mm).
Mild Clubfoot Deformity
Marfan Syndrome - incidence 1 in 5000 (see Photo below)
Tarsal Coalition (See Photo below)
How the feet can lead to pain throughout the body:
1. All feet have mechanical receptors on the bottom, which are stimulated through touch, as in standing or walking. This stimulation produces a signal which is sent to the brain.
2. Posture affects the health of all the weight-bearing joints/muscles and viscera in your body. Postural distortions (poor posture) misaligned the joints and can compress internal organs. Frequently, this leads to joint and muscle inflammation and visceral irritation.
3. If the postural distortions are not corrected, chronic disabling symptoms can develop.
PreClinical Clubfoot Deformity
Measuring the PreClinical Clubfoot Deformity (Cummings GS, Higbie EJ 1997)
Note the automatic and instantaneous postural correction when the appropriate proprioceptive insole is used to correct the proprioceptive signals to the cerebellum:
Gravity Drive Pronation observed in the PreClinical Clubfoot Deformity - Treadmill Analysis
The definition of abnormal pronation does not refer to the amount of pronation. Abnormal pronation refers to the timing of pronation. That is, the foot is pronating when it should be supinating, e.g., it has escaped Hip Drive Pronation and becomes engaged in Gravity Drive Pronation.