Directions for Measuring Rothbarts Foot

Rothbarts Foot is one of the most common causes of abnormal foot pronation. This occurs because gravity forces the gaiting foot to rotate inward and downward until the elevated first metatarsal and hallux rests on the ground (referred to as Gravity Drive Pronation).

Reference‚Äč

         Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46

Clinically, talar supinatus maintains the entire medial column of the foot in supinatus, clinically observed as an elevated and inverted first metatarsal and hallux when the foot is placed into its anatomical neutral position (e.g., subtalar joint congruity, See Photo below):

Exploding foot model demonstrating the retention of Talar Supinatus.  

Case Study

Rosario N.,  D.O.B. 13 July1962

Chief Complaints:

  • 7 year history of debilitating leg pain (left), increasing with activity, decreasing with rest
  • Chronic gastrointestinal symptoms, alternating constipation/diarrhea, discomfort

Prior Interventions: 

  • Chiropractic/Physical Therapy/Orthotics - non responsive to therapy

Significant Objective Findings:

  • Tendonitis of the Gastrocnemius (lateral) and Achilles Tendon, left leg and ankle
  • Weak abdominal muscles due to anterior rotation of innominates
  • Primus Metatarsus Supinatus Foot Structure


Rothbart Proprioceptive Therapy

Results:

  • Total elimination of pain in the Achilles tendon and Gastrocnemius muscle
  • Total elimination gastrointestinal symptoms


Discussion:

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.

If the foot structure is normal, correct signals are sent to the brain.  The brain acts on these correct signals by maintaining good posture.
If the foot structure is abnormal (such as in a Rothbarts Foot), distorted signals are sent to the brain.  The brain acts on these distorted signals by maintaining bad posture.

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.

Postural Analysis (Top), Gait Analysis (Bottom).  Note the decrease in foot twist (white arrow, right) and concurrent improvement in posture when the proprioceptive insole is used.

Gravity Drive Pronation observed in the Rothbarts Foot Structure

Screening for Rothbarts Foot (RFS) - Level of Confidence (LC) for Presence of Rothbarts Foot

1 of the 4 tests Positive -  65% Level of Confidence

2 of the 4 tests Positive -  75% Level of Confidence

3 of the 4 tests Positive -   85% Level of Confidence

4 of the 4 tests Positive  -  95% Level of Confidence

In 2002, I published a  paper in the Journal of Bodywork and Movement Therapies describing a previously unrecognized embryological foot structure, the Primus Metatarsus Supinatus foot (aka Rothbarts Foot).  I linked the etiology of  this embryological foot structure to the incomplete torsional development of the talar head, referred to as talar supinatus (See Animation below). 

Metatarsus Primus Supinatus (Rothbarts Foot)

Positive Knee Bend Test for Rothbarts Foot

Knees Straight - Feet Straight - plantar surface perpendicular to leg

Knees Bent  -  Feet Pronated

Red arrow on the left points to the retention of supinatus in the talar head.

Red arrow on the right points to the supinatus (inverted and elevated) first metatarsal and hallux pathogonomonic of Rothbarts Foot when the foot is placed into its anatomical neutral position

Gravity Driven Pronation observed in Rothbarts Foot - Treadmill Analysis

The definition of abnormal foot pronation does not refer to the amount of pronation.  Abnormal foot pronation refers to the timing of pronation.  That is, the foot is pronating when it should be supinating.  

Above is a 4 frame video analysis of the left foot during mid-stance to heel lift phase of gaiting: 

  • At mid-stance (Frame 2- red arrow) the left foot is pronating 
  • At late mid-stance (Frame 3 - red arrow)  the left foot is continuing to pronatie
  • At heel off (Frame 4 - black arrow) the left foot resupinates (Hicks Windlass Mechanism)  
  • Left Foot pronation (Frames 2 - 3) is occurring as the ipsilateral (same side) hip is externally rotating.