References

     Rothbart BA 2006. Asymmetrical Pronation Patterns linked to Thoracic Curves. Biomechanics - The Foot Blog. PICOMM/PIJ Editors, Oct.

     Rothbart BA 2013.  Preliminary Study: Adolescent Idiopathic Scoliosis Linked to Abnormal Foot Pronation.  Podiatry Review  Vol 72, No 2:8-11.

Adams Test - Right Thoracic Curve

Right Thoracic Left Lumbar Curve

Pure Ascending Postural Pattern

  • Foot Pronation right > left

Thoracic Curves Linked to the Feet

Clinical Study -  completed in 07Mar2006

  • Published OnLine 12Mar2006
  • Published Podiatry Review 2013

Inclusion Criteria:
n = 25
All diagnosed with Adolescent Idiopathic Scoliosis
All exhibiting a right thoracic curve

In a preliminary study of 25 patients with asymmetrical abnormal pronation patterns and a positive Adams Test, a positive statistical correlation was found between: the pronation pattern, the pelvic distortion pattern, and the pattern of frontal plane deviation within the thoracic spine [raw data].

Purpose of Study: To determine if a correlation exists between abnormal foot motion (in this case abnormal foot pronation) and the development of scoliotic curves. In this study I only included those subjects that:

  • (1) abnormally pronated and
  • (2) were positive for the Adams test. I ran a t-test on the clinical data to determine if a positive correlation existed between the prominence of the scapula wing, the direction of the thoracic curve and the abnormal pronation pattern. A positive correlation was identified in this study.

From clinical experience, we know that many abnormal pronators do not develop significant scoliotic curves (Cobb angle greater than 20 degrees). I believe the development of scoliotic curves is a multifactorial issue. There are other factors that still need to be identified if we wish to understand why only a few patients end up with significant scoliosis. 

The 25 patients in this study had a sundry of chronic musculoskeletal complaints. Many of these symptoms were contributed more to the abnormal pronation than directly to the scoliosis. In this preliminary study I made no attempt to separate the cases into functional or structural scoliosis. I believe that a rotated and unleveled pelvis is one of the biomechanical determinants that make an individual more prone to develop scoliosis.

Conclusion (See Raw Data): this study suggests that asymmetrical pronation patterns may be a critical factor in the development of scoliotic curves. Interesting enough, in the screening process, I found no patients with significant scoliotic curves that did not abnormally pronate.

Adolescent Idiopathic Scolisis is a two dimensional deformity (lateral and rotational) of the spinal column in the absence of associated congenital or neurologic abnormalities. Onset is between the ages of 10 and 18. Longitudial studies (Yawn et al, 1999; Soucacos et al, 1997) estimate the prevalence as high as 2% of the adolescent population, using a definition of a spinal curve greater than 10 degrees. (A side to side curve of at least 10 degrees with a rotational deformity, of at least 10 degrees, must be present before AIS can be diagnosed.) Side to side (frontal plane) curves greater than 20 degrees have a distribution of 5 females for every male.  
 
In young children, I have been very successful in stabilizing thoracic curves via Rothbart Proprioceptive Therapy. This therapy now makes it possible to reverse or even possibly prevent the development of these spinal lesions.

(Note: The motion depicted in the animated model (below) was intentionally augmented to help clarify the complex combination of rotations occurring in the pelvis and spine.)

Pure Ascending Postural Distortional Pattern

If the pattern of pronation was right > left, the pelvis was tilted downwards towards the right side. The ribcage was rotated clockwise.  The right shoulder was rotated forward and downward to the left with a protruding right scapula wing.  The thoracic scoliotic curve was on the right side.