Forefoot posting and tone reduction

Forefoot posting and tone reduction

Beverly Cusick, MS PT

11/22/2001

>>>>>
>>>>>Hello List Members -
>>>>>
>>>>>I recently replied to a query from an orthotist regarding the availability
>>>>>of literature or resources on the issue of forefoot posting in AFOs
>>>>>intended for tone reduction. I recommended TC Michaud's text: Foot
>>>>>Orthoses and Other Forms of Conservative Foot Care, as the best-written,
>>>>>best-illustrated, clearest and most comprehensive text I've ever found on
>>>>>the topics of foot and ankle biomechanics and function, compensation and
>>>>>intervention using plantar orthotic inserts. (The author took over
>>>>>publication when Williams & Wilkins stopped printing it. Michaud
>>>>>Chirporactic, Newton, MA : PH/FAX 617/969-2225.)

>>>>>As most of my clientele are neurologically involved, and the scope of
>>>>>my need for
>>>>>orthotic options is much broader than Michaud's, we differ at times on
>>>>>posting principles. I've also refined the assessment techniques that add
>>>>>to the decision-making body of data pertaining to orthotic design and
>>>>>posting.
>>>>>
>>>>>I'm wondering if any members of this list know of other such resources?
>>>>>
>>>>>By the way, tone'' is defined as a state of resistance to passive
>>>>>elongation. It is not a state of activation of the neuromuscular system,
>>>>>though a hyperactive stretch reflex ('spasticity) might be a component of
>>>>>hypertonus. Inappropriate or excessive recruitment of muscle groups, in
>>>>>synergy, or of antagonistis (coactivation) is not tone. It is evidence
>>>>>of injury to the CNS neuromotor regulation system.
>>>>>
>>>>>Anyway, back to the topic -
>>>>>
>>>>>After setting the hindfoot in the desired alignment, I use forefoot
>>>>>posting routinely in managing foot alignment and function problems in
>>>>>children and adults with CNS dysfunction, as they are
>>>>>generally unable to make any selective or subtle adjustments to
>>>>>malalignments or imbalances of foot joint configuration or ROM.
>>>>>
>>>>>The foot is our body-ground interface. In my experience, addressing its
>>>>>management is fundamental to optimizing its function in load-bearing
>>>>>circumstances. Considering that we (hopefully) load it 10,000 times/day on
>>>>>average, the attention to details of foot and orthotic configuration, to
>>>>>reduce mechanical stresses (through the closed chain) and the related
>>>>>muscle recruitment problems and the discomfort that ensues, is essential
>>>>>to effective care of anyone with LE muscle imbalances, orthopedic problems
>>>>>at the knee and hip joints, and those with CNS dysfunction, many of whom
>>>>>existed with orthopedic problems relating to foot function prior to
>>>>>enduring a head injury or stroke.
>>>>>
>>>>>I'm sure that varus posting is where the most common errors in forefoot
>>>>>posting occur. Either the post is terminated too proximal on the foot -
>>>>>the met heads must be included as they are the only part of the foot that
>>>>>is loaded at early propulsion - or the post is excessive in magnitude, or
>>>>>the first ray (of normal length) is prohibited from plantarflexing at
>>>>>early propulsion.
>>>>>
>>>>>Would any of you have other points of view or experience with this aspect
>>>>>of orthotic intervention?
>>>>>
>>>>>I discuss this issue in detail inmost of my courses, to which orthotists,
>>>>>biomechanists, podiatrists, and kinesiologists are invited along with PTs
>>>>>and other rehab clinicians. www.gaitways.com/bcsked.html .
>>>>>
>>>>>Thanks in advance for your thoughts.
>>>>>
>>>>>Regards -
>>>>>
>>>>>Beverly (Billi) Cusick, PT, MS
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>>Hello List members
>>>>>>Does any one have some literature on forefoot posting and on tone
>>>>>>reducing AFOs?
>>>>>>thanks
>>>>>>Vikram Choudhary
>>>>>>
>>>>>>