Professional Podiatrists Members' Day 2nd of October 2011 The foot as foundation of the body, an osteopathic point of view -- Mr. Jory Pauwels --

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2. The foot as foundation
of the body, an
osteopathic POV

3.  Communication
 T.E.A.M
Aim

4.  Know your anatomy
 Osteopathy is based on function
 A. rule
 Structure-Function
Osteopathic view

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8.  Fl.-ext. around axis
→
normal: (≈ fysiol. valgus)
 Art. TT = tib-fib. + talus
 Trochlea tali (3 fa ):
 AP: cv
 ventral wider then dorsal
 ventro -lat. sulcus
 Talus shaft:
 ventro- med. sulcus

9.  Fa:
1 part
2 parts F T
L M
T

10. A-P plane:
Tibia to ;
 eg. rugby tackle
 Not very often
 # anterior margo tibia

11.  Tibia to ;
 eg. Football kick
in the grass

12. Tarsus
 Tarsus posterior:
 calcaneus
 talus
 Tarsus anterior:
 cuboid
 naviculare
 cuneiformes (3)
 Artt.:
 subtalair
 Chopart
 Lisfranc

13. Subtalar
 Underestimated art. in classical medicine
 In case of block.: impact on roll-off pattern pes
A
 Os calc. =
initial contact during
marche
 2 parts:
.&
Bottom
side Talus Top side
 Talus is ‘embedded’ calc.
P

14. Subtalar pars posterior
pars posterior: =

autonome part
(capsula & ligg.)
talus cc and oriënt.:
dorso-caudal
calc.: thalamus of
Destot, AP= cv and
ML= flat or cc

15. Subtalar pars anterior
 pars anterior:
talus = bi-cv (contact
with calc + lig.
CNplant. + os nav. +
ligg. delt.)
calc = bi-cc
(sustentaculum) fa
often 2 parts

16. Subtalar
 Ligg. ‘chewing gum’
 Ligg. TCinterosseum:
 pars ant.
 pars post.
 Ligg. TC
 lat. & med.
 post.

17.  Antero-intern lesion:
 talus to med. (intern)
 eversion
 Postero-extern lesion:
 talus to lat. (extern)
 inversion
Subtalar lesion mechanics

18. Art. Chopart
 Francois Chopart (°1743 in Paris, † 1795)
 Art. mediotarsale
 Os calc.-talus
 Os nav.-cuboid
 Art. talo-nav.
 Art. calc.-cub.

19. Art. Chopart: talo-nav.
 Caput tali: cv
 Ligg.:
 calc.-nav.:
(floor)
 with cartilago, capsula & synovia
 Calc.-nav.-cub.:
 Lig. of Chopart / bifurcatum:
 pars vert.: to nav. ( .)
 pars horz.: to cub. ( )

20. Art. Chopart: calc.-cub.
 Calc.: complex fa
 planum transv.:
 pars cran. cc
 pars caud. cv
 caps. + syn.
 Ligg.:
 Calc.-cub. dors.
 Calc.-cub. pl. (longum):

21. Art. Chopart:
lesion mech.
 Osteop. flat foot/
‘distortio of Chopart’
 ‘collaps’ arcades (cfr. infra):
 Nav. to exorot.
 Cub. to endorot.
 Relation cub.-nav. with central line of gravity (cfr. infra)
 Keystone brick of the arcades (cfr.
infra)
 Cause & effect chains up & down (cfr. infra)

22. Art. Lisfranc
 Jacques Lisfranc de St.
3
Martin (°1790, 1847) French surgeon
& gynaecologist 1
2
 Art. Tarso-MT: 3 artt. (capsula
& synovia):
 Ligg. dorsalia, plant. &
interossea

23. Art. Lisfranc ROM
 Cuneiforme I: exo.-endo. rot. &
cran.-caud. TL
 Cuneiforme II & III: cran.-caud.
TL
 Cuneiforme III: greatest ROM
 More ampl. ↑ med. → lat.

24. Arc of Lisfranc
 Intern: Nav CF I,II&III MT I,II&III
 Extern: Cub CF III MT IV&V
 Key role =
 Key stone =
Podiatrists Membersday 2011
jory.pauwels@fico.be

25. Osteopathic lesion

26.  Know your anatomy
 Osteopathy is based on function
 A. rule
 Structure-Function
Osteopathic view

27. {

28.  5 arches: Top view
 AP:
 ML:

29.  2 pilars:
 posterior: calcaneus (2/3
GBody)
 anterior: MT (1/3 GBody)

30.  Construction:
 3 * MT (caput MT I plantar contact)
 3 * CF
 Os naviculare (key stone) (h = 15-18 mm)
 talus (top)
 Os calcaneus (plantar contact)
A P
Medial view

31.  Ligg. suspension: in big F for short time
Medial view
Plantar view

32.  Musc. suspension: in small F for long time
 M. TP (nav & MT): conc. ↑
 M. PL (MT I & Cuneiforme I): conc. ↑
 M. FHL: stab. talus + calc.↑ conc. ↑
 M. Abd. Hallucis: conc. ↑
 M. Plantaris conc. ↑
 M. EHL + M. TA: retinaculum: conc. ↓

33. Medial view

34. Plantar Aponeurosis
http://www.youtube.com/watch?v=aXl86K7OwVk&feature=related

37.  Construction:
 MT IV & V (caput plantar contact)
(h = 3-5 mm)
(top)
(plantar contact)
Lateral view

38.  m. PB: stab. artt. calc.-cub. & cub.-MT
 m. PL: stab. calc. via + conc. ↑
 m. Add. digiti minimi: conc. ↑
 m. EDL & m. triceps surae conc. ↓
Lateral view

42.  Distal arc (I)
Distal MT
 Middle arc (II)
Lisfranc
 Proximal arch (III)
Chopart

43.  Distal arch:
 Distal MT
 MT I (sesam) & V contact
(h = 6 mm)
 MT II (top) (h = 9 mm)
 MT III (h = 8.5 mm)
 MT IV (h = 7 mm)
 M. Add. hallucis: conc.↑
 Lig. Metatarseum
transv. prof.
Cross section

44.  Middle arch:
 Lisfranc
 CF I, II (top) &
: conc. ↑ Cross section

45.  Proximal arch:
 Chopart
 Naviculare
Cross section
: conc. ↑

49.  Consequence ankle varus or valgus
 Conc. ↓:
 GBody
 m. triceps surae, m. per. tert., m. TA, m. EDL &
m. EHL
 Conc. ↑:
 m. TP, m. PL & m. PB, mm. plantares &
flexoren
 Spring power ↓↓: in sports →

50.  Art. MT-P:
 Swelling bursa & os growth
 Red skin colour
 Hereditary

51.  Aetiologie:
 Pronation → ∆ G distribution forefoot → ↑ P
MT I
 CF I laesion
 Narrow shoes
 Sesamoid ossae → inter MT space caput MT I
& II
 m. A d. H << m. Abd. H → abd. MT I:
 m. Add. H pulls
maintains ext. & add. phalanges

53.  Know your anatomy
 Osteopathy is based on function
 Structure-Function
Osteopathic view

54. {

55.  Central gravity line
 Anteriorline
 Latero-lateral pubicline
 Antero-posterior (AP) line
 Postero-anterior (PA) lin
 Combination: biomechanic trigona

56.  Sella tursica
 dorsale 1/3 cranium
 corpus C3-6 (m. scal. med.)
 art. CO-vert. 3
 art. CF bilat.
 Arcus pedis bilat.

58.  Combination of:
 1:
 AP
 PA (2)
 Σ = 3  L3
 2:
 central gravity line
 AP
 PA (2)
 Σ = 4  T4

59.  Vertical lemnisci
 Horizontal lemnisci: ‘6’ diaphragm
 ‘Core link’
 The Fasciae Anatomy, Dysfunction and
Treatment
Paoletti, Serge
Sommerfeld, Peter (ILT) ISBN: 093961653X.

62. Cause & effect chain: : Chronol.
1. Pes: endo cuboid & exo nav.
2. Contracture m. PL & m. TP
3. Endorot. crus
4. Caput fib.: ventro-caud.
5. Contracture m. BF.
6. Ilium post. and relatieve sacrum ant.
7. Exo. femur
8. Contractuur m. pirif.
9. m. Pirif. stabilises sacrum ant. and keeps chain reaction

63. Cause & effect chain: :
Chronol.
 A. rule: Δ fib.  membr. IO: comp. syndrome, shin splints
 Inflam.: Δ arcades Δ calc.  frictie
 achillestendon (oblique orientation gives friction)
 Pan ligament (Haglund/’hielspoor’)
 Myositis / fibrosis m. TP and PL
 Pseudo ischialgia / RP m. pirif.
 Meniscus < exorot. femur
 …

64. Cause & effect chain:
Pes Planus

65. Secundary or prinmary lesion

66. Pes = base

68. En pointe

69. Welcome in the
wonderfull world
of osteopathy …
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70.  Communication
 T.E.A.M
 Stance 434
Aim