Foot Function & Fascial Lines Series, General

Are you doing short foot correctly? | Clearing the confusion

I think it goes without saying that I have a passion for sharing the power of foot activation and how it fascially connects to central core stabilization.  My go-to for foot activation is none other than – short foot!

Considered by some as merely of foot-specific exercise and not one that is integrated or applicable to total body function, I think it’s time to clear the confusion around this exercise – and foot function in general!

Having taught short foot to professionals, patients and athletes all around the world for over 10 years, I’ve seen it all.   I’ve literally taught short foot to over 25,000 people and have seen every confusion, mis-cueing, compensation pattern and foot type.

Because I understand the power of proper short foot activation, I get a little let’s say passionate when I see and hear professionals cueing short foot incorrectly.

What gets me even more worked up is that those that are cueing short foot incorrectly are professionals who are being followed and trusted as “experts” in the industry.

The Dunning-Kruger Effect

Having thousands of Instagram followers and posting cool pictures that favor natural foot function does not make one a foot expert.   Yet what these professionals are posting and saying is being taken as gospel, possibly because they are being stated with such confidence it must be correct.  Right?

Sadly most of the posts and statements that are being made are black and white concepts.  The foot is supposed to do X and therefore Y.    I wish it was that easy, but the human body is far too complex to be X = Y.    There is a lot of grey when it comes to programming, cueing and yes – overall foot function.

What is the risk of posting pictures and statements or teaching concepts that are black and white or X = Y?   People can get hurt.   Trust gets broken.   Confusion gets created.

Clearing the Confusion on Short Foot

It’s time to set the record straight.    I”m going to go into the proper way to cue and execute short foot.    My cueing technique is backed by anatomy, science and a deep understanding of true foot function.    No conclusions are being made based off of associations.

Disclaimer:   After reading this, if you realize that have been doing short foot incorrectly. It’s okay!   This is not an attack on anyone or a criticism to any professional out there – even to the ones that are cueing short foot incorrectly.   I just want short foot to be represented in its true form so that we get the optimal benefits and reduce the risk of injury. 

Step 1 – Teach 1 foot at a time. 

I usually cue to go into a split stance so that you can focus on just the front foot initially.

Why we want to teach one foot at a time is that the mind-muscle connection of executing short foot bilateral is too high for many clients.   To start with one foot allows the focus to be centered on a more local foot engagement.

Step 2 – Slightly bend the knees to unlock them 

When we do short foot we create a locking mechanism up the lower extremity.   If you do short foot on a fully extended knee you are essentially locking a locked joint.   This can create shear to the meniscus and create injury to our clients.

As the Hippocratic Oath states “thou shalt do no harm” – so I kindly remind you to slightly bend the knees.

Step 3 – Place the foot in neutral and find the foot tripod

foot-tripod-bottom-points

Ensuring the rear foot is not pronated during short foot is critical – reason being is that a pronated foot is unlocked and unstable with the muscles in a lengthened position.    This makes in ineffective to engage short foot.

After the rear foot is put into a neutral position, then it’s time to find the foot tripod.  This means to center body weight under the 1st metatarsal head, 5th metatarsal head and heel.

Disclaimer: This is NOT to be confused with the foot staying on the tripod throughout the exercise – or to push the tripod down during short foot. 

Step 4 – Lift the toes, spread them out and place them on the ground 

To further complete the base of support and centered foot position we need all digits to be spread wide and long.    We will shortly see that the true action of short foot is in the digits which is why this is going to be an important aspect of the short foot cue.

Step 5 – While exhaling, push the tips of the toes down into the ground 

The true cue for short foot is in the long flexors (FHL, FDL) which insert into the plantar, distal aspect of the toes.   These muscles anchor or root the tips of the toes (think toenails) down into the ground.

img_7139.jpgThe pushing of the distal tips of the toes into the ground not only activates the long flexors but it also engages the plantar fascia via the reverse windlass mechanism.   Both the action of the long flexors and plantar fascia is to increase the arches of the foot (longitudinal and transverse) which ultimately lifts us off of the ball of the foot.

What we should see when we push the tips of the toes down into the ground is that the 1st metatarsal head lifts off of the ground.

Now to be clear, I don’t want YOU to lift the 1st metatarsal head off of the ground – I want it to be a reaction of the contraction.

If YOU lift the 1st metatarsal head off of the ground, chances are you are going to over engage short foot and can create too much hypertonicity.

Now this is where the cueing goes wrong!

Many – I repeat – many professionals are cueing short foot as pushing the 1st metatarsal head down into the ground.   This is wrong.  This is incorrect.  This does not transverse to function.   This is a literal translation of the foot tripod and a gross misrepresentation of true function of the foot.    (More on this soon!)

Step 6 – Incorporate the pelvic floor 

The final step we want to integrate with short foot is the deep core.   To be truly integrated we need the entire Deep Front Line to be a part of this short foot exercise.  This means that as we exhale, we want to focus on lifting our pelvic floor and pushing the tips of our toes down into the ground.

The result?

All of the central domes in our body stack.   The arch, the pelvic floor, the diaphragm – and technically our palate all lift during activation.

Clearing the Confusion! 

So now that we know the proper way to cue short foot.   It’s time to clear the confusion how short foot.   The most common incorrect cue that I hear is pushing the 1st metatarsal head down as the activation.

I am not sure who started this trend but it is wrong.

Yes we do start by finding our foot tripod – but that doesn’t mean we should literally push into the foot tripod as the form of foot activation for foot stability.

DFL

So why not?     We need to defend our reason of why not!

Answer #1 –  Deep Front Line.    

Short Foot is a Deep Front Line activation.  Remember the true purpose of activating our feet is to get them to “talk to” our core or center.

If we look at the Deep Front Line, the muscles of the feet that we see are the Flexor Hallucis Longus, Flexor Digitorum Longus, Posterior Tibialis and Anterior Tibialis.

As mentioned earlier, the cueing I use for short foot is to push the tips of the toes down into the ground.  The reason?  Because this is the action of the flexors!

When we push the 1st metatarsal down into the ground we are activating the peroneus longus muscle.

Do you see that muscle in the Deep Front Line?   I don’t either!

Answer #2 – 1st Ray Plantarflexion & the 1st MPJ

To further understand the purpose of 1st metatarsal plantar flexion (or pushing the 1st met down) we need to understand the true functional reason behind this action.

When does our 1st metatarsal FUNCTIONALLY want to plantar flex?

During push-off!

The action of 1st metatarsal plantar flexion is to allow the 1st MPJ to dorsiflexion – an action that occurs during push-off.   When we take a step, run or jump our great toe dorsiflexes to create a rigid lever for forward (or vertical) progression.

I did a whole blog series on the 1st MPJ where I went into the actions of slide, glide and jam but essentially one of the most critical steps in dorsiflexion of the big toe is 1st metatarsal plantar flexion.    However.   We must pause there.   This 1st metatarsal plantar flexion is actually not DOWN but rather it is BEHIND us.

1st mpj

 

If you see in the image to the right, 1st metatarsal plantar flexion is actual BEHIND us as
we shift our COG forward, this is how we truly dorsiflex the great toe.

How does this relate back to short foot?  This means that to train the 1st metatarsal to literally push down into the ground has no true functional transfer.

Answer #3 – Sesamoids 

The final reason of why I do not cue pushing the 1st metatarsal head down has to do with the sesamoids.   The sesamoids are two small bones that sit within the Flexor Hallucis Brevis tendons and sit directly under the 1st metatarsal head.

Like the patella (knee cap) the sesamoids are not intended to be passive weight bearing bones but rather ones that transfer force during functional movement.

sesamoidThe image to the left shows that the sesamoids are the lowest bones in the foot and if there is intentional 1st met plantarflexion into the ground (due to a miscue of short foot) then there is increased force to these small bones.

This can greatly increase the chance for sesamoiditis and sesamoid fractures – two conditions that are a b*#! to treat.

In addition, some of the clients and patients being cued to push down into their 1st metatarsal head during short foot may actually have a functional plantarflexed first ray which can be exacerbated with improper short foot cueing.   The negative impact of a plantar flexed 1st metatarsal (ray) is functional hallux limitus, which can lead to a myriad of compensation patterns during walking.

Did I confuse you more?

If the above was a little like “what the hell is she talking about” then good!   This is is how confusing the foot is!

It is not black and white.   It is not X = Y.

It is grey with a lot of exceptions with any cue or exercise.   This is why I created the Barefoot Training Specialist® Certification and have trained a very niche group of qualified Master Instructors under EBFA Global.

Are you more of an auditory learner?

Tune in below for a video summary I did on this exact topic.

Still confused?    Email me!     dremily@ebfafitness.com

In summary, honor the power of the foot.   Consider who you are using as your sources.   Ask questions.   And don’t take anything anyone says as gospel.   Ask for the WHY?

Stay #barefootstrong

Dr Emily Splichal, DPM, MS, CES

 

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Barefoot Science, General

Toe Walking and Tactile Input

Walking on the toes as a child may be considered a normal phase of learning to walk, however in the child past 3 years old the absence of heel contact at initial contact is not normal.

According to Williams et al. (2010) an average 7% of children present with a toe walking toe walkinggait.  Any child walking on their toes should be assessed for medical causes of the gait pattern.

Some of the most common causes of toe walking include:

  • Equinus (structural limitation is ankle dorsiflexion)
  • Upper motor neuron trauma (cerebral palsy)
  • Neurogenic factors (autism)

But what if all of the above possible causes are ruled out?

What could be the driver of the toe walking?

This is where the diagnosis idiopathic toe walking (ITW) comes into play.    ITW means there is no known cause for the child’s gait pattern and absence of heel strike at initial contact.

Treatment Options for Toe Walking

If there is no known cause for a child’s toe walking it makes treatment options difficult. For ITW, most practitioners focus on ankle mobility as the most addressable option.

This means treatment options for these children include:

  • Physical therapy and manual release work
  • Stretching and night splints
  • Botox injections to calves
  • Achilles tendon lengthening

All of these treatment options have downsides including skin irritation, compliancy and invasive risks of infection and scarring.    Specialists are now looking for new treatment options for these children.  Treatment options that are simple, non-invasive and will have increased compliancy.

New Treatment Options for ITW

Researcher Dr Cylie Williams of Monash University in Australia has been exploring new treatment options that look specifically at the tactile input in these children.   It is proposed that by changing tactile input through the feet, one could change the neurological input and potentially influence the gait pattern.

Dr Williams’ initial exploration into this topic was related to whole body vibration fullsizeoutput_1805(WBV).   In her prior research she has noted varying vibration threshold in children who are idiopathic toe walkers and those with a normal heel toe gait.   The benefits of WBV are promising to this pediatric population however the only downside is that the effect is short term, temporary and requires a WBV platform such as Power Plate.

Dr Williams is seeking new tactile stimulation methods and has turned to Naboso Neuro Insoles.   Starting early 2019 Dr Williams will be researching the effects of Naboso Insoles as a simple, non-invasive intervention for ITW.

Sensory Seeking Children

As the inventor of Naboso Technology and our sensory products, my interest is of course in those children who are sensory seeking and the possible role the Naboso Insoles and Mats can have on the behavior and movement patterns in these children.

Lane et al. (2009) has identified three main types of sensory processing disorders in children with autism:

  • Sensory sensitive (covering ears to loud noises, restricted food preferences)
  • Sensory under-responsive (failure to react to pain)
  • Sensory seeking (rocking, hand flapping, noise-makingchildrens insoles

Due to the correlation between autism, sensory processing disorders and toe walking the possible application of Naboso for these children is exciting.    As the research around ITW and tactile input continues to be explored we will hopefully have new data to share on this topic.

In the mean time we encourage any professional working with ITW children to consider the possible role of Naboso Children’s Insoles and our Naboso Textured Mats.

In health,

Dr Emily Splichal, DPM, MS 

Citations:

Lane, Alison et al. (2009) Sensory Processing Subtypes in Autism. J Dev Autism Disorder 40: 112 – 122.

Williams, Cylie et al. (2010) Idiopathic Toe Walking and Sensory Processing Disorder. J Foot and Ankle Res  3: 16

 

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Foot Function & Fascial Lines Series

Tapping into Torsion | The Rotational Power of the Achilles Tendon

Power lies within the transverse plane.

We have all heard this concept at one point or another throughout our education or training career.  

javelinFrom the rotational moment of the trunk to generate power when throwing a javelin to the torque created from supination of the foot into the external rotational power of the glutes – rotational moments are in every aspect of human movement. 

The closer we look at the fascinating human body and the fascial system, the more we can find that spirals and rotations are everything and EVERYWHERE!

I want to take this time to explore an area of the body where rotational or spiraling properties are often under appreciated or perhaps not even know – within the human Achilles tendon.  

The Achilles Tendon

Enter the largest, strongest tendon in the human body – the Achilles tendon.   Formed by the gastrocnemius and soleus tendons (and sometimes plantaris), this fascinating structure is able to generate most of the elastic energy return during dynamic movement and from an evolutionary perspective is a critical structure in the spring-mass theory of movement efficiency. 

Now there are a few unique characteristics of the Achilles tendon that must be Achilles Rotationappreciated when training or rehabbing this structure.  All of these characteristics are emphasized in all trainings through EBFA Global:

  • The Achilles tendon is not one tendon but rather a stacked tendon 
  • 2/3 of the Achilles tendon is made of soleus fibers 
  • The Achilles tendon medially rotates toward its insertion
  • This rotation places the soleus fibers to the medial calcaneus 
  • While the MG / LG insert towards the lateral calcaneus

How cool are these facts?   But what does the above functionally mean?  

Functional Application #1 – Soleus Equals Power 

Since 2/3 of the Achilles tendon is soleus fibers this means that most of our elastic recoil and plantarflexion torque is coming from the fascial tension and loading of the soleus muscle and fascia.   

When you are training the elastic recoil of the Achilles tendon remember to incorporate soleus focused eccentric deceleration and acceleration training while the knee is bent or while transitioning through a knee flexion pattern.  

Functional Application #2 – Resupination of the Foot through Plantarflexion

The rotation or torsion of the Achilles tendon provides increased tensile strength IMG_9349and assists in fiber sliding during elastic movement.    In addition, due to the placement of the soleus fibers of the Achilles tendon plays a key role in thresupination action of the rearfoot during the push-off phase of gait.

This coupled concept means that when training jumping and push-off power drills emphasize a from the ground up approach the utilizes total ankle plantarflexion.   In EBFA Education we do this through teaching jumping by pushing off all 5 digits and envisioning a follow through with all digits (see image to the right) 

Functional Application #3 – Restriction of Blood Supply 

I must add that as much as torsion adds a rotational power to the Achilles tendon,  there can be a downside to this feature.   This rotation of the Achilles tendon fibers causes a disruption to the micro-circulation or blood supply to the Achille tendon. 

The area with the greatest compromise in circulation is called the watershed area and lies 2 – 6 cm above the Achilles insertion.   The mid-tendon or watershed area is the site of most Achilles tendon ruptures (especially as we age) and is the location of tendon degeneration.   

By appreciating this compromised Achilles circulation, professionals should ensurefullsizeoutput_1805 to properly warm up the elastic properties to the Achilles tendon and in those with a history of mid-tendon tendinitis to avoid movement patterns that increase stress to the watershed area of the tendon.   

In my office, I use the PowerPlate to increase micro-circulation to the Achilles tendon in my patients with a history of Achilles injury or degeneration.   Research has shown that 10 min of whole body vibration can create increased skin perfusion and decrease arterial resistance, both beneficial to tissue healing.   

Functional Application #5 – Non-Uniform Achilles Stress by Pronation

The non-uniform division of the Achilles tendon fibers with 2/3 being soleus, coupled with medial rotation of the tendon fibers there is a non-uniform stress placed on the Achilles tendon.  

Gils et al. has demonstrated that the soleus fibers are under the greatest stress with most Achilles tendon pathology occurring to the medial aspect of the tendon.   It was found that pronation increased this non-uniform stress to the soleus tendon fibers especially during the midstance phase of gait.  

Professionals who appreciate this concept can better assess how foot type and/ or a lack of foot stability can contribute to Achilles tendon pathology.    Foot strengthening and in some cases orthotics may be advisable for the prevention and management of medial Achilles tendon stress.  

To learn more about the fascinating functional foot please visit www.ebfaglobal.com or check out my book Barefoot Strong.    

Until next time, stay #barefootstrong 

Dr Emily 

www.dremilysplichal.com

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Barefoot Science, General

NeuroRehabilitation with Naboso Technology

Balance impairment and gait instability are common symptoms in patients living with Parkinson’s Disease (PD).   From an increased fall risk to reduced independence, compromised dynamic stability can place a heavy emotional burden on these individuals.

When developing a balance and fall reduction program for PD clients, research has OLYMPUS DIGITAL CAMERAshown that stimulation of the foot with texture shows promising results.   Study after study has demonstrated that the seemingly simple intervention of texture is actually quite powerful in its postural effects.

Why the Plantar Foot? 

Our hands and feet are some the most sensitive sensory gateways of the human body and allow us to connect our visual and vestibular systems with the exteroceptive (external) world.

The skin on the plantar foot is packed with unique nerve endings called mechanoceptors or touch receptors.   There are four main mechanoceptors found on the bottom of the feet.

SAI – which is sensitive to two-point discrimination & texture (Naboso!)

SAII – which is sensitive to skin stretch

FAI – which is sensitive to low-frequency vibration (walking impact forces)

FAII – which is sensitive to high-frequency vibration (running impact forces)

Texture & the Plantar Foot 

Texture such as that of two-point discrimination (Naboso) have been shown to improve posture and sway in those with Parkinson’s Disease.

A 2011 study by Hatton et al. showed that pyramid-like textures had the greatest efficacy on reducing postural sway in PD patients.   This was both the eyes shut and unstable environment.

A 2013 study by Qui et al. compared the effects of smooth versus textured insoles on balance and stability in those with Parkinson’s Disease.  Qui et al. found that the greatest effect was with textured insoles on unstable surfaces with eyes open and eyes closed.

A 2017 study by Silva et al. showed that continuous use of textured insoles over a one week period not only improved gait but also improved foot sensitivity and sensation.

Naboso Textured Insoles

Insole Pic 2To date, Naboso Insoles are the only commercially available textured insoles that are designed to enhance posture, improve gait and reduce falls in people with neurological conditions such as Parkinson’s Multiple Sclerosis, neuropathy, and post-stroke.  There is so much exciting textured insole research but until Naboso none of this information was commercially applicable to these PD patients.

At Naboso we are so excited to see that the effects of Naboso Insoles match that of the research!    Below are a few videos of just how powerful the Naboso Insoles are at improving gait in those with Parkinson’s Disease!

Coming Soon! – Naboso Clinical Insoles 

With these exciting results above Naboso Technology is working on a new version to their already existing Insole line – NabosoNeuro.   These clinical insoles will be specific to the enhanced somatosensory demands of Parkinson’s Disease, Multiple Sclerosis, diabetes (neuropathy), post-stroke + more!

To learn more about the benefits of Naboso Insoles in neurorehabilitation please click HERE

To carry Naboso Insoles in your office for patients and clients please contact Naboso Technology for our wholesale rates – orders@nabosotechnology.com

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Barefoot Science

Foot Strength & Arch Stiffness in Relation to Minimal Footwear

GladSolesTrail1Earlier this week one of my master instructors shared an interesting article with me on the relationship between foot strength and stiffness in those who chronically wear minimal footwear.

For those who study barefoot movement and integrated foot mechanics, the association between minimal shoes and stronger feet may seem like an obvious finding but I wanted to delve into this article a little bit more for those readers who may not be as adept to some of the terminology.

Foot strength and stiffness are related to footwear use in a comparison of minimally- vs. conventionally-shod populations – February 2018

 

Concept #1 – Foot Stiffness is a Positive Characteristic 

I want to start off by explaining that anytime you read about foot stiffness or leg stiffness running-1in relation to barefoot running or minimal footwear – this is a GOOD thing!    The term stiffness does not mean rigid or non-flexible and is not synonymous with how we may say “I woke up stiff this morning”

During dynamic movement, the concept of stiffness is actually a fascial response that is used to help efficiently load and unload impact forces.   Think off stiffness as transient rigidity as a means to increase stability.   This stability is achieved through integrated isometric contractions which influence the surrounding fascial tissue and muscle compartment pressures.

In the above-referenced article, Holowka et al. found that those that chronically wear minimal footwear have higher arch stiffness upon foot contact.   This can be interpreted to mean that in minimal footwear the intrinsic foot muscles are more responsive and adapted to help stabilize the foot and absorb impact forces.

This finding further demonstrates that traditional footwear can actually make our feet weaker and less responsive to impact forces, quite possibly to the point that eventually we become dependent on the footwear to absorb impact forces.

Concept #2 – Minimal Footwear Increases Intrinsic Muscle Size 

Repeated use of any muscle will result in hypertrophy of that muscle, this includes the intrinsic muscles of the feet.    If the chronic use of minimal footwear is associated with increased foot stiffness this means that those feet are engaging and strengthening their intrinsic foot muscles with every step they take.

abductor-hallucis-strain220In the above study, Holowka et al. demonstrated that in those that chronically wear minimal footwear there was a noted 2mm increase in abductor hallucis diameter.   Now, 2mm may not seem like a lot but when you are dealing with small muscles of the feet, 2mm is considering statistically significant.

If you are unfamiliar with the abductor hallucis muscle, this is the intrinsic foot muscle that is responsible for controlling the lateral longitudinal arch.   Originating on the plantar medial calcaneus and inserting on the medial aspect of the proximal phalynx of the hallux, the abductor hallucis runs under and supports the navicular bone.

In the picture to the right, you can appreciate that the navicular bone is the highest point calcaneonavicular-ligament_blogof the medial longitudinal arch.   By strengthening the abductor hallucis and controlling how much that bone drops during dynamic movement is essentially saying there is control of the medial arch.

Chronic use of minimal footwear and the strengthening of the abductor hallucis muscle is demonstrated to be an effective way to build foot control and resist the stress of flat feet and over pronation.

Concept #3 – There Are Exceptions to Every Finding 

As a Functional Podiatrist, I must end by saying that the findings of the Holowka et al. study are very exciting and definitely do build the support for the use of minimal footwear.  Having said that, there are exceptions to every finding.

As we take these findings and use them to make footwear recommendations for our clients and patients we cannot forget that there are still a few patients who minimal footwear may not be appropriate for.

Some of these may include:

– Accessory navicular

– Posterior tibial tendinitis or PTTD or post tib tear

– Hypermobility of the 1st Ray

– Flexible flatfoot with symptomatic post tib tenditis, plantar fasciitis, sinus tarsi syndrome

– Rigid flat foot with arthritic changes to the midfoot or rearfoot

All feet should be assessed by a qualified professional before transitioning to minimal footwear and all transitions to minimal footwear should be coupled with a barefoot foot-strengthening program, such as that created by EBFA and our Barefoot Training Specialist® Team

To learn more about foot types and the power of barefoot science please visit http://www.barefootstrong.com or http://www.dremilysplichal.com

Kindly

Dr Emily Splichal

Founder EBFA Global & Naboso Technology

 

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Barefoot Science, General

Enhancing Sensory Stimulation to Improve Balance in Multiple Sclerosis

Balance impairment is a common symptom in patients living with Multiple Sclerosis.   From an increased fall risk to reduced independence, compromised dynamic stability can place a heavy emotional burden on these individuals.

When developing a balance and fall reduction program for MS clients, research has shown that approaching it from a sensory perspective is the most effective.

Below are the top three sensory stimulation pathways that can be used to optimize balance and stability in your MS clients.

eyeSensory Gateway #1 – Vision

According to the Multiple Sclerosis Society, vision problems are some of the most common symptoms associated with MS.  The most common eye complications include optic neuritis, diplopia, nystagmus and internuclear ophthalmoplegia.

Our eyes are designed to move and accommodate for light, providing us with as much sensory detail about our environment as possible.  A decrease in visual acuity has been associated with impaired balance and delayed accuracy in motor patterns.

A 2018 study by Herbert et al. demonstrated the efficacy in the integration of eye movement exercises and visual stimulation in improving balance for those with MS.    The study that focused on the BEEMS (balance and eye motion exercises for MS) integrated the following exercises for improved sensory integration and brain balancing.

Sensory Gateway #2 – Vestibular

 The first sensory system to develop after conception is the vestibular system.  Often earreferred to as the gateway to the brain, the vestibular system is critical in how our brain and body relates to gravity.

In MS, vestibular disturbances typically present as vertigo, balance disorders, and the presence of nystagmus (rapid involuntary movements of the eyes).  When considering the implications of vestibular disturbances it is important to understand if the cause is related to disturbances in the peripheral vs central vestibular system.

The vestibular system can be divided into two main systems: the central system (the brain and brainstem) and the peripheral system (the inner ear and the pathways to the brainstem).   A 2008 study by Zeigelboim et al. found that vestibular disturbances related to MS were disruptions in the peripheral system, with a higher prevalence in female patients.

The following exercises are recommended to address the vestibular disturbances associated with MS.   You will notice that many of these exercises also integrate the visual system, as all of our sensory systems a linked in function with one input system enhancing the other.

Sensory Gateway #1 – Touch

104821576The final sensory system is one that is quite familiar to those who follow EBFA Global’s work and allows us to tap into the homunculus of the motor cortex.

Our hands and feet are some the most sensitive sensory gateways of the human body and allow us to connect vision with an exteroceptive world.   Neuropathies and disruptions in peripheral proprioceptive and vibratory input are often associated with MS and should be addressed before symptoms present.

The skin on the plantar foot and palmar hand contain four main mechanoceptors:

SAI – two-point discrimination & texture

SAII – skin stretch

FAI – low-frequency vibration

FAII – high-frequency vibration

Sensory Stimulation Balance Program for Multiple Sclerosis 

The following exercises integrate visual, vestibular and touch sensory stimulation into every exercise.   All of the exercises can be progressed from seated to standing to legs crossed and tandem to single leg stance.

Equipment needed:   Naboso Barefoot Mat, Ball (Textured), Card

To learn more about the sensory input systems and how they relate to brain, body and balance please visit:   www.ebfaglobal.com or www.nabosotechnology.com

Dr Emily Splichal

 

 

 

 

 

 

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Barefoot Science

Beyond Biomechanics | Addressing Foot Pain with Sensory Stimulation

I want you to picture a human foot.   Now picture a person standing barefoot, and then walking barefoot.   Do you see the foot striking the ground and flexing under impact, only to re-stabilize and push off just a few milliseconds later?

earthing

Often times when we think of human movement we can’t help but to be drawn to the thought of joints moving and muscles contracting.   Or in the case of foot function we are quick to consider the mechanics of flat feet, high arches, pronation and supination.   However when we delve deeper into the science of human movement there is more than meets the eye.

The Two Sides of Foot Function   

 When I teach on behalf of EBFA Global or speak to my patients I always emphasize that there are two sides to foot function (and dysfunction) – biomechanical and neuromuscular.    Now both play and important role in foot function which means that both must be appreciated – however to solely treat foot pain with just one belief system in mind is inherently flawed.

In most Podiatric Medical Schools we are taught foot function and foot pathology solely pronfrom a biomechanical perspective.   This means that every patient is tested for foot mobility and told to stand statically to determine arch height and foot type.   Based on this foot-focused biomechanical assessment and foot classification system the patient cause of injury and treatment protocol is determined.   Some of the favorite treatment recommendations include motion-controlled footwear and custom-posted orthotic both of which are prescribed with the hopes of controlling foot-focused biomechanics and thereby reducing their foot pain.

Beyond Biomechanics

The other side of foot function is one that is driven from a neuromuscular perspective and integrates the science of sensory stimulation and fascial systems.   In the case of neuromuscular function every patient would be assessed for sensitivity of plantar mechanoceptors as well as co-activation patterns between the foot and the core.  The role of minimal footwear, myofascial releasing, breathing patterns and compensation patterns more proximal would all be considered.

So which is more appropriate?  Well it depends.   In certain cases there will be a stronger argument towards a more biomechanical influence and in others it is more sensory.  This means it really is a marriage between the two approaches that provides the greatest patient outcome.

Sensory Stimulation in Foot Pain

My practice and Podiatry career is built around bringing an awareness to the important role sensory stimulation has on foot function and foot pain.

With every step we take impact forces are entering the foot as vibration.  This vibrational noise stimulates unique mechanoceptors on the bottom of the foot and is used to coordinate the loading of impact forces through coordinated contractions of the intrinsic (small) muscles of the bottom of the foot.   This co-contraction leads to a stiffening or strengthening response of the foot.

Researchers such as Nigg et al. and Robbins et al. have demonstrated a direct relationship between sensory stimulation of the plantar foot and intrinsic muscle strength concluding that one is necessary for the other.   This means that if our footwear or orthotics disconnect us from sensory stimulation – as in the case of cushioned footwear – this can actually weaken our foot making us susceptible to plantar fasciitis, Achilles tendinitis and stress fractures.

Beyond Vibration Stimulation

feet-mechanoreceptorsVibration stimulation is an extremely important sensory stimulation that enters our foot however it isn’t the only stimulation.   Another important stimulation is the ability for our foot to determine texture and if a surface is rough or smooth.   This information is used to help maintain dynamic balance (think walking on ice).

Enter the merkel disk mechanoceptors.   These superficial sensory nerves are used to determine what’s called 2 point discrimination which is translated to roughness or the texture of a surface.  Surface texture and insole texture is one of the most studied aspects of foot stimulation and posture or gait.  From decreased medial lateral sway in patients with Parkinson’s or MS to reduced prefrontal cortical activity in atheltes post-concusion the applications are promising!

One area that hasn’t been focused on for sensory stimulation and foot function is foot pain.  I am here to change the awareness around this concept and share the powerful application of sensory stimulation and foot pain.

As we mentioned earlier sensory stimulation of the foot leads to a contraction of the intrinsic muscles of the foot.   Intrinsic muscle contraction is not only is a criticial step in the damping of impact forces but has also been shown to increase the medial arch and build co-activation contractions in the core.

 The Evolution of Textured Insoles

In October 2017 Naboso Technology launched the first-ever commercially available OLYMPUS DIGITAL CAMERAtextured insole!   Naboso Technology essentially brought the science of touch and years of textured insole research to the market place giving new hope to people with foot pain.

Available in two strengths – Naboso 1.0 (1mm texture) and Naboso 1.5 (1.5mm texture) Naboso Insoles are designed to be worn without socks (or at the most very thin socks).  They fit into all footwear, are freely movable in all planes of motion and are only 3mm thick.

Learn more about the power of texture!    

http://www.nabosostechnology.com

#lifeissensory

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