POSTURAL D I STORTI ON S.

Th e Foot Con n e ct ion

Brian A. Rot hbart ( rot hbart sfoot @yahoo.com )
Guest Researcher, I nst it ut o Superiore di Sanit à di Rom a
Depart m ent biom edical engineering

Ke yw or ds
Post ure, Medial Colum n I nsole, Talar Torsion, Rot hbart Foot St ruct ure ( RFs) , Prim us
Met at arsus Supinat us ( PMs) , Chronic Pain Syndrom e, Unleveling of t he Pelvis, Shoulder
Prot ract ion, Class I I Dent al Occlusion.

Abst r a ct
Rot hbart described a foot in which t he 1 st m et at arsal is st ruct urally elevat ed and invert ed
relat ive t o t he 2 nd m et at arsal. He t erm s t his foot st ruct ure Prim us Met at arsus supinat us ( PMs) .
Rot hbart suggest s t hat PMs is t he end result of a failed or incom plet e unwinding of t he t alar
head. Clinically, t he 1 st m et at arsal and hallux are off t he ground when t he st anding foot is
placed in it s anat om ical neut ral posit ion. This dist ance bet ween t he 1 st m et at arsal and ground,
referred t o as t he PMs value, is quant ified using m icrowedges. PMs values bet ween 10 m m and
30 m m define t he Rot hbart Foot st ruct ure ( RFs) .
RFs is biom echanically dysfunct ional, dem arcat ed by it s prolonged m id- st ance hyperpronat ion.
Dynam ic hyperpronat ion shift s t he post ure forward: ( 1) t he innom inat es rot at e ant eriorly, ( 2)
t he pelvis unlevels, augm ent ing t he scoliot ic and kyphot ic curves, ( 2) t he shoulders prot ract ,
and ( 3) t he head m oves forward relat ive t o t he cervical spine. Rot hbart t erm s t his shift in
post ure BioI m plosion which closely resem bles t he com m on com pensat ory pat t ern described by
Zink and Lawson.
A m edial bar ( t he m edial colum n insole) has been developed which reverses BioI m plosion.

Ria ssu n t o
Rot hbart descrive un piede nel quale il 1° m et at arso è st rut t uralm ent e elevat o e invert it o
rispet t o al 2° m et at arso. Egli definisce quest a form a podalica Prim o Met at arso Supinat o
( P.M.s.) .
Rot hbart sost iene che il P.M.s. è il risult at o finale di un insufficient e o incom plet o rot olam ent o
della t est a dell’ast ragalo. Clinicam ent e il 1° m et at arso e l’alluce sono lont ano dal t erreno
quando in st at ica è post o nella sua anat om ica posizione neut ra. La dist anza t ra il 1° m et at arso
ed il t erreno, riferit o al valore del P.M.s., è quant ificat o usando m icrocunei.
I l valore del P.M.s. t ra 10 e 25 m m carat t erizza la Rot hbart Foot St ruct ure ( R.F.s.) .
R.F.s. è biom eccanicam ent e disfunzionale, delim it at o dalla sua prolungat a longit udinale
iperpronazione. L’iperpronazione dinam ica spost a la post ura in avant i : ( 1) le innom inat e
rot azioni ant eriorm ent e, ( 2) i dislivelli di bacino, che aum ent ano la scoliosi e le curve dei gibbi
dorsali, ( 2) le spalle prot rat t e e ( 3) e la t est a posizionat a in avant i nel t rat t o cervicale.
Rot hbart definisce quest a alt erazione post urale una Bioim plosione che ricorda da vicino la
com une form a com pensat oria descrit t a da Zink and Johnson.
Una barra m ediale ( il sost egno della colonna m ediale) è st at a creat a in grado di invert ire
( risolvere) la Bioim plosione.
Rot hbart ( 1) described a foot in which t he 1 st m et at arsal is st ruct urally
elevat ed and invert ed relat ive t o t he second m et at arsal. Referred t o as Prim us
Met at arsus { Elevat us} Supinat us ( PMs) , t his foot t ype is frequent ly ident ified
by it s deep 1 st web space ( Se e Figu r e 1 ) .

Fig. 1

PMs is biom echanically dysfunct ional, delineat ed by it s prolonged phase of

m idst ance hyperpronat ion. But what forces t his foot t o dynam ically
hyperpronat e? And what im pact does t his dynam ic hyperpronat ion have on
post ure?
Rot hbart suggest s t hat as t he body’s weight passes over t he inner longit udinal
arch, GRAVI TY pulls t he elevat ed 1 st m et at arsal inward, forward and
downward ( dynam ic hyperpronat ion) unt il it reaches t he ground. Dynam ic
{ walking} hyperpronat ion, in t urn, " init iat es" a shift in st anding post ure: ( 1)
t he innom inat es m ove ant eriorly, ( 2) t he knees hyperext end, ( 3) t he sacral
base t ilt s, ( 4) t he lum bosacral j unct ion side bends { dest abilizing t he spine) ,
( 5) t he shoulders prot ract , and ( 6) t he m axilla m oves ant eriorly relat ive t o t he
m andible ( Se e Figu r e 2 ) .
 Fig. 2

Rot hbart refers t o t his post ural shift as BioI m plosion ( 2) which he links t o t he
developm ent of chronic pain condit ions, foot t o j aw ( Se e Ta ble 1 ) ( 3- 5) .

Plant ar Fasciit is
Oblique pat ellar t racking pat t ern ( chondrom alacia)
Sacral iliac j oint inflam m at ion
Low back pain
Thoracic out let syndrom e
Tension Headaches
Tem poral m andibular j oint dysfunct ion
Ta ble 1 . Chronic Pain Condit ions Associat ed wit h BioI m plosion

By effect ively st abilizing post ure, chronic pain condit ions becom e m ore
am endable t o long- t erm resolut ion ( not long- t erm m anagem ent ) . Non-
support ive t ype ( m edial colum n) insoles have been developed t o m eet t his
end.
This paper discusses ( 1) t he norm al ont ogenesis of t he foot and abnorm al
ont ogenesis of t he foot which could result in PMs, ( 2) a m et hodology for
m easuring PMs, ( 3) t he bioim plosion pat t erns result ing from PMs, and ( 4) t he
t reat m ent of PMs.

EM BRYOLOGY

N or m a l Em br yon ic a n d Foe t a l D e ve lopm e n t of t h e Foot

At week 3 post fert ilizat ion ( pf) t he lower lim b bud appears as a slight swelling
opposit e t he lower lum bars. At week 6 pf, t he lim b bud sit s at right angles t o
t he rum p of t he em bryo, soles and post erior surfaces of t he foot and lower
lim b facing cephalad ( Se e Figu r e 3 ) .
 Fig. 3

By week 8 pf, t he foot and lower lim b have rot at ed 90 degrees around t heir
longit udinal axis. The plant ar and post erior m argins of t he foot and leg,
respect ively, now face one anot her ( Se e Figu r e 4 ) .

Fig. 4

By week 9 pf, t he prim ordial ankle j oint appears. Week 10 pf, t he lower leg
( not t he foot ) cont inues rot at ing around it s longit udinal axis ( left leg –
clockwise, right
leg – count erclockwise) . This places t he ent ire foot in a st ruct urally t wist ed
( supinat us) posit ion relat ive t he leg. Week 11 pf, t he calcaneus and body of
t he t alus renew t heir longit udinal rot at ion. This slowly and progressively
reduces t he relat ive supinat us of t he lat eral colum n of t he foot relat ive t o t he
leg. Week 12 pf t he head of t he t alus begins t o rot at e around it s longit udinal
axis relat ive t o it s body. This longit udinal rot at ion of t he t alar head, slowly and
progressively reduces t he relat ive supinat us of t he m edial colum n of t he foot
( navicular, int ernal cuneiform , 1 st m et at arsal, and hallux) relat ive t o t he
leg. Wit hin 1- 2 years post part um , t he foot has sufficient ly unwound t o place
t he ent ire sole of t he foot in a st ruct urally plant argrade relat ionship relat ive t o
t he leg.

Pr opose d Et iology of PM s
Measuring 1006 Egypt ian Feet , Sewell ( 6) was t he first t o publish on t he
subst ant ial variances in t he t wist of t he t alar head relat ive t o it s body ( angle
alpha) ( Se e Figu r e 5 , Plat es 1A & 2A) .
 Fig. 5

Subsequent ly, St raus ( 7) report ed angles ranging bet ween 26 and 43 degrees,
McPoil ( 8) bet ween 24 and 51 degrees and Sarrafian ( 9) bet ween 30 and 65
degrees. This t orsion or t wist wit hin t he t alar head ( t erm ed t a la r t or sion)
shapes t he ent ire m edial colum n of t he foot ( 10- 12) . Rot hbart ( 13) suggest s
t hat low alpha angles ( Se e Figu r e 5 , Plat e 1A) m aint ain t he navicular ( Se e
Figur e 5 , Plat e 1B) , m edial cuneiform ( Se e Figu r e 5 , Plat e 1C) , 1 st
m et at arsal ( Se e Figu r e 5 , Plat e 1D) and hallux in relat ive supinat us. I n t he
adult foot , t his supinat us of t he 1 st m et at arsal and hallux is t erm ed Prim us
Met at arsus supinat us ( PMs) .
PMs appears t o be an at avism ( t hrowback) t o t he chim panzee’s foot in which
t he big t oe funct ions as a prehensile appendage, a classic exam ple of ont ogeny
recapit ulat ing phylogeny ( 14- 16) .

PM s CLI N I CALLY

I n t he young pediat ric foot , t he bulging longit udinal fat pad and m alleabilit y of
t he t arsal bones m akes it difficult t o ascert ain t he presence of PMs. However,
by age 4 t he inner longit udinal arch ( I LA) has ossified int o it s adult shape ( 17-
20) . This subst ant ially facilit at es t he process of m easuring t he foot .
Figur e 6 dem onst rat es t he procedure for m easuring Prim us Met at arsus
Supinat us ( PMs) .
 Fig. 6

PMs values bet ween 10 and 30 m m define t he Rot hbart Foot St ruct ure ( RFs)
( 21) . This m easuring t echnique has proven t o have high int ra- relat er reliabilit y
( 22) .

Ta com a St u dy
I n a single blind clinical st udy ( 23) , 317 chronic pain pat ient s were cat egorized
int o 1 of 4 groups based on t heir arch t ype ( st able, flexible, funct ional and
dysfunct ional) . Visual gait analysis was conduct ed on each group. An obj ect ive
scale was used in j udging t he degree of dynam ic hyperpronat ion ( absent
= 1/ m ild = 2/ m oderat e = 3/ severe = 4) . The scores were m at hem at ically
com piled and an average com put ed for each group ( report ed under t he
heading pronat ion) . Concurrent ly, PMs readings were t aken on each of t he 317
individuals and m ean values calculat ed for each group.
Result s: A direct linear relat ionship was not ed bet ween PMs values and
dynam ic hyperpronat ion ( Se e Ta ble 2 ) . A dynam ic hyperpronat ion pat t ern of
left > right ( 72% ) was found t o be m ore com m on t han right > left ( 28% ) . An
unant icipat ed out com e was t he frequency of PMs values above 10 m m
( 307/ 317 pat ient s) . However, t his was at t ribut able t o t he skewed sam ple: only
pat ient s wit h a chronic hist ory of int ract able m usculoskelet al pain.

Mean Pronat ion Arch Phenot ype # Pat ient s Tot al% Pronat ion
PMs wit h Pat t ern
Values Arch Type Lf> Rt Rt > Lf
06 m m Absent St able Arch: Sam e arch height , 010 03% 70% 30%
sit t ing or st anding 007 003
14 m m Mild Flexible Arch: Arch height 270 85% 72% 28%
higher 194 076
sit t ing t han walking
24 m m Moderat e Funct ional Flat foot : Arch sit t ing. 035 11% 75% 25%
No arch walking 026 009
38 m m Severe Disfunct ional Flat foot : No arch 002 < 01% 100% 0%
sit t ing. No arch walking 002 000
TOTAL 317 100% 72% 28%
 229 088
Ta ble 2 . TACOMA STUDY - PMs Values vs. Pronat ion Pat t erns in Chronic Pain Pat ient s

Ot her researchers have report ed a sim ilar st at ist ical correlat ion bet ween
forefoot m easurem ent s and foot inst abilit y ( 24) .
Assum ing no concurrent occlusal or visual pat hology, RFs produces
bioim plosion pat t erns very sim ilar t o t he com m on and uncom m on
com pensat ory pat t erns described by Zink. I n t he Tacom a st udy, 305 of t he
317 pat ient s were diagnosed as RFs. 220 ( 72% ) of t hese RFs pat ient s
dem onst rat ed a dynam ic hyperpronat ion pat t ern of left > right ( Se e Figu r e
7).

Fig. 7

This asym m et rical inward, forward and downward rot at ion of t he feet relat ive
t o t he ground pulls t he innom inat es forward { ant erior} and downward, left >
right { using t he ASI S as t he reference point } , or forward and upward, left >
right { using t he PSI S as t he reference point } ( Se e Figu r e 8 ) .

Fig. 8

The asym m et rical ant erior rot at ion of t he innom inat es hyperext end t he knees
{ left > right } , shift s t he but t ocks post eriorly { left > right } ( Se e Figu r e 7 -
m iddle, right illust rat ion) and result s in a high left fem ur head ( 25) . The sacral
base t ilt s right { high left iliac crest , low right iliac crest } . The lum bosacral
j unct ion com pensat es by side bending left . This unleveling at t he LS j unct ion
dest abilizes t he spine, augm ent ing t he scoliot ic, kyphot ic and rot at ional curves.
The shoulders prot ract , t ypically right > left . The head and m axilla displace
forward relat ive t o t he cervical spine and lower j aw respect ively ( 26- 29) . The
left side of t he face ( eye t o m out h) loses vert ical height . I n essence, RFs
init iat es and gravit y " powers" t his post ural dist ort ion ( 30) .
Ot her researchers describe an alm ost ident ical post ural dist ort ion which t hey
t erm t he com m on com pensat ory pat t ern ( 31, 32) . However, asym m et ry in foot
hyperpronat ion is not assessed. Leg lengt h pat t erns are cit ed ( left leg and right
arm longer t han right leg and left arm ) .
Of int erest is a cadaver st udy in which 246 preserved lum bar spines are
m easured ( using a com put er graphics program ) t o gauge t he frequency of t he
com m on com pensat ory pat t ern. Result s: 76% of t he lum bar specim ens
dem onst rat ed facet angles consist ent wit h CCP ( 33) . This percent age
correlat es very closely t o t he Tacom a st udy.
A less com m on bioim ploded pat t ern result s from t he less com m on
hyperpronat ion pat t ern of right > left . The innom inat es rot at e ant eriorly { right
> left } . The fem oral heads displace post eriorly { right > left } ; hyperext ending
t he knees { right > left } and post eriorly shift ing t he but t ocks { right > left } .
The sacral base t ilt s left . The LS j unct ion side bends right . Spinal curves, in all
t hree body planes, are augm ent ed. The shoulders prot ract , t ypically left >
right . The right side of t he face ( eye t o m out h) loses vert ical height .
These t wo bioim ploded pat t erns are m irror im ages of one anot her driven by
t heir respect ive m irror im age dynam ic hyperpronat ion pat t erns. No discernable
leg or arm lengt h pat t erns were not ed.
I nm an defines norm al pronat ion as t hat degree of pronat ion generat ed by t he
int ernal t ransverse plane oscillat ions of t he hips ( 34) ( Se e Figu r e 9 ) .

Fig. 9

Clinically t his pronat ion pat t ern is invisible, e.g., t he ankle rem ains visually
st able ( vert ical) t hroughout t he ent ire dynam ic phase of gait . Conversely,
Rot hbart defines any visual ankle t wist t hat occurs during t he dynam ic
( walking) phase of gait ( e.g., t hat generat ed by PMs values > 10 m m ) as
dynam ic hyperpronat ion.

TREATM EN T OF RFs ( PM s va lu e s be t w e e n 1 0 a n d 2 5 m m )
H e e l W e dge s a n d Ar ch Su ppor t s
Medial heel wedging visibly decreases st anding hyperpronat ion. However, it
concurrent ly increases PMs values ( t he dist ance bet ween t he 1 st m et at arsal
and ground) , which in t urn, increases dynam ic hyperpronat ion. Arch support s
decrease rearfoot dynam ic hyperpronat ion, but are ineffect ive as t he 1 st
m et at arsal head becom es weight bearing. Paradoxically, recent research
ut ilizing 3d VRS Form et rics and Post urographic Rugs has dem onst rat ed t hat
ort hot ics incorporat ing heel/ t ot al forefoot varum wedging, arch support s
and/ or m et at arsal pads ( e.g. support ive t ype ort hot ics) , while dim inishing foot
sym pt om s, t end t o unlevel t he pelvis and increase t he kyphot ic and scoliot ic
curves wit hin t he spine ( 35) .

M e dia l Colu m n I n sole s

Medial colum n insoles do not support t he foot . They do not wedge or cup t he
heel ( Se e Figu r e 1 0 ) .

Fig. 1 0

These t ext ured insoles appear t o funct ion as a t act ile st im ulant t o t he bot t om
of t he foot ( 36) , m ore specifically, t o t he bot t om of t he big t oe and 1 st
m et at arsal. I n t erm s of post ural m echanics, t his m ost likely occurs via a
" propriocept ive act ivat ed" feedback loop t o t he cerebellum ( 37 - 43) . Wit h
each st ep, t he foot appears t o be rem inded where it should be and
aut om at ically m akes t he adj ust m ent . Dynam ic hyperpronat ion is reduced. The
body’s cent er of gravit y shift s post eriorly. The knees m ove out of
hyperext ension. The pelvis becom es visually m ore vert ical ( t ucked) . The
sym m et ry in t he post erior cont ouring of t he but t ocks is rest ored. The
shoulders ret ract . And t he head t ends t o cent er over t he spine ( 44) .
Medial colum n insoles are m anufact ured at approxim at ely 30% of t he
m easured PMs value. For exam ple, in a foot m easuring 20 m m , t he vert ex or
m axim um point of t act ile st im ulat ion in t he bar, ( Se e Fig. 1 0 ) is dim ensioned
at 6m m . This percent age is em pirically derived from t he Tacom a st udy. I t is
observed t hat a 30% t act ile st im ulat ion underneat h t he 1 st m et at arsal and big
t oe visually im proves post ure and reduces hyperpronat ion. I t is also observed
t hat a t act ile st im ulat ions > 30% t ends t o dest abilize t he pelvis. Fusco ( 35)
report s sim ilar findings in her evaluat ion of support ive t ype ort hot ics.
Using m edial colum n insoles in non- RFs places a disrupt ive upward load on t he
1 st m et at arsal head. This can dram at ically lim it t he range of dorsiflexion wit hin
t he 1 st m et at arsal- phalangeal art iculat ion and lead t o a funct ional hallux
lim it us.

SUM M ATI ON
Lower alpha angles result in Prim us Met at arsus supinat us. Funct ionally, gravit y
pulls t he elevat ed and invert ed 1 st m et at arsal downward and inward, which in
t urn, " powers" bioim plosion.
Measuring supinat us at t he level of t he 1st m et at arsal head facilit at es a
different ial diagnosis. PMs values of 10 m m – 30 m m define t he Rot hbart Foot
st ruct ure.
Medial colum n insoles effect ively st abilize RFs and reverse bioim plosion. These
insoles are dim ensioned at approxim at ely 30% of t he m easured supinat us.
As post ure becom es m ore vert ical, m usculoskelet al dysfunct ions becom e m ore
am endable t o t reat m ent .

CALL FOR FURTH ER RESEARCH

The linear correlat ion bet ween RFs and dynam ic hyperpronat ion is clinically
com pelling. Dynam ic hyperpronat ion dist ort s post ure, foot t o j aw. Medial
colum n insoles dram at ically reverse BioI m plosion, but t heir " m odus of
operandi" is st ill uncert ain and needs t o be clarified.

Ca pt ion s for Figu r e s 1 - 1 0

Figur e 1 . Deep 1 st Web Space. The 1 st m et at arsal is short er t han t he 2 nd m et at arsal creat ing
t he deep 1 st web space. This relat ive short ness of t he 1 st m et at arsal frequent ly occurs in t he
Rot hbart Foot St ruct ure.
Figur e 2 . Post ural Shift Associat ed wit h Hyperpronat ion. BioI m plosion ( upper diagram ) is a
gravit y induced post ural shift powered by dynam ic foot hyperpronat ion ( lower diagram ) . As t he
foot rolls inward, downward and forward ( hyperpronat es) , t he ent ire post ural axis shift s
inward, downward and forward.
Figur e 3 . Em bryo week 6.0 pf. Lat eral View. Lim b bud sit s at right angles t o rum p of em bryo.
Soles of feet and post erior com part m ent s of leg and t high face cephalad.
Figur e 4 . Em bryo week 8.0 pf. Front al View. Lower leg and t high has rot at ed 90 degrees
around it s longit udinal axis. Post erior leg and t high com part m ent s face one anot her, as do t he
heels and soles.
Figur e 5 . Torsional Developm ent of t he Medial Colum n of t he Foot . [ Sect ional Views, Front al
Plane] Lower alpha angles are linked t o Prim us Met at arsus Supinat us. Supinat us of t he t alar
head m aint ains t he ent ire m edial colum n of t he foot rem ains in supinat us. Plat e 1A illust rat es
Talar Supinat us, Plat e 1B Navicular Supinat us, Plat e 1C Cuneiform ( I nt ernal) Supinat us, and
Plat e 1D Met at arsal Supinat us and Microwedge. Higher alpha angles are linked t o t he
plant argrade posit ion of t he 1 st Met at arsal. The unwinding of t he t alar head, " direct s" t he
unwinding of t he ent ire m edial colum n of t he foot , navicular t o hallux ( See Plat es 2A –D) .
Figur e 6 . Prot ocol for Measuring PMs ( Right Foot ) . Pat ient St anding, Vision St raight Forward.
Locat e t he m edial t alocalcaneal ( subt alar) j oint . This easily palpable j oint is approxim at ely one
finger widt h below and in front of t he m edial m alleolus ( 21) . Keeping your finger on t he m edial
subt alar j oint , have your pat ient slowly rot at e t heir hips, first count erclockwise and t hen
clockwise. This will pronat e ( evert ) and supinat e ( invert ) t he right foot respect ively. Guide t he
foot t hrough t his range of m ot ion unt il t he upper and lower m argins of t he subt alar j oint feel
congruous ( parallel) t o one anot her ( 22) . This is t he anat om ical neut ral posit ion of t he subt alar
j oint . I f t he subt alar j oint is pronat ed or supinat ed, t he j oint space will feel collapsed
( oblit erat ed) or cavernous respect ively. While m aint aining t his STJ nP, slide t he m icrowedge
( 30) underneat h t he 1 st m et at arsal head unt il slight resist ance is encount ered from t he bot t om
of t he foot . Record t he PMs value ( vert ical displacem ent bet ween t he 1 st m et at arsal head and
ground) . Repeat t his prot ocol for t he ot her foot .
Figur e 7 . Com m on St anding Com pensat ory Pat t ern. Post erior view dem onst rat es st anding
hyperpronat ion pat t ern of left foot > right foot ( m ore apparent dynam ically) and right t ilt of
t he sacral base ( high left hip) . Middle diagram ( right ) illust rat es t he fem ur draw associat ed
wit h t he CCP ( left fem ur head post erior relat ive t o right fem ur head) . This dist ort s t he cont our
of but t ocks. Upper right diagram dem onst rat es t he out t oeing of t he right foot ( com pared t o
t he left ) and t he count erclockwise rot at ion of t he t horacic vert ebrae [ Adapt ed from Pope R S.
2003 The Com m on Com pensat ory Pat t ern. I t s Origin and Relat ionship t o t he Post ural Model.
AAOJ 14 ( 4) : 19- 40] .
Figur e 8 . Posit ion of t he Post erior Superior I liac Spines in t he Com m on St anding
Com pensat ory Pat t ern. The t hum bs of t he exam iner are placed direct ly on t he PSI S. Bot h
innom inat es are rot at ed ant eriorly, left > right . This result s in t he left PSI S being posit ioned
m ore cephalad relat ive t o t he right PSI S.
Figur e 9 . Transverse Plane Oscillat ions of t he Pelvis. ( Downward, Transverse Plane View of
t he Lower Body) As t he left leg is swung forward, t he left innom inat e rot at es inwardly on t he
t ransverse plane, and wit h it , t he left fem ur and t ibia. The int ernal rot at ion of t he left t ibia
pronat es t he weight - bearing left foot . This m echanical link bet ween t he subt alar j oint and
pelvis defines norm al pronat ion: pronat ion generat ed by t he int ernal t ransverse plane
oscillat ions of t he pelvis. Pronat ion generat ed by t he elevat ed 1 st m et at arsal is, by definit ion,
abnorm al ( hyper) pronat ion.
Figur e 1 0 . Medial Colum n I nsoles. Manufact ured by a Subsidiary of GRD BioTech I nc. ( t op
right phot ograph) . The dim ensions of t he m edial colum n wit hin t he propriocept ive insole is
dem onst rat ed ( m iddle right drawing) : 60 represent s t he slope, 63 t he vert ex ( m axim al t act ile
input ) and 64 t he nadir ( m inim al t act ile input ) of t he m edial colum n. Arch support s ( 80) are
used in funct ional flat feet where t he st ruct ural int egrit y of t he t alonavicular j oint is severely
com prom ised.

REFEREN CES
1. Rot hbart BA. M e dia l Colum n Foot Syst e m s: An I nn ova t ive Tool for I m pr ovin g
Post u r e . Journal of Bodywork and Movem ent Therapies 2002( A) 1: 37- 46.
2. Rot hbart BA, McCom bs A, and Riniker L. BioI m plosion. Th e Tr e a t m e n t of
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