Prof / Dr Brian A Rothbart
March 2006
Podiatric Biomechanical Engineering is a subspecialty in Podiatric Medicine dealing with the mechanics of the foot and how it affects the postural stability of the body (foot to jaw).

To access Prof/Dr Rothbart's Current Websites:

If you are a person in chronic pain
and looking for a solution to eliminate it,
visit Prof/Dr Rothbart's patient website -
Freedom from Chronic Pain


If you a researcher, visit his research website.

 

Information for Healthcare Providers

Rothbart described a foot in which the 1st metatarsal is structurally elevated and inverted relative to the 2nd metatarsal.  He terms this foot structure Primus Metatarsus Supinatus (PMs)

Rothbart suggests that PMs is the end result of a failed or incomplete unwinding of the talar head.  Click here to view the embryology.

Clinically, the 1st metatarsal and hallux are off the ground when the standing foot is placed in its anatomical neutral position (e.g., joint congruity) (Pressure Plate Analysis, click here).  This distance between the 1st metatarsal and ground, referred to as the PMs value, is quantified using microwedges.  PMs values between 10 and 30 millimeters define the Rothbart Foot structure (RFs).

RFs is biomechanically dysfunctional, demarcated by its prolonged mid-stance hyperpronation.  Mid-stance abnormal pronation frequently shifts the posture forward (See Figure 2 – BioImplosion): (1) the innominates rotate anteriorly, (2) the pelvis unlevels, augmenting the spinal curves, (3) the shoulders protract, (4) the head moves forward relative to the cervical spine resulting in (4) a Class II occlusion.  Rothbart terms this shift in posture BioImplosion which closely resembles the Common Compensatory Pattern originally described by Zink (1979).  Rothbart also suggests that the pathomechanics linked to the PMs foot lesion is a plausible etiology for the development of scoliotic curves and diabetic ulcers.

Proprioceptive activators (insoles) have been developed which effectively reverse BioImplosion and the associated chronic pain compensations associated with a Primus Metatarsus Supinatus Foot.


Zink GJ, Lawson WB 1979.  An Osteopathic Structural Examination and Functional Interpretation of the Soma.  Osteopathic Annals 7:12-19.

Note:  It is important to keep in mind that not all postural distortions come from the feet.  There has been a great deal of research done on cranial mechanics (both on teeth and the temporalmandibular joint), which link dental and cranial lesions to pelvic distortions (e.g., sway back).

In my private practice, approximately 40% of the postural distortions I see come from the feet, 45-50% are mixed (feet and jaw, feet and teeth, etc) and the remaining 10-15% come from the bite or teeth alone.  These may require a proprioceptive guide (oral night splint) or orthodontic treatment.  However, before orthodontic therapy is initiated, the head must be positioned over the spine (e.g., bioimplosion, if present, must be reversed).