A S A TECHNIQUE INSTRUCTOR OF ALMOST 18 YEARS IN OUR WONDERFUL PROFESSION. I HAVE SEEN AND HEARD A LOT FROM THE ATTENDEES. SOME TALK ABOUT SEMINARS THEY HAVE ATTENDED THAT WERE FILLED WITH FIRE AND BRIMSTONE AND THEY WERE SO EXCITED ABOUT IT WHILE THEY WERE THERE. ONCE THEY ARRIVE HOME. HOWEVER. THEIR ENTHUSIASM WANES AND THEY END UP GOING RIGHT BACK TO PRACTICING LIKE THEY HAD BEFORE THE SEMINAR HAD OCCURRED. THEY DID NOT THINK THE INFORMATION WAS VALUABLE ENOUGH TO BEGIN USING. So what happened? Where"s the disconnect? How did that magic fizzle out from the seminar? Why didn't that Doctor implement that new technique or aspects of the new technique into thcirpracticc that very next day? Its almost as if they were entranced for 12 hours and once they awoke from the dream, they shook their heads and went back to normal life. When I teach, my goal is to inspire, educate and entertain you so well that it makes common sense for you to start using some of the ideas and tips I share. The cnix of what I teach at all of my seminars is firmly rooted in a fundamental understanding of human foot anatomy and biomcchanics. Not only can the subject be interesting and fun. it can be incredibly illuminating, too. Almost everyone who walks into your office is a candidate you can help from the ground up. Take a deep breath, clear your head and give me a few moments to tell you about the foundation of the body. I always tell patients: "everyone's feet tell a story: arc you listening?" The first glance at someone's feet will tell you so much. Are the patient's feet rolling in (flatter) or rolling out (high instep)? Do you see bunions, corns, callouses on the toes? Everything that happens to the feet, good or bad. will be reflected all the way up the axial kinetic chain to the TMJ. How mam' functional arches arc under our feet? You know the answer because I ask every time I teach and you always answer correctly. We have three arches, the medial longitudinal, lateral longitudinal and transverse (mctatarsal) arches, which together form the plantar vault on the bottom of the foot. The prime stabilizer of the three arches is the plantar fascia: that thickened connective tissue (in essence a giant ligament) that starts at the underside of the calcaneus and extends to the metatarsal heads. The muscles on the bottom and top of the foot provide secondary support. Their job is to help the foot/ ankle in their various movements. The muscles do not support the arch structures under normal weight-bearing circumstances. The arches give the foot the ability to absorb 30% of the ground shock with gait: balance the weight so that 50% is on the forefoot and 50% is on the hindfoot: and store energy to propel the foot onto the next step. In fact, healthy arches arc responsible for ensuring that the ground force shock wave that begins from the feet/ankles moves safely up through the long axis of the body all the way to the TMJ. When the arches arc working, the body is supported and all is well. By age 6-7 the arches fully form and then, the story starts getting interesting. From this point forward, the arches can fall due to genetic predisposition, weight-bearing activity, poor shoes, etc. It can be observed that 8()%of the patients walking through your door will liavc some degree of collapsed arches. Think about that! Eight out of ten people who you see in your office w ill have Hatter feet. Do you think this affects your adjustments and your care? Oh yes! When tliosc arches fall and tlie foot starts moving downwards towards tlic door, it changes the biomcchanics and tlie way the bones move and work together. It begins in the foundation of the feet and goes up through the ankles, knees, hips, pelvis, spine, shoulders, head and TMJ. Stand up and let's make this simple. Put your hands on your greater trochantcrs of your femur bones and then roll your feet in as much as you can towards the floor. This simulates excessive foot pronation and the fallen arches. Do you feel the following: pressure on the mid/forcfoot/hindfoot stretching the plantar fascia? pressure on the calcancus (heel) bone as it drops down stressing the Achilles tendon? excessive inward rotation of the tibia and femur bones? • pressure on the inner ankles and inner knees? lateral pressure on the greater trochantcrs? induced rotation of the pelvis and lower back which feels tight or painful? Can you feel what I am talking about? Your patients sure do. You have seen the follow ing picture before, but let's refresh our memories because this gives you a guide for what to quickly and easily look for. We arc talking about the five red flags. Having your patient stand in front of you and while you look for these indicators is fast and very reliable. Remember earlier I talked about bunions (on MT"s 1. 5). callouses, corns, hallux valgus. etc. Those arc indicators of arch collapse (especially the transverse) and the resultant physical changes and deformities that occur over time. You can run but you can't hide from stress, gravity and its effects on the kinetic chain. So what do you do now? Use the appropriate physiotherapy modalities: adjust the feet: show them some stretching and strengthening exercises. But don't forget an important component: custom molded. 3 arch, flexible orthotics. After you adjust the patient and they arc feeling great, they walk out of the office. Under or un-supportcd feet will then have the excessive pronation put the body right back in to the negative pattern we just discussed. The proper orthotics not only support the arches of the feet, but the entire body from toes to nose. It is amazing what I have seen them do in hundreds of patients, including myself, my wife and my 11 and 8 year old son and daughter. Patients have learned incorrectly through their own experiences with other healthcare professionals that the feet can be supported just with good shoes or with over-the-counter arch supports. Please be the voice of reason and understanding. Teach these patients about foot anatomy and biomechanics using simple terms like we have discussed above. You have a window into the lives of the patients who have never been taught that we have three arches. Almost c\ cry patient thinks we have just one arch, the instep. They believe that by supporting this one arch, they are fine. Most custom orthotics (usually rigid or semi-rigid ones) made by the foot doctor don't address all three arches, so it is up to you to be the conduit of this information. You understand how the joints of the body are related and every patient who walks through your door can have their lives enhanced by the work you do. So support those patients from the ground up like only you can! Dr. Kevin Wong is an expert on foot analysis, walking and standing postures and orthotics. Teaching patients and chiropractors is a passion for him. and he travels the country speaking about spinal and extremity adjusting. Dr. Wong practices full-time in Orinda, California. Contact Dr. Wong at 925-254-4040 or drkevinwongiagmail.com.
