ORTHOKINESY FOR ALL IN PREVENTIVE OR CURATIVE CARE

The flat foot is characterised by a sagging of the arch of the foot with a decrease in the height of the inner arch of the foot. The phenomenon is usually accompanied by excessive pronation (overpronation).

Some parents are concerned about their child's flat feet. First of all, it is important to know that at birth, the foot is chubby with excess fat which is reduced in the first two years of life. From this age onwards, the foot will start to take shape according to its curvature. It is also important to know that the arch of the foot begins to take form through the activity of the foot muscles during walking. A child completes the muscular and proprioceptive development of his feet at the age of 8 years. An assessment is therefore necessary to visualise the development of a child's feet. The foot is therefore flat at its first steps and its deformity is progressively reduced until the age of 8 years, provided that it has a correct muscular development.

The congenital flat foot is said to be caused by muscular insufficiency and ligamentous distension of the foot which would not allow the arch to position itself normally.

An acquired flat foot is the result of a deformity of the foot in which the position of the bones in relation to each other has been altered. This modification can be caused by many factors which disrupt muscle and ligament function (footwear, trauma, etc.).

The OPS postural assessment will be all the more important because of the podiatric analysis.

The hollow foot (oversupination) is characterised by the exaggerated accentuation of the arch. Specifically, it means an increase in height of the arches of the foot and is regularly accompanied by claw toes. The hollow foot is often rigid and unstable. It is therefore more easily subject to external ankle sprains.

The OPS postural assessment will be all the more important because of the podiatric analysis.

Instability of the foot is caused by hypermobility of the joints. It refers to every movement that occurs in a joint in response to the forces that interact with the joint when it should be stable under such forces.

Overpronation of the foot produces joint instability, called hypermobility when the foot is under load. This hypermobility is the cause of certain problems such as metatarsalgia, subluxation of the metatarsophalangeal joint and neuromas.

When the foot is in pronation during propulsion, the bone locking mechanism of the tarsus becomes less effective. The tarsus becomes unstable, the muscles in the support phase are unable to effectively stabilise the distal joints. No distal bones can be stabilised if the proximal bones are unstable. When the heel detaches from the ground, the forces supported by the forefoot cause abnormal movements of the forefoot bones towards each other, as well as a decrease in bone stability. Partial dislocations (subluxations) occur in the joint.

The OPS postural assessment will be all the more important because of its podiatric analysis.

Metatarsalgia is a non-specific term that defines pain in the metatarsals, generally in the metatarsophalangeal joint.

Chronic metatarsalgia is mostly caused by microtraumas produced by overpronation of the foot during propulsion. As the foot cannot be locked, its deviated and hypermobile joints stretch the ligament and capsular tissues, causing inflammation. Overpronation of the foot can also cause abnormal shearing on the heads of the metatarsals, which can lead to pain.

An anterior fall of the trunk can also cause an overload of weight on the front of the foot. Anterior head posture can be caused by maxillofacial imbalance (jaws), oculomotor (eyes) or vestibular (inner ear) disorders.

The OPS postural assessment will be all the more important because of its global vision.

Intermetatarsal neuroma, also known as Morton's syndrome, is a pain that develops in the region of the bifurcation of the neurovascular bundle passing between the toes.

The pain generally occurs in the third intermetatarsal space, more rarely in the second one and, exceptionally, in the first and fourth one. This pain is of the ‘electric discharge’ type, often forcing the patient to take off his shoes in order to calm the symptoms. It can be awakened by punctiform pressure on the plantar surface and is frequently accompanied by irradiation towards the adjacent toes, which are the seat of paraesthesia.

Morphostatic disorders of the foot (overpronation) and the wearing of narrow shoes with high heels are predisposing factors. Likewise, heavy sporting activities can facilitate the occurrence of this pathology due to the micro-traumatic stresses they generate.

The OPS postural assessment will be all the more important because of its podiatric analysis.

The hallux valgus of the foot is a deviation of the big toe towards the outside of the foot. Its deformation mechanism is mainly caused by prolonged excessive pronation of the foot. The unlocked medio-tarsal joint induces hypermobility of the first radius during propulsion. The unstable first ray is forced into dorsiflexion and inversion, causing subluxation of the first metatarsophalangeal joint. The deformation is progressive and influenced by the degree of pronation.

The OPS postural assessment will be all the more important because of its podiatric analysis.

This is a deformity of a toe at the proximal and/or distal interphalangeal joint. It can be isolated or associated with hallux valgus.

It is favoured by the wearing of shoes with too narrow toes and high heels. A malpositioned foot (overpronated or oversupinated) can lead to instability of the foot and promote the formation of toe claws. This prolonged claw formation can become rigid over time and end up in a claw position.

An anterior fall of the trunk can also cause a weight overload on the front of the foot and lead to claw formation of the toes to improve the stability of the body. An anterior head posture, responsible for anteriority of the trunk, can be caused by a maxillofacial imbalance (jaws), an oculomotor disorder (eyes) or a vestibular disorder (inner ear).

The OPS postural assessment will be all the more important because of its global analysis.

The Achilles tendon is the tendon of the body which is subject to the greatest stress, up to several hundred kilos of traction for a minimum size of about 1 cm². It is better to speak of tendinopathy than tendinitis, given the anatomopathological diversity.

Tendinopathies of the Achilles tendon are often related to overpronation of the foot.

The OPS postural assessment will be all the more important because of its podiatric analysis.

Sever's disease is a type of osteochondritis or osteochondrosis. It is an abnormality in the growth of bone and cartilage in children. It is a group of diseases of unknown causes characterised by the interruption of the vascularisation of the primary or secondary ossification nucleus of the affected bones.

Osteochondritis appears between 5 and 14 years of age depending on its location and mainly concerns individuals who are more or less athletic.

Sever's disease is characterised by pain in the calcaneus (back of the heel).

Sever's disease is often aggravated by overpronation of the foot. Excessive pronation is accompanied by an internal rotation of the tibia which tends to pull the Achilles tendon inwards with a quick whiplash. This can therefore lead to injury of the cartilage insertion with which the tendon attaches itself.

The OPS postural assessment will be all the more important because of its podiatric analysis.

Tendinopathy of the hind leg is quite frequent and is clearly favoured by overpronation of the foot. It may be an insertion tendinopathy on the tarsal scaphoid or a tenosynovitis behind the internal malleolus. Dislocation of this tendon is rare. However, degenerative tendinopathy with progressive stretching and then partial and complete rupture of the tendon is more frequent.

The OPS postural assessment will be all the more important because of its podiatric analysis.

The plantar aponeurosis or fascia is a fibromuscular structure that is part of the sural-Achilles-plantar system. It is poorly vascularised and more elastic. It is called upon in the event of impulse movements and sagging feet.

It is most often at the posteromedial level, at its insertion on the calcaneum, that the plantar aponeurosis presents a painful inflammation. This pain can radiate towards the big toe. It is typically present when the foot is first placed on the ground in the morning, after resting at night. There is an palpatory pain, which is revived at dorsiflexion of the big toe. X-rays will usually be normal in young sports patients, but will show a ‘calcaneal spur’ in the older patient. This spur is the result of traction of the fascia on the calcaneus, but is not painful on its own.

Plantar fascia also appears to be related to overpronation. In fact, the prolonged eversion of the calcaneus during the intermediate support phase leads to a stretching of the plantar aponeurosis. If the foot does not return to supination, the tension of the plantar aponeurosis increases at the moment the heel is detached from the ground, when the weight of the body is concentrated on the forefoot and when the triceps by its contraction exerts a traction on the calcaneus. Excessive pronation coupled with these factors during running causes an enormous increase in tension which results in microtraumas of the plantar fascia due to repetitive overloading and stress build-up.

Lenoir's spur is what is more commonly known as the calcaneal spur. It is an abnormal bone excrescence (pointing towards the forefoot), visible on X-rays, named in honour of Mr Lenoir (who made its discovery). Calcaneal spur forms where the plantar fascia meets the heel bone (calcaneus). It is not a disease in itself, but a consequence of chronic plantar fasciitis (also known as plantar aponeurositis).

The OPS postural assessment will be all the more important because of its podiatric analysis.

Bone tissue is able to repair its structure in response to stress. The normal remodelling process requires a balance between bone resorption and bone replacement. Microfractures therefore occur when the resorption process is faster than the replacement process. This imbalance is caused by the continuous application of repetitive stress. The calcaneus and metatarsals are the most common locations of stress fractures in the athlete.

The aetiology of stress fractures is multifactorial :

- Training intensity,
- Dietetics,
- Overpronation of the foot: this overloads the soleus muscle which can tire the posteromedial part of the tibia and cause a stress fracture. In addition, this overpronation is likely to lead to a stress fracture of the calcaneus due to the lack of shock absorption caused by the absence of ‘spring action’ of the foot. 

The OPS postural assessment will be all the more important because of its podiatric analysis.

Algodystrophy or algoneurodystrophy, also known as ‘complex regional pain syndrome’, manifests itself by tingling, burning, intense pain and even stiffness. Its cause is often difficult to find, and in 20% of cases it remains mysterious. Algodystrophy occurs in the joints and peri-articular areas. It is essential to combat joint stiffness as early as possible in order to avoid complete fixation of the affected joint. Active rehabilitation is essential.

The OPS postural assessment will enable to analyse the level of joint damage (stiffness) and to visualise the body's compensation for this pathology.

Neuropathy is one of the most recurrent complications of diabetes. It first affects the feet and then the hands. It is described as a loss of sensation, or numbness or tingling in the toes. Symptoms usually appear progressively with diffuse and intermittent pain at the beginning and may intensify over time. Symptoms come and go, but eventually become more frequent. Over a long period of time, a person may experience a loss of sensation to the point where they cannot feel the tightness of their shoes, or don’t even know if the bath water is hot or cold, or if they have injured themselves.

Symptoms of muscular weakness and progressive sagging of the arches of the foot also appear. Diabetic neuropathy is the main cause of foot ulcerations and infections and, in extreme cases, amputation.

It is essential to check that the foot does not suffer from a pressure disorder that could lead to ulceration.

The OPS postural assessment will be all the more important because of its podiatric analysis.