PROFESSIONALS AREA

FINDING SOLUTIONS TO BODY PAIN

DETECTING POSTURAL DISORDERS

The human body sometimes faces difficulties because of injuries, malformations or various pains.

Many symptoms can be identified: stiffness, limping, a burning or hot feeling, pinching or clinging sensations, etc.

Solutions adapted to each part of the body exist to relieve these different ailments.

Select the part of the body that is causing you pain to identify which condition it might be.
HEAD PAIN
NECK PAIN
SHOULDER PAIN
BACK PAIN
LUMBAR PAIN
HIP PAIN
ELBOW PAIN
WRIST PAIN
KNEE PAIN
LEG PAIN
ANKLE PAIN
FOOT PAIN
DETECTING POSTURAL DISORDERS

DETECTING POSTURAL DISORDERS



The human body sometimes faces difficulties because of injuries, malformations or various pains.br>
Many symptoms can be identified: stiffness, limping, a burning or hot feeling, pinching or clinging sensations, etc.br>
Solutions adapted to each part of the body exist to relieve these different ailments.

Select the part of the body that is causing you pain to identify which condition it might be.

HEADACHE, MIGRAINE

Pathology
Head pain of mechanical origin is often caused by a maxillofacial disorder (jaw), an oculomotor disorder (eye), a vestibular disorder (inner ear), or even a foot disorder.

In general, pain occurring in the evening is often related to fatigue of the eye muscles. An imbalance of the eye muscles can be amplified by strain due to working in front of a computer screen.

Pain that occurs in the morning is often related to nocturnal bruxism (teeth clenching). This bruxism is generally associated with a general tightening of the body and causes strong morning fatigue.

In order to detect the causes of head pain, it is advisable to carry out an orthokinesic assessment (OPS postural assessment). Through this assessment we can detect if the patient has one or more disturbed postural entrances.

NECK PAIN

Pathology
Cervical pain is located in the neck area. When the pain extends and radiates towards an arm, it is called cervico-brachial neuralgia. Pain can also radiate to the head through headaches.

Most often, cervical pain is favoured by inappropriate postures and movements (often called torticollis) or by arthrosis. Cervical pain can also occur after a trauma (‘whiplash’).

Poor posture of the head can lead to overstraining of the neck muscles and intervertebral discs. Poor head posture of postural origin is often caused by a maxillofacial (jaw) disorder, an oculomotor (eye) disorder, a vestibular (inner ear) disorder or even a foot disorder.

In order to detect the origin of cervical pain, it is advisable to perform an OPS postural assessment.

SHOULDER PAIN

Pathology
The origin of shoulder pain is mainly due to muscle injury. In extreme cases, it can be a fracture (of the clavicle or the humerus) or a tear (rupture of the rotator cuff in particular) or finally a dislocation (the head of the humerus coming out of its articular cavity).

Shoulder pain is mostly associated with neck pain, which is why it is essential to check the correct posture of the head.

Poor head posture of postural origin is often caused by a maxillofacial (jaw) disorder, an oculomotor (eye) disorder, a vestibular (inner ear) disorder or even a foot disorder.

In order to detect the origin of shoulder pain, it is advisable to perform an OPS postural assessment.

BACK PAIN

Pathology
Dorsalgia is a pain felt from the base of the neck to the waist (between the first and twelfth dorsal vertebrae). It is often postural in origin. Its origin can be postural descending, ascending or mixed. A poor head or feet posture can change the position of the spine and overload the intervertebral muscles and discs. A deficiency of the respiratory system can also cause a disturbance of the spine.

In order to detect the cause of back pain, it is essential to perform an OPS postural assessment combined with a detailed analysis of the mobility of the spine.

LUMBAR PAIN

Pathology
Lumbar pain is located in the lower back.

Symptoms, intensity and type of pain may vary depending on the cause. Lumbar pain can be mild or severe, periodic or chronic. It can be deep, stabbing, throbbing or pulsating. Lumbar pain can sometimes be worse in the morning and improve with movement and stretching.

Most lumbar back pain is caused by lower limb deficiencies (overpronated feet, flat feet, hollow feet, lack of cushioning, unevenness of the lower limbs, etc.). In 80% of the cases, a mixed ascending and descending postural stress is detected. The spinal column is put under tension like a cloth that twists on a vertical axis. The lower back is the central area of this tension, and it is the area that suffers the most, with a risk of wear and tear and herniated discs.

The OPS postural assessment has the advantage of analysing all possible deficiencies in posture, walking and running.

- Mechanical consequences in an ascending chain :
Abnormal subtalar eversion is likely to lead to internal rotation of the tibia and femur, resulting in an anteversion of the corresponding iliacus. The opposite is true for inversion. Joint malposition can lead to muscular discomfort, which can further cause the development of pain.

- Unequal functional length of the lower limbs :
The inequality in functional length of the lower limbs may be due to an excess of eversion of one foot in relation to the other. This inequality can be responsible for a series of deformations which can lead to low back pain: an anteversion of the pelvis, functional lumbar scoliosis, an increase in the lumbo-sacral angle. If a difference in anatomical length is compensated by a subtalar eversion, the resulting internal rotation causes pressure on the sacroiliac joint. In addition, a biomechanical imbalance in the lower extremities has a much greater impact during running than during walking. Thus, an imbalance of the forefoot of 4 to 5° is as significant as an imbalance of 12° in the walker.

- Lack of shock absorption :
During heel contact, at the beginning of the support phase of walking, the leg comes on the ground in exorotation and passes into endorotation by carrying out 6° of eversion at the joints under the astralagus. This mechanism allows the foot to function as a ‘spring’. It helps to absorb the shock created by the contact of the foot with the ground.

If the foot is too or insufficiently mobile, the 6° margin may be exceeded (hypereversion) or not reached. In this case, the shock wave rises towards the lumbar spine. In conclusion, the lack of cushioning of the foot favours the ascent of the shock wave to the spinal column.

- The concept of the thoracodorsal fascia :
The human being is the only species on earth to be provided with a posterior ligamentary system allowing the function of straightening the trunk.

It has been proven that the posterior ligamentary system, called the thoracodorsal fascia, provides the energy necessary for the erection of the spine.

It is important to know that while one fifth of the force is transmitted to the erector muscles of the spine, the remaining four fifths are transmitted to the posterior ligamentary system. The posterior ligamentary system therefore plays a major role in the transmission of the forces generated by the hip extensors.

The erector muscles of the spine have a 50% weaker lever arm than the posterior ligamentary system. Therefore, using the erector muscles of the spine in preference to the posterior ligamentary system would lead to high compressive stress on the intervertebral disc.

Muscle imbalance in the pelvic girdle can reduce the efficiency of the posterior ligamentary system during walking. Indeed, hypertonicity of the psoas-iliac muscle leads to an anteversion of the pelvis. This tilt relaxes the thoracodorsal fascia and thus creates a lumbar imbalance which must be recovered by the erector muscles of the spine.

In the same way, the hypertonicity of the gluteal and/or hamstring muscles will favour the retroversion of the pelvis, resulting in an increase in the tension of the thoracodorsal fascia. As a result of these muscular retractions, the psoas-iliac and transverse muscles of the abdomen will relax by reciprocal inhibition of the antagonists. However, the transverse muscle of the abdomen is the only muscle which maintains the lateral stability of the thoracodorsal fascia. Losing its lateral stability, the thoracodorsal fascia will therefore be more strongly supported by the erector muscles of the spine.

In short, a muscular imbalance in the pelvic girdle can lead to over-stressing of the erector muscles of the spine as a result of abnormal tension (hypertension or hypotension) in the thoracodorsal fascia. This mechanism favours the appearance of spinal pain.

In order to guarantee the best possible tension of the thoracodorsal fascia, it is therefore essential that the feet function correctly in movement. By articular action, the rotations of the foot act on the rotations of the lower limb and the pelvis, and thus indirectly on the thoracodorsal fascia.

HIP PAIN

Pathology
Hip pain can occur more or less quickly. It is usually felt in the groin fold and can radiate to the knee. The origin of hip pain can be caused by muscle and joint damage. A malposition of the foot joint can affect the hip in an ascending chain.

Inversely, a malposition of the spine can also cause a compensation of the hip in descending chain.

Mechanical consequences in an ascending chain: abnormal eversion of the foot is likely to cause internal rotation of the tibia and femur, resulting in an anteversion of the corresponding iliacus. The opposite is true for inversion. The hip can therefore be stressed by compensation of the upper or lower stages. An orthokinesic assessment is a good indicator to detect the origin of the stress in the hip.

The main pathologies related to hip pain are the following :

The two muscles, iliacus and psoas, originate in the lumbar area and join to insert themselves through a tendon in a small area inside the thigh: the lesser trochanter. The iliopsoas muscle is often injured as a compensation for excessive internal rotation of the femur caused by overpronation of the foot (flat foot).

The psoas-iliac muscle retracts, pulling the spine downward, forward and in contralateral rotation. The psoas-iliac muscle (accessory external hip rotator) retracts to counteract the excess internal rotation of the hip.

It tries to compensate for the excess amplitude of the foot in eversion (due to a weakness of the supinator muscles of the foot).

Through its podiatric analysis in movement, the orthokinesic assessment can detect a dynamic proprioceptive fault and/or muscular and articular deficiencies of the feet.

The pyramidal muscle runs from the sacrum, in the lower part of the spine, through the sacroiliac joint to the top of the femoral bone or femur. The sciatic nerve passes directly below this muscle.

When the muscle becomes tense or spastic, it can cause a brief irritation of the nerve. This muscle often causes pain in the buttocks and the lumbar area. The pyramidal muscle is often injured as a compensation for the excessive internal rotation of the femur caused by subtalar hypereversion.

The pyramidal muscle (external hip rotator) retracts to counteract the excess internal rotation of the hip. It tries to compensate for the excess amplitude of the foot in eversion (due to a weakness of the supinator muscles of the foot).

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

Tendinitis of the gluteus medius is a fairly common problem. It is also called hip tendinopathy or trochanteric bursitis. The problem can occur spontaneously, or after an effort, or following the implantation of a hip prosthesis.

To compensate for the excessive internal rotation of the femur caused by overpronation of the foot, the gluteus medius muscle (external rotator of the hip) retracts to counteract the excess internal rotation of the hip. It tries to compensate for the excess amplitude of the foot in pronation (following a weakness of the supinator muscles of the foot).

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

Pubalgia is a tendinitis of one of the many abdominal muscles that end in a fibrous blade (linea alba, musculus rectus abdominis, obliquus abdominis...) or of the thigh muscles (adductor, abductor...) which are inserted on the ilio-pubic wing.

This inflammation is due to repeated and traumatic stress on the concerned tendon. The mechanism of the lesion is often linked to an asymmetry in the mobility of the 2 halves of the pelvis, mainly caused by an asymmetrical position of the 2 feet during walking or running. It is common to encounter 2 asymmetrical overpronated feet that force the pelvis to position itself in a twist that overworks the pubic symphysis.

This pelvic torsion mechanism can also be caused by, or even coupled with a torsion of the trunk in descending chain.

The OPS postural assessment will be all the more important because of its global analysis in order to detect the different origins that create tension on the pubis: feet, spine...

Coxarthrosis (or arthrosis of the hip) is wear and tear of the hip joint caused by friction on the joint surfaces. X-rays show the destruction of the cartilage. It is common from the age of 50 onwards. Coxarthrosis can be asymptomatic and go unnoticed, or it can be very disabling and cause a lot of pain.

The malposition of the foot can cause a lack of cushioning, which can lead to excessive stress on the cartilage of the knee and hip.

Foot malposition during walking (overpronation or oversupination) can cause a poor distribution of joint pressure in the knee and hip joints, leading to abnormal cartilage wear.

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

ELBOW PAIN

Pathology
Également appelée « tennis elbow », l’épicondylite est une inflammation qui survient au voisinage d’une petite saillie osseuse de l’os du bras (humérus), juste au-dessus de l’articulation du coude sur la face externe du bras. La douleur provient principalement d’une lésion des tendons situés à proximité du coude. Les tendons sont de solides bandes de tissu qui fixent les muscles à l’os.

L’épicondylite est souvent amplifiée par une crispation nocturne associant du bruxisme (serrage de dent) et du serrage du poing. Cette surfatigue de nuit inconsciente peut occasionner un surmenage des muscles épicondyliens.

Un bilan orthokinésique (bilan postural OPS) peut détecter les éléments perturbateurs qui freinent la guérison.

WRIST PAIN

Pathology
Le syndrome du canal carpien se manifeste par la compression du nerf médian au poignet. Le nerf médian est un grand nerf qui parcourt le centre de l’avant-bras et dont les ramifications se prolongent jusqu’à la peau du pouce, de l’index, du majeur et de la moitié de l’annulaire.

Dans le poignet, le nerf médian et les tendons fléchisseurs des doigts traversent un « tunnel » nommé canal carpien. Celui-ci est très étroit et peut être facilement réduit par une inflammation ou ses séquelles (fibrose).

Le syndrome du canal carpien est souvent amplifié par une crispation nocturne associant du bruxisme (serrage de dent) et du serrage du poing. Ce surmenage de nuit inconscient peut occasionner une inflammation des muscles passant dans le canal carpien.

Afin de détecter l’origine du syndrome du canal carpien, il est souhaitable d’effectuer un bilan postural OPS.

KNEE PAIN

The main pathologies related to knee pain are the following :

Instability of the knee can cause misalignment of the lower limb and patella slippage. It promotes rotation of the leg and misalignment of the ankle and hip.

Knee instability is often caused by ligament hyperlaxity and muscle deficiency. Over time, it can lead to pathologies such as the patellofemoral syndrome, osteoarthritis and even patellar dislocation.

The knee is a hinge joint between the foot and the hip. A malposition of one of the two segments can cause a compensatory overload of the knee. A flat foot (overpronation) is unstable and causes compensatory problems directly at the knee. A foot in abnormal eversion is unstable and causes compensatory difficulty directly at the knee. Conversely, a foot in excessive inversion is a rigid foot that can force the knee to compensate for the foot's lack of mobility when walking on uneven ground. A walking shoe that is too rigid can have the same effect. When the foot cannot play its role as a shock absorber (‘spring’) adapting to variations in the ground, the knee compensates by trying to increase its amplitudes. The ligaments are thus put under excessive strain and can become distended or even ruptured (sprained knee).

Mechanical consequences in an ascending chain :
Eversion of the foot is likely to lead to internal rotation of the tibia and femur, resulting in an anteversion of the corresponding iliacus. The opposite is true for inversion.

Joint malposition can lead to muscular discomfort, which can further cause the development of pain.

The orthokinesic test is suitable for detecting a dynamic proprioceptive fault and/or muscular and articular deficiencies of the lower limbs. It allows the analysis of the stages above and below the knee.

The patellofemoral stress syndrome is also known as anterior knee pain syndrome, and has often been compared in the past to patellofemoral chondromalacia. It is frequently encountered in young athletes. This pathology is often caused by a misalignment of the lower extremity: increased femoral anteversion, tibia vara, external torsion of the tibia and pronation of the foot.

Patients with this anatomical configuration increase the value of the Q-angle which encourages external traction of the patella. At first glance, excessive pronation seems to contradict the patellofemoral stress syndrome, in the sense that internal rotation decreases the Q-angle. However, the association of excessive eversion with an increase in Q-angle in patellofemoral stress syndrome leads to an increase in tension on the internal side of the knee.

Eversion of the foot causes the tibia to rotate internally and disrupts the patellofemoral biomechanics, predisposing the athlete to develop patellofemoral stress syndrome. Excessive or prolonged eversion, beyond the mid-point of the support phase, is associated with an increase in the internal rotation of the tibia, while the femur rotates outwards, thus modifying the force vectors of the quadriceps. The patella is deviated from its normal trajectory and is no longer aligned with the femur, leading to the development of abnormally high pressure between the patella and the femoral condyles, and creating an incongruity in the joint.

If there is prolonged eversion, the abnormal rotations cause the origin and insertion of the quadriceps muscle to move so that it is positioned more externally to the patella. Thus, the contraction of the quadriceps muscle tends to pull the patella outwards as it slides against the external condyle of the femur, which irritates the underside of the patella.

The orthokinesic assessment is suitable for detecting a dynamic proprioceptive fault and/or muscle and joint deficiencies of the lower limbs. It allows the analysis of the stages above and below the knee.

Osgood-Schlatter 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 with unknown causes characterized by the interruption of the vascularization 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.

Osgood-Schlatter's disease is characterized by pain located in the anterior tibial tuberosity (upper tibia).

This osteochondrosis can be aggravated by overpronation of the foot. It should be noted that the internal rotation of the tibia, induced by pronation, can cause an anterior displacement of the proximal end of the tibia and an early flexion of the knee, causing eccentric traction of the tendon on its cartilage attachment.

The orthokinesic assessment is suitable for detecting a dynamic proprioceptive fault and/or muscle and joint deficiencies of the lower limbs. It allows the analysis of the upper and underlying stages of the foot.

Sinding-Larsen-Johanson 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 with unknown causes characterized by the interruption of the vascularization 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.

Sinding-Larsen-Johanson disease is characterized by pain at the tip of the patella.

This osteochondrosis can be aggravated by overpronation of the foot. It should be noted that the internal rotation of the tibia, induced by pronation, can cause an anterior displacement of the proximal end of the tibia and an early flexion of the knee, causing eccentric traction of the tendon on its cartilage attachment.

The orthokinesic test is suitable for detecting a dynamic proprioceptive fault and/or muscular and articular deficiencies of the foot.

It is a tendinitis that affects the insertion of the patellar tendon at the distal end of the patella, and, less frequently, at the anterior tuberosity of the tibia.

This tendinitis may be related to overpronation of the foot. It should be noted that the internal rotation of the tibia, induced by pronation, may cause an anterior displacement of the proximal end of the tibia and early flexion of the knee, causing eccentric traction of the tendon.

The orthokinesic test is suitable for detecting a dynamic proprioceptive fault and/or muscle and joint deficiencies of the lower limbs. It allows the analysis of the stages above and below the knee.

Goose foot tendinitis is an inflammation of the three tendons of the muscles making up the ‘goose foot’ located in the upper-inner part of the tibia.

The inflammatory mechanism is generally caused by a hypereversion of the foot which favours an internal rotation of the leg segment associated with a valgum of the knee. It is especially this valgum which promotes the tension of the goose foot muscles. These tendons can, by superposition, rub against each other or against the femur, which leads to inflammation.

The orthokinesic assessment is suitable for detecting a dynamic proprioceptive fault and/or muscular and articular deficiencies of the lower limbs. It allows the analysis of the stages above and below the knee.

Maissiat’s band is an aponeurotic expansion of the fascia lata tensor muscle which is inserted on Gerdy's tubercle.

During effort, this band causes a conflict by passing in front of the lateral femoral condyle at each flexion-extension movement of the knee. This intermittent friction causes a painful inflammatory reaction and sometimes a bursa serosa is interposed between the deep side of the band and the lateral condyle.

The most affected sportsmen are cyclists and especially joggers. The pain is located in the lateral compartment of the knee. It occurs rapidly during effort and forces the athlete to stop.

The orthokinesic assessment is appropriate to detect a dynamic proprioceptive fault and/or muscular and articular deficiencies of the lower limbs. It allows the analysis of the stages above and below the knee.

Gonarthrosis (or arthrosis of the knee) is wear and tear of the knee joint caused by friction on the joint surfaces. X-rays show the destruction of the cartilage. It is common from the age of 50 onwards. It can be asymptomatic and go unnoticed, or it can be very disabling and cause a lot of pain.

The malposition of the foot can cause a lack of cushioning, which can lead to excessive stress on the menisci and cartilage of the knee. This malposition can cause a poor distribution of pressure in the knee joints, leading to abnormal wear of the menisci and subsequently of the cartilage.

The orthokinesic assessment is suitable for detecting a dynamic proprioceptive fault and/or muscular and articular deficiencies of the foot.

The genu valgum is an inward deformation of the lower limb. In a standing position, both legs form an X, the two knees are touching each other while the ankles are spread apart.

The more pronounced the genu valgum is, the more it can interfere with walking. Also, with age, it is often a predisposing factor to gonarthrosis (arthrosis of the knee) because the pressures and forces exerted on the knee are not in the right places.

The genu valgum can be caused by an imbalance in the muscle tone of the lower limb and hyperlaxity of the internal ligaments of the knee. The foot in overpronation (flat foot) and weight excess accentuate the deformity of the knee in an X-shape.

The orthokinesic assessment is suitable for detecting a dynamic proprioceptive fault and/or muscular and articular deficiencies of the lower limbs. It allows the analysis of the stages above and below the knee.

The genu varum is an outward deformation of the lower limb. In standing position, both legs form an O. It is the opposite of the valgum genu (X-shaped knees). The ankles are in contact with each other, while the knees do not touch each other. The more the knee is ‘varum’, the greater the gap. The legs are called bandy or bow legs.

The genu varum is one of the main factors that promote arthrosis of the knee by loading the medial compartment of the knee.

The genu varum can be caused by an imbalance between the muscle tone and flexibility of the lower limb. It can be amplified by a poor position of the feet and hips.

The orthokinesic assessment is suitable for detecting a dynamic proprioceptive fault and/or muscular and articular deficiencies of the lower limbs. It allows the analysis of the stages above and below the knee.

The intoeing walk is a walk with closed hips. It appears from a very young age. The feet turn inwards due to excessive internal rotation of the hip. It can lead to regular falls.

This mechanism is caused by a disturbance in the muscle tone of the hips and/or feet.

Deficiency in ascending chain: a hypereverted foot causes the lower limb to rotate and may promote an internally rotating hip.

Deficiency in descending chain: an insufficiency of the external rotator muscles of the hip can also favour an internal rotation of the hip, which in turn will force the foot into hypereversion.

The orthokinesic assessment is suitable for detecting a dynamic proprioceptive fault and/or muscular and articular deficiencies of the lower limbs. It allows the analysis of the stages above and below the knee.

LEG PAIN

The main pathologies related to leg pain are the following :

Tibial periostitis manifests itself as a painful inflammatory syndrome, located along the medial two-thirds of the tibia.

The term ‘internal tibial stress syndrome’ is more specific and refers to overload injuries producing a painful inflammatory reaction along the postero-internal border of the tibia.

The origin of the posterior tibial muscle was long time considered to be the only tissue source of pain. However, it is now known that tibial periostitis is often the consequence of inflammation of the fascial attachment of the soleus muscle, much more so than the posterior tibial muscle. This is because the fascial attachment of the soleus muscle is inserted distally along the posteromedial border of the tibia, the most common site of pain. While the posterior tibial muscle inserts itself on the upper two thirds of the interosseous membrane, on the internal face of the fibula and on the anterolateral face of the tibia.

Tibial periostitis is linked to subtalar hypereversion by the following phenomenon: the soleus muscle is not only the main flexor of the ankle, it is also the inverter of the heel. During running, the soleus muscle, which is inserted more internally on the calcaneus, contracts eccentrically to limit eversion. When this eversion is excessive, the eccentric work of the muscles controlling the eversion, including the soleus, increases sharply, causing stress to the muscle.

This is more commonly known as a ‘posterior tibial syndrome’ in which the anterior and posterior tibial muscles are stretched by excessive eversion of the foot. Excessive eversion strains the muscles supporting the internal arch of the foot, namely the anterior and posterior tibial muscles. During excessive pronation, the leg muscles try to support the inner edge of the foot. Thus, prolonged eversion leads to excessive stress on these muscles, which finally causes periostitis. This syndrome is characterised by pain along these muscles and their tendons behind the internal malleolus.

The orthokinesic assessment can detect a dynamic proprioceptive fault and/or muscular and articular deficiencies of the feet by means of podiatric analysis in movement.

The anterior tibial muscle extends from the bridge of the foot to the anterior part of the leg. It participates in the elevation of the forefoot in order to prepare the contact of the foot with the ground, and in the elevation of the internal arch (by supination) helping thus the posterior tibial muscle (main supinator of the foot).

Excessive pronation of the foot is the main cause of anterior tibial inflammation. Wearing a heeled shoe can also be a cause of abnormal stress since its working amplitude is more consequent.

By means of podiatric analysis in movement and footwear analysis the orthokinesic assessment can detect the deficiency causing the inflammation.

ANKLE PAIN

The main pathologies related to ankle pain are the following :

Ankle instability is caused by joint hypermobility. It refers to every movement that occurs in a joint in response to the forces that interact with the joint when the joint should be stable under such forces.

Overpronation of the foot produces joint instability, called hypermobility, when the foot is under load. The ankle undergoes partial dislocations (subluxations) and is more prone to sprains.

The orthokinesic assessment allows to quantify hyperlaxity, muscular and proprioceptive deficiencies likely to favour ankle instabilities.

An ankle sprain is an injury due to stretching or tearing one or more ligaments. Ligaments are elastics stretched from one bone to another and allowing the joints to remain stable in the event of extreme movements. Ninety percent of ankle sprains correspond to damage to the external collateral ligament between the tibia, the talus (astragalus) and the calcaneus (heel bone)

. Following a first sprain, statistics show that a recurrence occurs in 50% of cases. It is therefore important to prevent this phenomenon by carrying out adequate proprioceptive and muscular rehabilitation.

A hypereverted foot is unstable when it is caused by muscle weakness. Its malposition can therefore disturb the stability of the foot. The hyperinverted foot, on the other hand, is too rigid. Its lack of mobility makes its ligaments vulnerable to the slightest variation in the ground.

The orthokinesic assessment allows to quantify hyperlaxity, muscular and proprioceptive deficiencies likely to promote ankle sprains.

FOOT PAIN

The main pathologies related to foot pain are the following :

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.).

By means of podiatric analysis, the orthokinesic assessment is suitable for detecting joint deformations of the foot.

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.

Through its podiatric analysis, the orthokinesic assessment is suitable for detecting joint deformations of the foot.

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.

Through its podiatric analysis, the orthokinesic assessment is suitable for detecting instability of the foot.

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.

What is hypermobility? Hypermobility is every movement that occurs in a joint in response to the forces that interact on the joint when it should be stable under such forces.

The hypereversion 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 everted 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 bone 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.

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

The orthokinesic assessment is suitable for detecting factors that cause metatarsalgia by means of its podiatric and postural analyses.

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.

Morton's disease is related to hypereversion. The metatarsals move during eversion of the foot, diminishing the intermetatarsal space and causing pinching of the neurovascular bundle located just below and outside the metatarsal heads. In addition, eversion of the foot during propulsion causes hypermobility of the metatarsals which slip excessively under the weight of the body, while the soft tissues are unable to follow the movement of the metatarsals. The slipping metatarsals shear on the plantar soft tissues, traumatizing and fibrosing them over time.

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.

What is hypermobility? Hypermobility is every movement that occurs in a joint in response to the forces that interact on the joint when it should be stable under such forces.

The hypereversion 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 everted 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 bone 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 orthokinesic assessment is suitable for detecting the factors that cause hallux valgus by means 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).

Through its podiatric and postural analyses, the orthokinesic assessment is suitable for detecting factors that cause claw toes.

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.

These tendinopathies can be divided into :
- corporal tendinopathies,
- peritendinitis or tenosynovitis,
- low tendinopathies.

Corporal tendinopathies : these are degenerative tendinopathies caused by micro ruptures of the tendon fibres, due to repeated traumas. This tendinopathy is very frequent in sportsmen, particularly in long-distance runners over thirty years of age. It appears in the vast majority of cases in the less well vascularised area of the tendon, about 4 cm above the calcaneal insertion.

Peritendinitis : this is an inflammation with fibrin deposition from fibrinogen-rich fluid between the sheath and the tendon. There is a diffuse and painful swelling of the inflamed area, sometimes with crepitus.

Low tendinopathies : it will be necessary to look for an inflammatory origin (pelvispondylitis, Feissinger-Leroy-Reiter syndrome, rheumatoid arthritis or psoriatic arthritis) in these insertion tendinopathies, more than in other tendinopathies.

Achilles tendinopathies are often related to hyperpronation of the foot. Excessive pronation of the foot is accompanied by an internal rotation of the tibia which tends to pull the Achilles tendon inwards with a rapid whiplash. This can therefore lead to microscopic tears and inflammation of the tendon. Because eversion is accompanied by internal rotation of the tibia while knee extension is accompanied by external rotation of the tibia, a prolonged excessive eversion will favour the beginning of knee extension while the subastragalar joint is still in pronation. This torsion will cause a transfer of the Achilles tendon, and will cause vascular damage, leading at the end to degenerative changes.

Tendinopathy can also be related to a postural disorder, poorly adapted shoes, a tonic muscular and proprioceptive imbalance etc. In order to detect the various origins of Achilles tendinopathies, it is advisable to carry out an orthokinesic assessment.

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.

Through its podiatric analysis, the orthokinesic assessment is suitable for detecting the factors that cause osteochondritis.

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.

Through its podiatric analysis, the orthokinesic assessment is suitable for detecting factors that cause tendinopathies of the posterior tibial.

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.

Through its podiatric analysis, the orthokinesic assessment is suitable for detecting the factors which cause tendinopathies of plantar aponeurosis.

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).

Through its podiatric analysis, the orthokinesic assessment is suitable for detecting the factors that cause Lenoir’s spur.

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.

Through its podiatric analysis, the orthokinesic assessment is suitable for detecting the factors that cause stress fractures.

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 orthokinetic assessment allows to analyse the level of joint damage (stiffness) and to visualise the body compensation related to algoneurodystrophy.

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.