Heel Spur
Basically, you can see on that radiograph, the heel spur. 

Chondromalacia Patella
Clark's test is the crepitus, Waldron's, Chondromalacia Patella, which is the cracking.  You know, you do the patellar scraping – there's a procedure for that.  Also, you're going to see a lot of weakness or a lot of pain in the back of the leg, which is the bicep femorus, it's on the left lateral aspect. 

Tibial Torsion
Because the tibia…, what happens is when the patient puts their foot down, the collapse of the foot causes the tibia to twork. And in an internal rotation.  And it happens very quickly.  It happens in 8/100th's of a second. Twenty degrees of tibial tortion in that short of time.  That's a tremendous amount of stress for those small muscles to overcome.  So as a result, they become damaged. 

Hip Objective Findings
We went over hip muscle testing.  These are the muscles hwere they're located. All you have to do is press on them, deeply and you'll find the weakness.  The positive Trendellenburg Test and getting up from a seating position.  Also, Patrick forbaresess test – or figure 4 – you put the patient in a figure 4 position, like this, press down.  They're going to feel some pain.  Usually right around this area of the hip. 

Hip Training Exercises
Now, we're going to talk about training tips for the hip area. This is the four way hip machine.  they have them in our office.  Patients like seeing those.  We have a workout machine in our office.  it's the most unused equipment in the gym, and it's the most important piece of equipment in the gym.  Encourage your patients to use it. 

Lower Back Objective Findings
Positive Hibs and positive Elys which is a test for the hyper lordosis of the lower back.  Bilaterals and unilaterals sacriliac fixation of the bones are stuck.  As a result of those bones not moving, there is no longer a good diffusion of nutrients into the cartillaganus tissue.  Simple fusion is the way in which the joints get their movement.  And if there's no movemtn in that area, you're going to have degenerative disc disease.

Foot Examination
This is the Mid Tarsal Joint Axis and that axis as well as the oblique axis are the two Axis that we have to look at when we look at the foot rotation.  This is where all the action occurs.  It will becoming important shortly.  The Mid Tarsal Joint Axis and the Longitudal Joint Axis – you don't have to look at this.  If you want to look into this some more, you can look at the paperwork we provided, or else on the website. This is very important, the midtarsal pronation is limited when the cuboid comes in contact with the calcaneus.  The foot will not grow if the calcaneus is stabilized.  That's the principal of our treatment.  By stabilizing the foot or the heel with a good strong leather counter, you're not going to get the pronation.  If the calcaneus is not in a valvus position, then the entire complex will not collapse.  The cuboid will stop the whole process from occurring, and that's what's helpful for you.

Patients with Multiple Complaints
(Recomend Supportive Footwear)
If you are a doctor, an orthopedic surgeon, or a family practitioner, and if you have a patient who comes in with these multiple complaints, you can do something for them.  Monday, get them in a good pair of shoes.  The first thing you do is look down at their shoes to see what's happening here.  This is a shoe that I recommended for a boxer who comes to our office.  The shoe has a very good counter, as you can see.  It has a triple layer and a good quality shoe.  I went to the shoe store and they told me, “Look, if you want we can put a stabilizer on the inside of the shoe, I don't think that's good.  I totally disagree with that.  That's like saying that if you have a gutter in a bowling alley, your ball will end up there.  That's not true. Basically if there's a stabilizer on the medial aspect of the foot, it will not allow the foot to turn to pronator.  It will keep it from pronating.

Nonsupportive Footwear
We're looking at shoes with simple pronation. Here it is.  I stood outside the shopping mall for 5 minutes and took pictures of people's shoes.  Look at those shoes.  I wouldn't even allow a patient to walk out of my clinic with those shoes.  First of all, I'd remove them, and if there was no snow on the ground, I'd tell them to go home in their stocking feet.  Those shoes are typical of a nurse.  Nurses wear those shoes and you wonder why they're so tired and crabby.  Look at those – terrible.  They have the metal runs.  I don't know what they're called.  The laces go into them.  Look at how weakly tied those are.  That's typical of young people now.  They're all tired from these shoes.  You wonder why their homework isn't done.  You know, my 7 year old daughter has good shoes well tied.

Footwear Construction
Okay, here's another example of the metal runs.  They're not good because it's slippery and the shoes become untied and they can fall.  Here's another example, very sad.

This one – look at this guy; they're terrible.  That's another thing, if you're going to tell your patient to go out and buy construction shoe, tell them to buy some with good strong leather and tell them to buy two pairs.  One pair is going to go on the shelf on Monday and is going to be worn on Tuesday.  Because if you wear them too often, the perspiration gets in there and ruins the leather.  The same thing with you, doctors.  If you're going to buy a pair of shoes, get out your credit card and buy 2 pairs.  Because you're going to wear one pair and let the other sit on the shelf and dry out. 

Footwear Stores
You know, the same principle holds true in sports.  When you wrap or tape an ankle, it's only good for a half hour.  Because the abrasion breaks down material.  The same thing is true for calcaneous.  The key to our treatment program is simple.  Maintain the calcaneous in the neutral position is one of the key treatments to our program.  Make sure they have a motion control shoe.  And if you prescribe or make a recommendation that  they go to the store to get motion control shoe.  If you're dealing with a decent shoe store, they ought to know what you're talking about.  If you're not, then you need to find a different shoe store.  I have a good relationship with my shoe stores.  I know where to send my patients.  And if I have some patients that are really suffering, I say, look, you only can buy these shoes.  And I'll tell you, if they don't do it after about the 5th or 6th visit, I'm going to say, “You know what? I don't think you're really serious about getting well and I think maybe you should come back when you're more serious about this.  Because, look I'm doing all this work here, I'm working here, you're supposed to do your part and if you just don't feel like complying with the instructions, then come back at another time. 

Footwear Compliance is everything
You doctors that are seeing these patients once and are recommending these shoes, I don't know.  It takes me 3 or 4 visits before I hammer home that importance of the shoes.  It gets to the point that they get aggravated and I get aggravated and they just do it to because they don't want to hear me anymore.  They're sick and tired of hearing me. We had a patient that came into our office and I said, the reason that you have this problem – he could hardly walk –  is because of your shoes.  He said, you know what, I don't believe it.  And he went out and ordered the shoes, and about 2 or 3 visits later he felt great.  It was a Friday afternoon, and he said I'll see you on Monday.  On Monday he came in and said, “Doctor, I'm right back where I started.  This is not working.  Discontinue all my appointments and cancel everything, but I'm getting the shoes.”  I said, “Alright, get the shoes, put them on and let me know how it works out.”  He came back about a week later, and I said, “How are you ding?” he said, “I'm doing great. I'm much better.”  I said, how come, Larry?” because of the shoes.  Okay, let's get started, get him in the back and let's get his therapy started.

These are the ligaments that are affected when the bones start to shift and that's what happens to the ligaments, the bones start to stretch and the ligaments start to subluxate.  Subluxation is one of our fabulous terms we use in chiropractics.  It's not quite a fracture, but it's a bone that's out of alignment.  Does it hurt?  You bet it does.  You saw an example of it right there.  Larry was in pain.  So what we have to do as doctors is we have to manipulate the foot.

Foot Manipulation
What we have to do as doctors is we have to manipulate the bone to the foot. Does it make a cracking noise? Of course they do. They crack. Sometimes you can't get the bone to move in 3 or 4 visits.  You work on the muscles of the foot, and then finally they'll let go. And then the movement will occur.  See, if the bones don't move, you don't have proper biomechanics. If these ligaments are damaged or stressed, they will not assist in eliminating pronation, or else they may cause pronation.  If we eliminate the bones and work on the intrinsic muscles of the feet with a technique called neuromuscular re-education. There are a million names for it.  

Tonic Protective Spasms
Basically, what I'm talking about is a patient comes in with atonic protective reflex where the muscles are weak.  They're here.  This is normal, and this is strengthening.  So the first thing I have to do is move all the atonic protective reflexes.  So what I do- I'll give you an example.  Larry, lay on your back.  It's very simple; it's time consuming, but it's simple.  I'll take my thumb and put it here.  Now what's going to happen is that Larry is going to think ‘wow is this ever going to go away?'. 

Dr Stoxen:    Is that what you're saying? Yeah, on a scale of 1-10, what is it?  Ten?  There's that sign again.  Don't see the smoke yet, but it's getting there.

Larry (patient) :   it hurts

Dr Stoxen:    Now how is it feeling now?

Larry (patient) :   it's going away.

Dr Stoxen:    Ooh, really?  How about that? On a scale of 1-10, what is it?

Larry (patient) :   down to a 5.

Dr Stoxen:    Its down to a 5.  it started at 10, and now we're down to a 5. we're not doing anything here, just standing here.  Maybe I'll stretch my calf a little bit.  What's ging on?

What's it down to now?

Larry (patient) :   2.

Dr Stoxen:    2. 

Larry (patient) :   it doesn't hurt.

Dr Stoxen:    Okay, that's all we're doing there.  Thank you, Larry. Basically what we're doing here is just putting pressure on the muscle and that's all I did.  It could be any muscle, it could be on the shoulder, it could be on the knee, or it could be on the thigh, or the intrinsic muscles of the foot.  And what happens is that on about the 5th or 6th visit, he says, ‘hey, it doesn't hurt there, it doesn't hurt anymore.  What happens is in all the areas where it used to hurt, it doesn't hurt anymore.  all of a sudden, the patient will say, my energy is starting to come back.  When I used to come home, I was tired, now my energy is starting to come back.  You know why? Because he doesn't have spasms draining his energy, tiring him out. 

Dr Stoxen:    So, the first phase is just getting rid of all that atonic protective muscle spasms.  You know you can't put a patient on exercise or rehab training when muscles are pulling bones in the wrong direction, because what you're going to get is a simple thing.  If you have a machine, a printing press, it goes like this, and now it goes like that, it's going to wear out faster.  That's the principle behind arthritis.  It's as simple as that.  The patient asks how do you get arthritis?  Well, the bones aren't aligned. They're not moving the way they were designed to move. 

Medications dont help Conditions Related to Abnormal Biomechanics
So we remove the stress. Does that happen with medication? Absolutely not.  Doctors, if you're giving your patients for these types of problems, you're making a big mistake. You're only prolonging this problem.  That is not going to solve the patient's problem.  The patients come to you for advice.  They need advice – proper advice to fix the mechanics.  Doctor, why does my back hurt? I'll give you some medication to help.  Don't do that.  I mean, if you care about your patients, find someone in your area that can fix their biomechanics.  Give them a pair of shoes.  If anything, just do that.