Pronator/Supinator Cuff
Now here are the calf muscles right here.  What we're talking about here is if those muscles supinator cuff does not work, the arch collapses.  The load is taken up by the calf.  Here's an example of that.  I named that the Pronator/supinator cuff.  It's not in any literature.  Flexor Hallucis Longus is how strong the flexor of the ankle joints is.  Weak, sub Talar Joint Supinator.  If it's a supinator, then it resists.  You have to be patient and you have to work on it. 

Peroneus Longus
This is the Peroneus Longus.  This is very important because it stabilizes the first 3 digits of the foot.  Those 3 digits if not stabilized, what will happen, is it will collapse, and the patient kind of walks like this.  No calf contraction whatsoever.  Because the first three digits of their foot is no longer stabilized, they can't push off with their toes.  It's very important because the Windblass effect is no longer there. The arches cannot come together because we're not getting intrinsic muscle contraction of the foot.  The arches are further collapsing.  Flexor Digitorum Longus – that was the muscle that was screaming when I hit Larry's on the back of his calf.

Pronator/Supinator Cuff
We're talking about a supinator here. This is the extensor digitorum is on the front of the calf area.  And what do we do with that one? We stretch it.  Commonly, we're going to check this person's foot.  Lay on your back, Larry.  I'm going to check his foot and I'm going to bring his foot like this, and let me have it.  We have very little movement in his foot in this direction.  This is the area that we're looking at here.  If you or he does the stretching, in about 2 to 3 weeks, the movement will come back because the stretching is helping.  It won't take long if you treat it aggressively.  The patient wants to get well fast. 

Tibialis Anterior
Tibialis anterior is the strong supporter of the leg. Tibialis Anterior:  what I'm looking at the Tibialis Anterior, which located around the front of the calf area, I'm looking at the size of it, the thickness.  And I'm going to look at it for comparison of the thickness of the calf.  Because I don't want the patient to walk around like this.  I want him to walk around like this.

Anatomy of the Leg and Knee:

Frequency and Duration of Care
It takes about 10 office treatments on the legs.  As long as the patient has the shoes, to get this muscle contractions out.  We're going to go from here,  from weakness to normal.  And then we're going to build strength from there. 

Neuromuscular Reeducation
Okay, here's the external rotators of the hip socket area.  Which is observed in patients which walk with their feet rolling to the sides.  Because their ankles are weak and stiff.  Those are the intrinsic muscles of the feet that we have to work on.  All these slides are in your program.  There's a picture of me working on them.  That's me applying the nerve pressure therapy, or neuromuscular re-education. what it does, is it strengthens the arch support muscles of the foot and you don't need an arch support.  Because you have the counter support of the shoe.  And here you have a picture of the arch support where the shoe is laced across the top.  That's how the shoes are properly laced.  I suggest you take out the laces and place them from underneath because you can get the counters to come together a little bit better. 

Electrical Muscle Stimulation
So, we're going to use electrical muscle stimulation, we're going to use, deep tissue work and maybe some vibration to get that out of there.  The muscle spasms.  These are the muscles we're going to work on.  They're in your program.  The basic principles I've already discussed.  This is a picture of an Olympic athlete who boxed in the 1996 Olympic games.  He came to my office from a major institution, a large hospital in Chicago after his procedure was performed.  How did it happen? He stepped back in the rink in a bout, and his Achilles tendon snapped.  How does that happen? He's a world class boxer, 15-0, and he competed in the 1996 Olympics. 

Achilles Tendon Tear
How does this Achilles just completely snap?  It happened because the supportive muscles of the arch dumped all the load on the gastroc.  Now, did they address that in the rehab program? Absolutely not, they had him do some sort of calf raises, which did nothing for the supportive muscles of his calves because the calves do not support the arch.  I'm talking about the gastroc and solius.  We train the patient with his foot in the alignment in flexion and extension in alignment with the midtarsal axis.  There's the application of the muscle stimulation – very simple. 

Phase II is strength training. 
Phase II is strength training.  There's a stretching example.  Treatments and adjustments of the foot, and then there's the Windblass effect we talked aoubt.  Peroneous Longus we talked about, stabilization of the toes: 1st, 2nd and 3rd digit.  And Peroneus Training.  I train my patients with bands and also with weights.  I use weights because I want to see some strength by adding another notch to the plates.  Internal rotation; we have to do internal rotation aduction. Basically what we're looking as one is when we're looking at the patient he rotates not only the foot, but also the entire lower extremity.  Keep the lower extremity stabilized until you can rotate the foot.

I would like to thank the the American Academy of Anti-aging Medicine for the opportunity to give this educational presentation to the 4500 doctors and scientists in this audience.  I will be available to answer questions after the presentation.

Email Dr James Stoxen DC any of your questions:  Dr James Stoxen DC