And let's do this thing.
David, Amanda, welcome to the podcast.
Thank you for having us.
Thank you.
Excited.
So you will be presenting in
Orlando at the AOMT conference.
So this is the prequel.
This is the teaser.
This is the movie trailer of
what will be coming up when
we get together in Florida.
So my first hard-hitting question is,
will you be presenting in
Mickey Mouse ears?
Are you going to be hitting Disney?
That's the question everybody asks.
Are you going to be hitting
Disney beforehand?
Amanda's already nodding.
Of course.
Yes.
Or at least a Disney costume,
maybe of some sort.
Maybe not Mickey ears, but Disney costume.
A little flavor.
Yeah.
I'm expecting that.
I do not have the ears,
but I will be wearing the slippers.
That's all I'm looking for.
All right.
Let's get down to business.
What are you presenting on?
What do people get to learn
from you when you'll be
together on stage at the AM
conference this October?
Yeah,
so we're actually continuing off of a
series of presentations
that we've given at prior AM conferences.
You know, we've done the shank,
if you will,
and the tibialis posteriors
roll on the hind foot, mid foot last year,
talking a little bit more
specific of hind foot and
transverse tarsal joint.
And then based on feedback,
we're continuing down the
mid foot to the medial and
lateral columns.
So it's a sequel is what you're saying,
which just fits with the
Universal Studios and the
whole Florida mindset.
That's great.
All right.
So let's dig into some
specifics now that we
understand where in the
body we're located.
Can you explain the
importance of the
interdependent relationship
of motion among all the
segments of the foot and ankle?
We'll say in functional
weight bearing because
that's where we hope people
are a lot of the time.
yeah um that's a loaded
question yeah right to
start off with but uh yeah so
The interdependent relationship, I think,
is best summarized in, you know,
the concept that we as
physical therapists
probably all know is the
windlass mechanism.
You know, great toe MTP extension,
raising up the arch.
Yes, it's by way of plantar fascia,
hindfoot supination.
But I think the outcome of
that is perhaps even more important.
And that puts the actual
gastrocnemius and soleus on
its best length tension
relationship to produce
force to actually propel us forward.
Adding to that,
I think knowing that the
foot is a load-sharing system,
So it's considered the
longitudinal arch load sharing system.
You know,
obviously just everything is related.
And you have to have that
internal rotation of the
shank to have that proper
supination pronation of the
hind foot and the
subsequent elevation and
depression of the midfoot
for our function and weight bearing.
The biggest factor to that
is really just what is the
ground reaction forces
doing and what can the
muscles actually produce
for force against that.
I mean,
it seemed like he handled the
knuckleball pretty well
right off the bat.
Okay.
Moving on then, next pitch would be,
there's a lot of segments in the foot.
It might seem simple,
but there's a lot of different parts,
right?
How do the different
segments contribute to the
overall function of the foot?
If someone were to ask you that,
let's say a new graduate PT,
now they understand the basics,
now they're moving on to a
little more advanced concepts.
How do those segments or how
would you explain those
segments contributing to
the overall function of that foot?
Yeah, great question.
First question is how many?
There's 10.
If you really dive into the
biomechanical descriptions,
there's 10 segments of the
actual hind foot, mid foot, forefoot,
even then the toes included to it.
And yeah,
they all are working interdependently.
I think what's perhaps even
more important than just
that is understanding all
of the muscles that
actually contribute to it.
I mean, we're talking 19 intrinsic,
12 extrinsic muscles.
Um,
and we're trying to have a good
understanding of how are
each of those muscles
controlling those segments.
All in a very small space as well.
Very much.
That's a lot to it.
How about this one?
Who wants to answer this?
What role does the extrinsic musculature,
you mentioned that a second,
play in controlling the
combined motion of the foot?
That feels like a good continuation.
We'll say foot and ankle
because that also comes into play.
Mm-hmm.
So as far as that, yeah, I'll keep going.
The extrinsics, you know,
that's part of my area of
particular interest and
what I'm trying to do a
little bit of investigation
on more specifically.
But there is recent
literature that's
indicating that the
extrinsic musculature
actually supports the quote
unquote heart arch height.
I argue that it's actually
arch mobility more so than
the actual intrinsic musculature.
So having very good, you know, activation,
strength,
endurance of those muscles is just vital.
All right.
So we mentioned key kinetic
principles a second ago,
and I want to continue to play off this.
Help us understand some of
those key kinetic
principles relevant to that
foot and ankle segments
that we just mentioned.
Yeah, kinetic as far as the motion goes,
you know,
you can't have the proper
pronation supination of
anywhere within the foot
without having the
appropriate motion at the shank, right,
internal, external.
I think a good summary of the kinetics,
the motion is, you know,
for the students that are listening in.
When we do our basic
odiometry of plantar flexion,
dorsiflexion of the ankle,
we know that there's a
total range of approximately 70 degrees.
However, in fact,
there's really only about
45 to 47 degrees of that 70
that is really happening at
the talocrule.
The rest of it is actually
occurring minimally at subtalar joint,
but the majority is
actually talonavicular and
some also at calcaneocuboid as well.
You could include the
forefoot transverse
metatarsal joint in there as well.
Point being,
there's approximately 35% to
37% of our plantar flexion, dorsiflexion,
that is not at the talocruel that we,
as entry level,
are taking our measurements at.
Understood.
And I'm glad that was not on
the MPTE because that would be right.
All right,
let's get down to what I like
about conferences when they
go into in terms of labs
and techniques and hands on
and observations.
Talk about some of those
specific techniques or
approaches that will be
covered in the lab
presentations to help
enhance that clinical practice.
But I think just as what David described,
we really go into taking
that detail we talk about
in how joints move and why
it's important to look at
multiple areas and break
that down into the lab
technique and look at very
specific techniques that
feel both quantity and
quality of movement.
And the way we've organized
the lab sessions is there's
time for active feedback from myself,
David, Catherine Patla,
who's our other colleague
who's presenting with us,
Because I think a lot of
individuals move too fast
and too quick through end
range and actually feel
things are stiff when in
actuality they're not
because they've blown
through the end range and
don't get to appreciate how
the motion actually is.
So we take that time to go
back and forth and actually
feel the motion together
and provide feedback.
And last time we were
fortunate to have someone
who had a problem in our
session and we could do an assessment,
treat,
reassess and see tremendous
improvements
instantaneously with what we were doing.
So we're hoping we can be
lucky again this time too.
How was that?
Treating in front of your colleagues,
like no pressure there, right?
Yeah.
Easy peasy.
Yeah.
So that's actually what
inspired this year's
discussion is that there
was so much feedback
requests that we could
actually dive in further
into our treatment
approaches due to the
success that we had seen in our session.
That's great.
And how, I mean,
how is it presenting with Dr. Patla?
I mean, no pressure there as well.
We're talking about pressure situations.
That can be kind of fun if
you're on your team, right?
Yeah, no, it's awesome.
I think because we've both
gone through the fellowship
with Catherine for so many
years and our colleagues,
it's awesome to be on the stage with her.
It's got to be great.
All right.
So let's talk about biases.
I feel like that's a word
that I don't know that I
used it a ton before the last three,
five years.
What are some of the common
biases clinicians might
have in assessing foot and
ankle function?
We sort of alluded to one a second ago.
And how can self-appraisal
help identify these?
Because we got to identify
it before we can fix it or solve it.
You got to know it's there.
Yeah.
And you first have to admit
that there even is a potential bias.
Right.
And then you kind of walk
through those steps.
And so I think part of it is
going back to one of our
principles in that you must
have normal joint function
to have effective muscle
function as well.
And so we really take.
Say that again.
One more time.
You must have effective joint mobility,
quantity,
quality in order to have proper
muscle function.
Okay, good.
Okay.
And so going, starting at that principle,
we recognize the importance
of looking at individual
joint motion at the foot
and ankle versus just gross
osteokinematic assessment.
I think that's the first
bias that when people look at a foot,
they,
it's this nebulous and it's too
complicated.
There are too many joints
and it becomes sloppy in
the assessment and the treatment.
And then they get frustrated
that no one's getting better.
And so you have to break it down and go,
okay,
what do I know and what don't I know
and how can I get better at that?
And the foot is one of those
areas that I think can be
particularly tricky if you
don't understand the
biomechanics well enough.
All right,
so you'll be providing an opportunity,
and that's sort of what an
AOPT conference has,
which is there's a lot of hands-on.
If there wasn't,
it would feel a little weird.
But what's the best way you
might suggest for
clinicians to apply the
hands-on practice from your presentation,
from a conference, when they get home,
the neck, you know,
we call it Monday morning applicable.
Is there a suggestion like, hey,
we want some carryover.
We want to have the magic in the room,
but then we want to be able
to apply these things.
We want to make them applicable.
What would you suggest?
Yeah, I think ideally in the session,
being able to go back and
forth with one of us, like I feel,
you feel, I feel, you feel.
And we compare right then
and there and then doing it
a couple of times.
Right.
This is a skill that you
need to be using right away.
But also what I like to do
clinically is I do a
functional assessment.
Then I look at my osteokinematic,
look at my joint mobility, treat,
and go back and look at my
function right away.
So you know right then and
there if something is working or not.
And so I think that's a
piece that people could take away.
Day one is using that
functional assessment,
going and looking at the joint mobility,
treat if there's a restriction,
and go back and reassess.
And if not, go back again and look again.
So doing that continual assess, treat,
reassess is a piece that I
think is so critical.
Do you want to add something, David?
Yeah.
And speaking clinically, I would say,
you know,
they have to just jump in to
learn how to swim.
Right.
If you don't get into the water,
you're never going to learn.
So when it comes to the clinical approach,
they have to just start investigating.
They have to start putting
their hands on and they
have to feel many different emotions.
feet types.
Going back to the bias,
I think one bias is
presuming that arch height
is related to risk of injury,
but that's inconclusive in
the literature.
Mobility is arguably more
important and they have to
get their hands on
different feets because
there's different types of
mobility for different
sizes of feet related to
different amounts of ground
reaction force for specific
demands of functional activity in sport.
So you just got to start touching,
touching, touching in my opinion.
I now know what the promo
will be for the episode.
It'll be touch as many feet
as possible from day one.
Yes, yes, yes.
And shoes off immediately
when you first come in the room.
That'll air the puppies out a little bit.
But also, too, when we think about,
I think especially at an AOMT level,
we feel confident in our
manual therapy skills,
in our hands-on skills,
our manipulation skills.
But taking...
time in the clinic to work
with your to get feedback
on your techniques and
maybe spending a lunchtime
on a friday hey let's run
through some techniques and
let's see if it feel the
same as that I did at the
conference that we had or
let me show you some cool
techniques let's talk
through what we're doing
but taking time to hone
your craft outside of the
time with the patient
that's smart all right so
I'm gonna I'm gonna make
you pick only one
What is each of your one key
takeaway for clinicians
that they'll be able to
walk away from after your presentation?
So this is, again,
the teaser before the
teaser regarding your topic.
What do you got, Amanda?
What do you think people
will be able to walk away
with and be armed with?
Is that pun intended?
I'm literally trying to
think of a foot pun and I
couldn't before it came out of my mouth.
Yeah, you got it.
I think being more confident
in their ability to assess
specific joint motion.
I think that's one thing we
started last time,
and we're going to be able
to capitalize more on that this time.
All right, David, same question.
Yeah, I would say two things.
I would say try to remain as
objective as possible.
And then number two is to ask for help,
right?
Seek, you know,
reaffirmation from your
colleagues like Amanda had highlighted.
And I think that also speaks
to the self-appraisal component too.
Perfect.
Looking forward to,
I think October is a good
time to head south.
It's not too shabby to go to Orlando.
So this is the prelude to
one of many presentations
going on at the AOMT
conference this October.
For more information about the event,
check out aomt.org.
David, Amanda, looking forward to it.
Thanks for the time sharing
what you'll be presenting on this year.
Thank you, Jimmy.