PREVIOUS CONSIDERATIONS:

The skeleton gets deformed, according to some experts, because of age. But other experts allege incorrect posture habits. Although there are a number of different opinions regarding the motives, these opinions are worthless if we are not able to know the motive of the deformity, the derived pathology and, most importantly, correcting it.

For developins this subject we will analyse and compare the 2 figures (fig. 1 and 2). The firts one is symmetric. It’s the model of a system in equilibrium. We observe that the horizontal lines that are situated on the shoulders, pelvis and on the surface plan are parallel amongst themselves. The vertebral column emerges erect, perpendicular to the pelvis and divides the body into two symmetric hemitoras. The spaces on the sides of the vertebral column are equidistant. These spaces are occupied by the muscles of the own zone along the vertebral column. They are muscles with equal shapes and strength. They constitue what is know in physics as equal strengths in intensity and in the opposite sense. The result is zero and it results an equilibrium between both strengths. The angle pelvis-femur of one side is equal to the angle of the other side. The result is the same between the angle of the scapular waist and the humerus.

Figure 2 is asymmetric because the lines which are situated on the shoulders, pelvis and on the surface plan are not parallel. The vertebral column does not emerge erct and perpendicular to the pelvis. The body is not divided into two symmetric hemispheres. The spaces on the sides of the vertebral column are not equidistant and the muscles that occupy these spaces have lost the equality of the streghts which achieve the perpendicularity. They are a pair of muscles but they are not equal in shape and strenghts. They form a system in desequilibrium. The angle pelvis-femur of one side is not equal to the angle of the other side. The result is the same between the angle of the scapular waist and the humerus.

If we compare the two figures, we can appreciate that on the first one the distance between the line of the surface and the pelvis line is the same on both sides of the body. On the second figure, the distance is greater on one side of the body.

With a superficial observation of this asymmetric structure we might suppose that if the distance between the surpafe line and the pelvis line is smaller on one side of the body, this is because one leg is shorter than the other one. We have to think about this question accurately.

Legs and feet exercise different functions: legs are two rigid extremities with a sustainer function with only flexion poin –the knees- and that we measure with lengh units. Feet are not rigid extrems with a great articulation capability and due to the high number of flexion points, the have an elastic arch. As feet are elastic (as a spring) we cannot measure them with lengths units. We have to measure them with stregth units –newtons or kilopondios. Measuring legs and feet with utis of the same kind may induce us to wrong appreciations and to consider one leg and feet with units of the same kind may induce us to wrong appreciations and to consider one leg shorter than the other one when it’s not true. Let´s go back to figure nº 2: the minor length of the segment (a) regarding the segment (b) will be due to the major downfall of the plantar arch (c) which presents less resistance than the plantar arch (d). We can verify this measurement –in newtons or kilopondios, never in cm’s –the arch’s resistances. So we can understand the virtual shortness of the leg. This virtual measure of the leg, not real, leads to place a filling on the shoes with the conviction of correcting a real magnitude. But this is an apparent magnitude. With this action we deform the skeleton because we are not aware of the cause which is flattening due to the lesser resistance of support of the plantar arch.

The deformity that shows the second figure regarding to the first one is due to the incidence that the gravity stregth has in the skeleton when it shows an alteration of the statics. These two factors, gravity and the alteration of the statics, are responsible for the skeletal deformity 1. Now we will see the reason.

PROCESS:

The arch is made up of several arches and elastic supporting poins whose magnitudes –length, strength and mass- and parameters must be constant to maintain itself in equilibrium. We describe a parameter as the constant and immutable line that enters in the equation of a curve and especially in the equation of a parabola.

The difference of the gradient planes between both plantar arches will suppose an alteration of the statics. The body will lose its equilibrious state under the action of the applied strengths. The difference between the strength of the 2 plantar arches causes a difference between their gradients planes that makes the arch of minor supporting resistance descend and pull the leg. The leg, at the same time, makes the pelvis descend. This descend lateralizes the vertebral column. The lateralized structure gives more surface to gravity and receives a bigger strength that eludes with 1 or 2 scoliotic curves of gravity compensation. The scoliotic curves compensate the pressure increase thet the body receives but, at the same time, the damage it. Depending on the importance of the curve or scoliotic curves, the damage will be more or less important, but there will always be a diseasedness because the vertebral bodies traumatise themselves due to their position.

SOME CONSEQUENCES OF THE SKELETAL DEFORMATION:

The number of afflictions affecting the skeleton is quite large. Although there are a lot of pathologies that result from statics alteration, multiple pathologies are also due to the equilibrium of the pelvis as the scoliotic curves or the scapular desequilibrium. Some of them are frequently seen in the clinic and they are related to the alteration of the statics of the body.

1. As we have seen, before talking about the different sustainer resistances between both plantar arches, we should comment that a leg and the hip descend, depending on the arch of minor sustainer resistance. It results an oblique position (fig. 3).

The pelvic obliquity creates serious alterations on the hip and on the vertebral column that reach, not only the pelvic skeleton and the femurs, but also affects by compression the harmony and tone of the functionality of the neuromuscular and sanguine system on which return circulation depends. Depending on the aperture grade of the angle (pelvis/femur), the difference between angles of one and other side of the body, will make a "contention barrier" which will difficult the circulation of return blood (we should keep in mind its relation with the tromboangitis obliterante or Buerger disease)(2). This results in a logical softening of the veins which may provoke a new pathology above all for those people who stand for long periods of time.



2. Within the pathologies provoked by the desequilibrium of the pelvis there is a very

common disease: the coxofemoral osteocondritis. The disease is a necrosis of the superior epifisaric nucleus of the femur of slow initiation that remind us of the first phases of the tuverculosis coxitis. With a radiological exam we can confirm this diagnosis when we see some spots on the epiphysis of the long bones, of isquemic ethiology by compression. If this compression persists, the spots become darker by osseous rarefaction due to condensation.

The femur head is in the cotiloideic cavity. This cavity presents a rim on the superior area. When the hip is inclined the rim exerts pressure on the femur head. This pressure is, in fact, an isquemia that hurts and inflames the cotilodeic cavity. It appears in a unilateral way and sometimes it appears after a long time. There are different opinions 3 about the origin of this disease. There are authors that think its origin is congenital, microbial or posttraumatic. Others relate it with alterations of tiroideic and hipophisiaric hormonal origin. Others with ricketysm.

In children the disease (of Waldenströen, Calvé, Legg and Perthes) appears with some molestations on the hip which make them limp whithout feeling pain. Pain appears later on the hip and leg area. Sometimes it appears a hypotrophic reduction of the thigh (due to the lack of activity) and some rigidy of the hip articulation. The epiphisiaric nucleus and the yuxtaepiphisiaric cartilages are affected and the latter help ensure regular development and grown of the long bones. As no cause (4) is known which justifies the molestations or the pains, the disease has received names as peculiar as "growth pain".

When this pathology is due to physicestructural desequilibriums, the disease disappears in a period of 3-13 months.

3. If the pelvic situation compromises the nervous fibres of the motor neurones by a mechanical aggression, direct traumatism, stretching or compression, the message may be interrupted presenting an unequal gravity. In the first phase it may appear as the decrease of the muscular motor function (paresia) gereally on the legs. If the compression, traumatism or streching are maintained, in the second phase the sensitive alteration predominates, followed by nervous systems injury (parestesia) with the appearance of radicular pain. In the case of a previous existing neurological injury due to pelvic laterality, cramps are constant as happens in the case of ciatalgia.

6. Finally, the relation between the deformation of the skeleton and some pathologies which affect the brachial cervical plexus is frequent. When the angle formed by the scapular waist and the humerus of one side is not equal to the other side, it generates a cervical scoliosis which produces traumatisms of mechanical action and compression nature, streching and rachis torsion. Stretching happens on the escalen muscles, angular omoplate and major serrato. It’s favoured by the cervical scoleotic curve which makes the shoulder descend at the same time that the rachis turns round with the body, inclining the scapula until winged position with deformation of the thoracic box. Ribs go to the bottom of the corresponding thoracic area and and plexus roots and the peripheric nerves get injured. (fig. 4).

   

   The interruption of the major serrato produces paralyses of the omoplate. The interruption of the circumflex nervous produces paralysis and deltoide atrophy and anaesthesia of the stump of the shoulder. The interruption of the muscledermical nerve can also be produced by direct traumatical injures. Also, the radial, medium, cubital and other nerves are susceptible to being injured by the mechanical action which the deformation of the skeleton has on them. The brachial plexus stretching on the costocalenical area presents important neurological sign: parestesias, hipostesias on the D1 area and sometimes motor deficiencies an amiotrofia. Some vascular disorders such as Raynaud syndrome 6 can be associated with these neurological sign.

   
   

    

   A MEDICAL-ETHIOLOGICAL PATHOGENICAL THERAPY:

   We have seen, in summary, diverse pathologies which respond to a common cause: static alteration.

   The treatment of static alteration must take into account different aspects:

   First of all, it’s necessary to correct the equilibrium with orthopedics on the feet (first sole). The orthopedic solution must give back to the feet the condition of an arch in equilibrium. So there must be reflected on the arch all the measures that the foot and the funtion which corresponds to each one of its parts. Muscular tonification, retractions, muscular spasms, stiffness in the articular system must also be treated with controlled exercices.

   Another important point that, although it may not seem relevant, according to some authors (7) is proper footware: people must try wearing shoes as wide and large as their foot, well tied up and on a horizontal position regarding the floor. We cannot forget the skeletal equilibrium when it is in a resting position. Beds must offer some conditions: rigid and hard bed, adaptable mattres made with natural and elastic fibres of 15-25 cm depending on the weight of the person.

   
   

   CONCLUSION:

   The alteration of statics, this "anomaly" on the feet of 95% of the popularion, approximately, generates injures of different levels and they have received different explanations throughout the ages: somes of them as plain and peculiar as "growth pain". Others generate confusion, such as osteocondritis , Perthes, and so on. But the alteration of statics is responsible for meralgias, parestesias, gonalgias, lumbalgias accompanied by severe citalgias and important cervicalgias wich can even affect the vasculonervous system originating disatesias that, in some particular cases, can even develop phenomenons as Reynaud or brachial plexus syndrome or a Buerger disease or tromboangitis obliterante.

   As we know these injuries have several ethiological factors such as mechanical processes becasue they favour their progression for people with some specific characteristics. It is proved that when the equilibrium is restored, spectacular improvements appear.

   Thankfulness

   To Mr. Francesc Sureda. His comments and suggestions have enriched this article.

   Bibliography

    

   1. Maure F. Tratado de podología. Barcelona: JIMS. 1997; 3-19 Y 26.

   2. El manual Merks de diagnóstico y terapéutica. Nueva York: Harcourt Brace, 1992; 644-646.

   3. Segatore L. Diccionario médico. Madrid: Teide 1963; 943-944.

   4. Apley A.G. Ortopedia y tratamiento de fracturas. Barcelona: Salomón – Masson, 1996; 423-429.

   5. Cambier J et al. Manual de neurología. Barcelona: Toray – Masson, 1981; 190-192.

   6. El manual Merk de diagnóstico y terapéutica. Nueva York: Harcourt Brace, 1992; 646-648.

   7. El manual Merk de diagnóstico y terapéutica. Nueva York: Harcourt Brace, 1992; 644-646.