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Ascending Foot Cranial Model  - links abnormal foot motion to facial and/or cranial imbalances as follows:

  • (1) If the foot has a structurally elevated first metatarsal (e.g., Rothbarts Foot), gravity in combination with the body's weight forces the foot to move forward, inward and downward (e.g., gravity driven pronation) until the first metatarsal rests on the ground (Rothbart and Esterbrook, 1988).
  • (2) This gravity driven pronation can unlevel the innominates (e.g.,tilt or drive the innominates into anterior rotation) (Rothbart and Esterbrook, 1988; Rothbart, 2006; Khamis and Yizhar, 2007; Pinto, Souza et al, 2008))
  • (3) Anterior rotation of the innominates can drive the temporal bones into posterior (external) rotation.** This rotation changes the Vhf *(Rothbart, 2008)

Vhf - distance between the outer orbit of the eye and the ipsilateral outer margin of the lip.  An asymmetry >3mm is clinically significant.

Standing “neutral” position of the pelvis is that position where both the posterior superior and anterior superior iliac spines sit on the horizontal plane (Kendall, 1983).


 Kendall F, McCreary E. Muscles: testing and function. 3rd ed. Baltimore (Md): Williams & Wilkins; 1983.

 Rothbart BA, Esterbrook L, 1988. Excessive Pronation: A Major Biomechanical Determinant in the Development of Chondromalacia and Pelvic Lists. Journal Manipulative Physiologic Therapeutics 11(5): 373-379.

 Rothbart BA 2006. Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation. Journal American Podiatric Medical Association;96(6):499-507

 Rothbart BA 2008. Vertical Facial Dimensions Linked to Abnormal Foot Motion. Journal American Podiatric Medical Association, 98(3):01-08, May.

 Khamis S, Yizhar Z 2007. Effect of feet hyperpronation on pelvic alignment in a standing position. Gait and Posture, Vol 25(1):127-134.

 Pinto ZA, Souza TR, Trede RG, Kirkwood RN, et al, 2008.  Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position.  Manual Therapy, Vol 13(6):513-519.

 Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, Hirayama H, Kawasaki T, Yokoyama A, 2007. Examination of the relationship between mandibular position and body posture. Cranio, Vol 25(4):237-49

Pure Ascending Postural Distortion Pattern

Pure Ascending Postural Distortional Pattern