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This paper discusses the impact abnormal foot motion can have on the cranial bones and occlusion.  Section I describes this foot-cranial-dental coupling. Section II describes the Ascending Foot Cranial Model. Section III describes an embryonic foot type that is frequently responsible for cranial imbalances and malocclusions. And Section IV describes a Proprioceptive Therapy using Proprioceptive Insoles that can reverse (in children) or stabilize (in adults) cranial imbalances and malocclusions.
本文讨论了异常足部运动对颅骨和咬合的影响。 第一节描述了这种足颅齿耦合。第二节介绍了上升足颅骨模型。第三节描述了一种胚胎足类型，这种类型经常导致颅骨失衡和咬合不正。第四部分介绍了一种使用感知鞋垫的感知疗法，这种疗法可以扭转（儿童）或稳定（成人）颅骨失衡和咬合不正。

Intuitively, we know that the body’s framework functions as a unit:  instability in one area of the body can reverberate throughout the entire body. This understanding underpins the concept that cranial imbalances and malocclusions can be the result of abnormal motion within the feet. While many scientists accept the plausibility of this correlation, little or no clinical research has been published that supports this foot-cranial-dental linkage until recently.
凭直觉，我们知道身体的框架是一个整体：身体某个部位的不稳定会影响到整个身体。这一认识支持了颅骨失衡和咬合不正可能是足部异常运动的结果这一概念。虽然许多科学家都认可这种关联的合理性，但直到最近，很少或根本没有临床研究支持这种足部-颅骨-牙齿之间的联系。

Over the past several years, I have collected clinical data that statistically suggests cranial imbalances and malocclusions are linked to abnormal foot motion.  These findings are presented below, and hopefully will prove useful in treating malocclusions and cranial imbalances.
在过去的几年里，我收集了一些临床数据，这些数据从统计学角度表明，颅骨失衡和咬合不正与足部运动异常有关。 下面将介绍这些研究结果，希望能对治疗咬合不正和颅骨失衡有所帮助。

Section I: Foot-Cranial-Dental Coupling
第一节：足-颅-齿耦合

One of my recent published statistical studies suggests that abnormal foot motion can result in facial distortions. Specifically, asymmetrical abnormal pronation, where the feet are rotated inward, forward and downward (See Fig. 1), can result in an asymmetrical loss of Vertical Facial dimension (VFd), the distance between the outer orbit of the eye (exocanthion) and outer margin of the ipsilateral lip. Two facial distortion patterns have been identified relative to the asymmetrical pronation patterns in the feet.[1]
我最近发表的一项统计研究表明，脚部的异常运动会导致面部变形。具体地说，不对称的异常前倾，即双脚向内、向前和向下旋转（见图 1），会导致面部垂直尺寸（VFd）的不对称损失，即眼眶外侧（外眦）与同侧嘴唇外缘之间的距离。相对于脚部不对称的前倾模式，已确定了两种面部变形模式[1]。


Figure 1. Abnormal Pronation Left Greater than Right
图 1.异常前倾左侧大于右侧

• Left Foot More Pronated than Right Foot: vertical distance between the left eye and ipsilateral lip is shorter, relative to the distance between the right eye and lip (referred to as the Vertical Facial dimension [VFd]) (See Fig. 2). This is frequently associated with a Class II malocclusion (overbite) and narrowing of the dental arch.
  左脚比右脚更前倾：相对于右眼和嘴唇之间的距离，左眼和同侧嘴唇之间的垂直距离较短（称为面部垂直尺寸 [VFd]）（见图 2）。这通常与 II 类咬合不正（咬合过度）和牙弓变窄有关。

• Right Foot More Pronated than Left Foot: vertical distance between the right eye and ipsilateral lip is shorter, relative to the distance between the left eye and lip.  This is frequently associated with a Class II malocclusion (overbite) and narrowing of the dental arch.
  右脚比左脚更前倾：相对于左眼和嘴唇之间的距离，右眼和同侧嘴唇之间的垂直距离更短。这通常与 II 类咬合不正（咬合过度）和牙弓变窄有关。

In both cases, a torsional (twisting) strain develops in the facial bones (side to side and front to back).  This can lead to a plethora of symptoms, including TMJ dysfunction and/or headaches.
在这两种情况下，面部骨骼都会出现扭转（扭曲）应变（左右扭转和前后扭转）。 这会导致一系列症状，包括颞下颌关节功能障碍和/或头痛。

Section II: Ascending Foot Cranial Model
第二部分：上升脚颅模型

The science studying how the foot moves when walking is termed foot biomechanics. 
研究行走时足部如何运动的科学被称为足部生物力学。

• Normal Pronation: Foot is pronating when the ipsilateral (same side) hip is internally rotating. This hip to foot coupling is referred to as Hip Drive (See Fig. 3);
  正常前伸：当同侧（同一侧）髋关节内旋时，脚处于前旋状态。这种髋关节与脚的耦合被称为髋关节驱动（见图 3）；

      Figure 3. Hip Drive 图 3.臀部驱动

• Abnormal Pronation:  foot is pronating when the ipsilateral hip is externally rotating, I have theorized an Ascending Foot Cranial Model to explain the observed coupling affect between the feet, cranium and occlusion (See Fig. 4);
  异常前倾： 同侧髋关节外旋时足部前倾，我提出了 "上升足颅模型"（Ascending Foot Cranial Model）的理论来解释观察到的足部、颅骨和咬合之间的耦合影响（见图 4）；

      Figure 4. Ascending Foot – Cranial Model
图 4.上升足 - 颅骨模型

• Abnormal Foot Pronation (inward, forward and downward) forces the innominates (hip bones) to rotate anteriorly (forward) and the downward (ASIS), the more anteriorly rotated hip being ipsilateral to the more pronated foot;[2]
  异常足前倾（向内、向前和向下）迫使腹股沟（髋骨）向前方（前方）和向下（ASIS）旋转，髋关节前旋较多的部位位于足前倾较多的同侧；[2]
• Anterior Rotation of the Hip Bones draw the temporal bones into an anterior (internal) rotation, the more anteriorly rotated temporal bone being ipsilateral to the more anteriorly rotated hip bone;
  髋骨前旋使颞骨前旋（内旋），前旋幅度较大的颞骨位于前旋幅度较大的髋骨的同侧；
• Anterior Rotation of the Temporal Bones extends the sphenoid and cants both the sphenoid and maxilla:
  颞骨内旋延长了蝶骨，并使蝶骨和上颌骨尖突：
  – If the right temporal bone is more anterior rotated (tip of right mastoid more cephalad, less prominent), the sphenoid bone is forced into a left torsional pattern (canted downward to the right) and the right maxilla is canted superiorly;
  - 如果右颞骨更多地向前方旋转（右乳突顶端更靠前，不那么突出），则鼻骨会被迫向左扭转（向右下方倾斜），右上颌骨会向上方倾斜；
  – If the left temporal bone is more anterior rotated, the sphenoid bone is forced into a right torsional pattern (canted downward to the left) and the left maxilla is canted superiorly;
  - 如果左颞骨更多地向前方旋转，则鼻骨会被迫向右扭转（向左下方倾斜），左上颌骨则会向上方倾斜；
• The resulting cants in the sphenoid and maxilla bones result in asymmetrical Vertical Facial dimensions, the shorter VFd being on the same side as the more pronated foot;[3]
  由此造成的鼻骨和上颌骨的凹陷导致面部垂直尺寸不对称，较短的面部垂直尺寸与较前倾的脚位于同一侧；[3]
• Extension of the sphenoid bone narrows the dental arch and crowds the teeth. The curve of Spee deepens. (See Fig. 5).
  蝶骨的延伸使牙弓变窄，牙齿变拥挤。斯佩曲线加深。(见图 5）。

Figure 5. Curve of Spee
图 5.斯佩曲线

Dental Orthogonal Radiographic  Analysis (DORA) supports the above proposed Ascending Foot Cranial Model and the observed facial distortions resulting from this model. This radiographic technique was first introduced by Gerald Smith, DDS, to visualize cranial lesions resulting from occlusal lesions. Later, I adapted DORA, correlating (linking) the distortional patterns in the cranial bones to the loss of Vertical Facial dimensions. 
牙科正交放射摄影分析（DORA）支持上述提出的上升足颅骨模型以及观察到的由该模型导致的面部变形。这种放射学技术最早是由牙科博士杰拉尔德-史密斯（Gerald Smith）引入的，用于观察咬合病变导致的颅骨病变。后来，我对 DORA 进行了改良，将颅骨的变形模式与面部垂直尺寸的丧失联系起来。
Figure 6 is a DORA of a patient with an abnormal pronation pattern left > right.
图 6 是一名患者的 DORA 图像，其前倾模式异常，左 > 右。


Figure 6. DORA Dental orthogonal radiographic analysis visualizing a cranial imbalance. An inferior cant of the sphenoid (cephalad red sphenoid line) concurrent with a superior cant of the maxilla (caudal red malar line) can result in a relative loss of vertical facial dimension. This author suggests that the cant in the sphenoid and maxilla bones results from an anterior (internal) rotation of the temporal bone. The petrous acts as the axis of rotation of the temporal bone. As a point of reference, internal rotation of the temporal bone is defined as a relative medial, anterior displacement of its squama. The sphenoid line is the horizontal line through which the two lowest points on the inferior border of the malar bone. (Reprinted with permission from Smith[8])
图 6.DORA 牙科正交射线分析显示颅骨失衡。蝶骨下斜（蝶骨头侧红色线）与上颌骨上斜（上颌骨尾侧红色线）同时出现，会导致面部垂直尺寸相对减小。作者认为，蝶骨和上颌骨的凹陷是颞骨前旋（内旋）的结果。岩骨是颞骨的旋转轴。作为参考点，颞骨的内旋被定义为颞骨鳞片的相对内侧、前方位移。蝶骨线是颧骨下缘两个最低点所通过的水平线。(经授权转载自史密斯[8]）。

The following lines are drawn:
划线如下

• VRL (Vertical Reference Line): a vertical line drawn through the centre of the nasion and the anterior nasal line;
  VRL（垂直参考线）：一条穿过鼻翼中心和鼻前线的垂直线；
• LWSL (Lesser Wing of Sphenoid): a line connecting the height of the convexity of the right and left portions of the lesser wings of the sphenoids;
  LWSL（蝶骨小翼）：连接蝶骨小翼左右两侧凸起高度的一条线；
• ATL (Apex of the Temporal Bones): a line connecting the tips of the right and left malar (zygomatic) bones;
  ATL（颞骨顶点）：连接左右颧骨顶点的一条线；
• Malar Line is the horizontal line through the two lowest points on the interior border of the malar bone;
  颊骨线是通过颊骨内缘两个最低点的水平线；

The following changes are observed on the DORA:
在 DORA 上可以观察到以下变化：

• LWS Line is canted downward left, suggesting a right torsional pattern;
  LWS 线向左下方倾斜，表明是右扭模式；
• AT Line is canted cephalad right, suggesting a more anteriorly rotated left temporal bone);
  AT 线向右前方倾斜，表明左侧颞骨更加前旋）；
• ML line is canted cephalad left, suggesting a left cephalad cant of the maxilla (a maxilla that is shifted upwards on the left side of the face).
  ML 线向左前方倾斜，表明上颌骨向左前方倾斜（上颌骨在面部左侧上移）。

Section III: Etiology of Abnormal Foot Pronation
第三部分：异常足前倾的病因

The author discovered an embryological foot type in which the first metatarsal is elevated and inverted relative to the second metatarsal, referred to as a Primus Metatarsus Supinatus (PMS) foot structure.[4,5]
作者发现了一种胚胎脚型，其中第一跖骨相对于第二跖骨是抬高和倒置的，被称为Primus Metatarsus Supinatus (PMS)脚型结构[4,5]。

This foot structure is the result of an incomplete unwinding of the talus (a tarsal bone sitting on top of the heel bone). Clinically, this places the first metatarsal and hallux (big toe) off the ground, when the foot is placed in its anatomical neutral position. (See Fig. 7)  In order for the 1st metatarsal and hallux to reach the ground, when walking or standing, the foot must roll inward and downward, e.g. abnormally pronate.[6] It is this abnormal pronation that can result in loss of VFd.
这种足部结构是距骨（位于跟骨顶部的跗骨）未完全松开的结果。在临床上，当足部处于解剖中立位时，第一跖骨和躅骨（大拇趾）就会离地。(见图 7）在行走或站立时，为了让第一跖骨和躅骨到达地面，脚必须向内和向下滚动，即异常前凸[6]。


Figure 7. PMs Foot Structure Resulting From Talar Supinatus
图 7.距骨上翻导致的 PMs 足部结构

Section IV: Proprioceptive Therapy Using Proprioceptive Insoles
第四部分：使用感知鞋垫的感知疗法

Proprioceptive Therapy is the process of using Proprioceptive Insoles to reverse the postural distortions, and eliminate the associated pain resulting from the Primus Metatarsus Supinatus foot structure. Computerized postural and video analysis is run to determine the correct strength of signal (prescription) to use in the Proprioceptive Insoles. If the wrong prescription is used, it can exacerbate the pain.
感知疗法是指使用感知鞋垫来扭转姿势扭曲，并消除因跖趾骨上缘足部结构而引起的相关疼痛。计算机化姿势和视频分析用于确定感知鞋垫的正确信号强度（处方）。如果使用了错误的处方，可能会加剧疼痛。

The Rothbart Proprioceptive insoles are non-supportive type foot insoles which apply a tactile stimulation to the bottom of the foot (See Fig. 8). In theory, this tactile stimulation transmits a signal to the brain (cerebellum). Acting on this signal, the cerebellum initiates a positional correction affecting the entire body posture, including the cranial bones. The torsional rotations within the temporal bones and sphenoid are reversed. Frequently this improvement in position reduces or eliminates many of the symptoms associated with cranial imbalances (headaches) and malocclusions (TMJ).
罗斯巴特足底感觉鞋垫是一种非支撑型足底鞋垫，可对足底产生触觉刺激（见图 8）。理论上，这种触觉刺激会向大脑（小脑）传递信号。根据这一信号，小脑启动位置矫正，影响包括颅骨在内的整个身体姿势。颞骨和蝶骨的扭转旋转被逆转。这种姿势的改善通常会减轻或消除许多与颅骨失衡（头痛）和咬合不正（颞下颌关节）有关的症状。


Figure 8 (Inset). Rothbart Proprioceptive Insole
图 8（插图）。罗斯巴特足部感觉鞋垫

Proprioceptive insoles can prevent malocclusions from developing in young children. However, if a malocclusion has developed, orthodontic therapy should be considered (e.g. the Advanced Lightwire Functional appliance) to improve the functional alignment of the cranial bones and teeth.
先天性感觉鞋垫可以防止幼儿出现错颌畸形。但是，如果已经出现错颌畸形，则应考虑进行正畸治疗（如高级光丝功能矫治器），以改善颅骨和牙齿的功能性排列。

Proprioceptive insoles are used to realign the head over the cervical spine. This must be done before orthodontic intervention is initiated. Otherwise, orthodontic intervention can lock the head in a forward position that will prove intractable to correction.  A forward head position can result in headaches, neck and shoulder tension and pelvic instability.
先觉鞋垫用于重新调整头部与颈椎的位置。这必须在开始正畸干预之前完成。否则，正畸干预会将头部锁定在一个难以矫正的前倾位置。 头部前倾会导致头痛、颈肩紧张和骨盆不稳。

References 参考资料

1.    Rothbart BA. Vertical Dimensions Linked to Abnormal Foot Motion. Jour Amer Podiatr Med Assoc. 98(3): 189-195. 2008.
1. Rothbart BA.垂直尺寸与异常足部运动有关。Jour Amer Podiatr Med Assoc.98(3)：189-195。2008.
2.    Rothbart BA. Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation. Journal American Podiatric Medical Association. 96(6): 499-504. 2006.
2. Rothbart BA.功能性腿长不一致与异常前倾的关系。Journal American Podiatric Medical Association。96(6):499-504。2006.
3.    Rothbart BA. Vertical Facial Dimensions Linked to Abnormal Foot Motion. Journal American Podiatric Medical Association. 98(3): 189-195. 2008.
3. Rothbart BA.面部垂直尺寸与异常足部运动有关。Journal American Podiatric Medical Association.98(3):189-195。2008.
4.    Rothbart BA. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal Bodywork and Movement Therapies. 6(1): 37-46. 2002.
4. Rothbart BA.内侧柱脚系统：改善姿势的创新工具。Journal Bodywork and Movement Therapies.6(1)：37-46。2002.
5.    Proprioceptive Stimulation – The Primus Metatarsus Supinatus Foot Structure. Available Online at http://www.rothbartsfoot.info/RFS.html
5. Proprioceptive Stimulation - The Primus Metatarsus Supinatus Foot Structure。可上网查阅：http://www.rothbartsfoot.info/RFS.html.
6.    Proprioceptive Stimulation - Abnormal Pronation, Gait Animation. Available Online at
6. Proprioceptive Stimulation - Abnormal Pronation, Gait Animation。可在线查阅
http://www.rothbartsfoot.info/TreadmillAnalysis.html

Further Information 更多信息

For more information regarding the Primus Metatarsus Supinatus foot structure and Proprioceptive Therapy, visit: www.rothbartsite.com
有关 Primus Metatarsus Supinatus 足部结构和感知疗法的更多信息，请访问： www.rothbartsite.com