Dr.  Maria Antonietta Fusco is graduated in Medicine and Surgery and lives in Avellino, Italy. Owing to her ongoing researches she succeed in identifying the relationship between the different muscles of the sole of the foot and the muscular chains of the whole organism. On the basis of this outcome she devised a new and original method to diagnose and to treat the muscular-skeletal and myo-fascial pains, and vascular disorders caused by a dysfunction of the venous and lymphatic circle in lower limbs. 

This innovating method is based on the study of the intrinsic muscles of the sole of the foot that are responsible for maintaining the physiological structure of the arches of the foot.   A normal tone of these muscles, a normal elasticity of  ligaments, tendons, plantar aponeurosis and articular capsules belonging to the 3D spatial arrangement of the foot allows a normal functioning of the whole organism.

This method is not only based on considering the relationship among the different organs and interior apparatus, that had been already studied by the traditional Chinese medicine, but it is based on a new approach enabling to relate the state of the plantar stance to alterations of the spatial arrangement of different bony segments and to alterations of different kinds of functional overloading of each joint of the body.

According to these studies, the foot is no more to be considered only as a basis to stand upon, but it has to be considered as a real nervous receptor able to transmit information (input) to the Central Nervous System that, by using this information, organizes the distribution of the muscular tone and of the fibro-fascial elasticity of the whole anti gravitational system of our body (output). Furthermore the foot has to be considered as a peripheral vascular organ that develops the so called "vis a tergo", that is the propulsive mechanic force, that allows and facilitates the venous and lymphatic return throughout lower limbs.

The method focuses on alterations of the plantar stance, flat foot, claw foot of various degrees, pronated foot or spiny foot, valgus or varus back foot caused by an hypo tone of some intrinsic muscles, that because of hypo tone are no more able to maintain the physiological structure of the  foot's arches neither in statics nor in dynamics.

There are seven muscles, that are responsible to maintain the physiological structure of the foot's arches:

1) FLEXOR HALLUCIS BREVIS

2) ADDUCTOR HALLUCIS

3)FLEXOR DIGITI MINIMI BREVIS PEDIS

4) ABDUCTOR HALLUCIS

5) ABDUCTOR DIGITI MINIMI BREVIS PEDIS

6) PRONATOR WEDGE

7) SUPINATOR WEDGE

The two wedges belong to the Achilles-calcaneal system and consist above all of fascial tissue and proximal insertions of plantar aponeurosis.

Dr. Fusco was the first doctor, who indicated these muscles or areas of the foot's sole as the ones and only responsible for maintaining the physiological structure of the plantar arches, the 3D arrangement of the foot's structure and of all articular structures of our body.  Furthermore, for the first time, she related the function of these muscles or areas to the functioning of the whole organism and above all of the muscolo-skeletal apparatus and of the locomotory apparatus. She also singled out the relationships and the proper function of autonomous nervous structures of the sole of the foot.

The myo-fascial and capsular structures of our body are made up of a lot of pressoreceptive, proprioreceptive, and exteroreceptive nerve endings. These autonomous nerve endings transmit, involuntarily, information  about the characteristics of the ground on which we stand to the brain and to the Central Nervous System, both cranial and spinal. So as consequence of this function they control and determine the 3D spatial arrangement of the whole organism.

According to this new and original method, the incorrect functioning of these nerve endings belonging to hypo or hyper tonic muscular structures, to fascial tissue with slightly elasticity due to the excessive tension or excessive relaxing, or belonging to altered capsular structures and therefore in functional overloading, causes a transmission of false inputs to the CNS and as consequence disharmonic outputs are transmitted to the whole anti gravitational system of our organism.

In particular the above mentioned anomalous inputs cause asymmetry of pelvis and/or shoulders, alterations of the spatial arrangement of ankles, knees and hips, alterations of the physiological curves of the vertebral column, both on the frontal plan: sideward deviation and idiopathic scoliosis; and on the sagittal plane: hyperlordosis, hyperkyphosis, verticalization of the low back and/or of cervical back and inversion of the physiologic curvatures of the spine. These premises cause ongoing and disturbing articular pains, that can handicap the person affected by these pains. This false information coming from disharmonic foot's structures causes a disharmonic distribution of the muscular tone and of the fascial, tendineous and capsular elasticity of supporting structures of our organism, responsible for developing the anti gravitational force, that allows us to maintain an erect posture. These structures build the so called static chain. According to Dr. Fusco a disharmonic distribution of the anti gravitational force on the static chain of our organism causes chronic contractions of the superficial muscles, that should be activated only to perform a dynamic movement and should then return to a state of inactivity. Starting from these remarks we can claim that the chronic asymmetric contraction of some of the superficial muscles such as the deltoid, the scalene, rectus, gluteus etc. causes an alteration of the spatial arrangement of the different girdles and of the different joints,  asymmetry of shoulders and/or pelvis, deviation and non alignment of knees, head tilted towards the higher shoulder etc..

It is very important to single out the structures from which this anomalous information originates and above all to treat them in order to re-normalize the information. In fact, in this way is is possible to influence the whole body's physiology for therapeutic purposes and to correct therapeutically all ascending postural syndromes. Therefore, if the disorder originates from the foot, this method allows to remove the symptoms and to re-establish the normal spatial arrangement of the altered and sore bony segments.

About the vascular system we have to consider that the development of the anti gravitational force exercised on the blood's column during the gait cycle is allowed not only by the contraction of the gemelli, but also and above all by a normal elasticity of plantar arches, that during the gait cycle modify their shape and squeeze the blood out from the Lejars' venous sole, that is located in the sole of the foot. Therefore the venous systole occurring in the sole of the foot is not due to the contraction of the intrinsic muscles, but it is due to the elasticity of the supporting structures of the plantar arches, that enhancing the normal modification of these arches, achieve a squeezing effect involving  the ground and the shoe on one side and  the plantar arches pulled down during the gait cycle on the other side. The possibility to single out and to treat the hyper tonic or hypo tonic musculo-legamentous structures allows to re-normalize the pump's function, performed by the foot and to eliminate subjective symptoms such as heaviness sensation in legs, swelling, etc., but also venous, capillary ectasiae,  teleangectasiae and varices.

This new approach to the postural disorders enabled Dr. Fusco to coin the term "neuro-bio-mechanics".  The spatial arrangement of our body depends not only from the rigid supporting levers, that is the bones, but it depends above all from the peripheral information coming from the interaction of the person with the surrounding environment and particularly from the interaction of the autonomous nerve endings of the foot's sole and the ground. Therefore, we can assert that the mechanical rules, that when referred to our body are called biomechanical rules, are not enough useful to describe in detail the alterations we observe in our patients or to provide a detailed physio-pathologic survey about these alterations. Only by means of the neuro-bio-mechanical approach to the functioning of our organism we can understand that all those asymmetries of our body refereed to as "attitudes" are in reality real clinical pathologies, causing symptoms and pains to the 78% of world population( functional diseases).

In a recent article published on Lancet, Dr. Anderson provides a detailed documentation on the incidence of chronic back pain in industrialized societies. In the U.S.A. this pathology is the most frequent cause of work limitations for people under 45 years old, the second most frequent reason for asking a medical examination, and the third most frequent causes for surgical operations. A lot of people, about the 2% of the whole American working population, get every year  insurance indemnities because of back pains.

Back pain has the same incidence in European countries too.

In Great Britain the 12% of missing work days because of a disease is due to back pains.

In Sweden, in the last 30 years, from the 11% to the 20% of missed work days was due to back pains.

Anderson states that during one single year the 8% of the for diseases insured people was recorded at least once with a diagnosis of back pains.

On the contrary, starting from this innovative approach Dr. Fusco could draw an etiological  diagnose of the musculo-skeletal diseases and above all back pains. Furthermore she could implement a physiologic therapy, by respecting the proper complex functioning of our organism, and what's more she succeed in removing the symptoms and in normalizing the bony segments by removing the asymmetries of the body and of the spatial arrangement of the bones, as showed and confirmed by the radiographic examinations.

CLINICAL INVESTIGATION'S METHOD

The clinical diagnosis is performed by means of specific tests, used to discover if the postural disorders of the patient and his muscular-skeletal pains arise from the feet, the so called ASCENDING syndromes, or if they arise from other receptors located in the cranium, in this case the syndromes are called DESCENDING syndromes, or if they arise from both and they are therefore called MIXED syndromes.

To carry out this diagnosis we devised the so called "Test of rotators".

All postural disorders are characterized by a disharmonic distribution of the muscular tone between the two sides of our body. It is very easy to analyze the tone of the rotator muscles of the hip, so if we discover a difference between the tone of the muscle of the right lower limb and the one of the left lower limb, that means that the patient has postural disorders.

To investigate if the postural disorders arise from anomalous inputs coming from cranial receptors you should put the patient's hand, which is  opposite to the side of the hypo tonic muscle on the shoulder on the same side of the hyper tone of the rotator muscle ; if the hyper tone disappears the syndrome is a DESCENDING one.

To investigate if the postural disorders arise from anomalous inputs coming from feet's receptors, you should put the hand, which is on the same side of the rotator muscle in hyper tone under the nape of the neck; is the hyper tone disappears the syndrome is an ASCENDING one.

If the hypo tone disappears in both cases, the syndrome is a MIXED one.

To identify the hypo tonic muscles of the sole of the foot, Dr. FUSCO devised a clinical method of neurological type. She related the function of the cutaneous exteroreceptores in the insertion's zone of each muscle, that should be investigated,  through a muscular test on a pattern muscle. That is she related  the insertion's points of each intrinsic muscle of the sole of the foot, that is responsible to maintain the normal static plantar arches, through a classical kinesiological test of the Applied Kinesiology according to Goodheart's method.

The test is a modified challenger: to perform this test you firstly have to choose a pattern muscle, such as the deltoid muscle, then you have to evaluate its basis strength, and afterwards you have to evaluate this strength again after performing a tactile stimulation of each point of insertion of the concerned muscle of the sole of the foot; the stimulation has to be performed in a delicate way. If after performing this stimulation, the pattern muscle is still strong, it means that the stimulated muscle of the sole of the foot functions in the right way and it doesn't need to be treated, on the other side if after performing this stimulation the pattern muscle is weak,  that means that the stimulated muscle of the sole of the foot functions in a false way and it needs to be treated.

This way of implementing the Applied Kinesiology is really original and Dr. Fusco compared this method with neurological tests such as patellar reflex or ulna's reflex, it can only be used for diagnostic purposes.

THERAPEUTIC PHASE

The therapeutic phase is aimed above all to correct the hypo tonic muscles. Any treatment of muscles having already an increased tension is not tolerated by the organism, so we can only perform a selective stimulation on those muscles and fasciae, that are relaxed and hypo tonic.

Till nowadays the merely mechanic and mechanicistic approach to the functioning of our supporting or locomotory apparatus prescribed to use more or less rigid passive supporting tools for the therapeutic treatment of an incorrect plantar stance. These tools set passively the sole of the foot in a like physiologic position. The use of this therapeutic tools never corrected the plantar stance or the postural alterations of the whole organism.

The therapeutic phase improved and widely experimented by Dr. Fusco is based on an exteroceptive, pressoceptive, proprioceptive and reflex triggering stimulating orthotic aimed to correct musculo-skeletal, myo-fascial and vascular disorders. The orthotic is designed to fit the patients shoes and is provided with some elastic pockets. In this way once established which muscles don't function in the right way or are in hypo tone, it is possible to carry out this stimulation for many hours, without disturbing the patient, simply by using an orthotic fitted in the patients shoes.

To manufacture the orthotic we choose elastic and soft materials, because they make our foot's sole "deaf" to the continuous contact with rigid grounds and with rigid shoes' soles. Our feet must act as sensor, feel the characteristics of the ground on which we are standing and inform the CNS about them, but while we walk on rigid grounds, the sensibility of these receptors reduces itself.

The orthotic was manufactured with a special elastic material, that expresses an elastic force equal to the weight pressing on the orthotic. The material is the so called Indian Rubber. It is hypoallergenic and it was crushed in little irregular pearls used to fill the pockets of the orthotic. In this way the elastic stimulating force can be expressed in the right way at least one year long.

The surface of the orthotic touching the foot's sole is manufactured with alcantara and it is soft to touch and hypoallergenic. Furthermore the alcantara pays back a hundredfold.

The postural proprioceptive neuro-bio-mechanic acting orthotics devised and experimented by Dr. Fusco are manufactured by the firm KS  ITALIA and are called "ATTIVO KS MEDICAL".