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Human locomotion is a phenomenon of the most extraordinary complexity in which so great are the multitude of individual motions occurring simultaneously in the three planes of space that analysis is difficult without some unifying principle. The adoption of the concept that fundamentally locomotion is the translation of the center of gravity through space along a pathway requiring the least expenditure of energy supplies the necessary unifying principle which permits of qualitative analysis in terms of the essential determinants of gait. The six major determinants are pelvic rotation, pelvic tilt, knee and hip flexion, knee and ankle interaction, and lateral pelvic displacement. The serial observations of irregularities in these determinants provides insight into individual variation and a dynamic assessment of pathological gait. Pathological gait may be viewed as an attempt to preserve as low a level of energy consumption as possible by exaggerations of the motions at unaffected levels. Compensation is reasonably effective with the loss of one determinant of which that at the knee is the most costly. Loss of two determinants makes effective compensation impossible and the cost of locomotion in terms of energy is increased threefold with an inevitable drain upon the body economy.

Legs of unequal length are a serious handicap and the prevention and cure of this deformity constitute a major orthopedic problem. Phemister (5) gives six causes for unequal length during the growing period: fractures with overriding fragments or obliteration of the epiphyseal line; joint infection destroying adjacent epiphyses; bone infection causing loss of bone or fusion of epiphyses (occasionally causes lengthening due to stimulation); bone tumors at ends of shafts of growing bones; congenital disturbances; infantile paralysis. The shortened leg must be compensated by pelvic tilt and spinal curvature, or by an elevated shoe on the affected leg, or corrected by operation. Since short legs of nearly equal length are preferable to legs of unequal length, various surgical methods have been advocated for correcting the inequality: Abbott's leg lengthening; Ferguson's drilling of the diaphysis to stimulate growth in the affected leg; shortening of the healthy femur at the end of the growth period; and Phemi...

The author has attempted a presentation of the rationale in the attack on the distortion of physiology leading to the common type of weak foot, that associated with poor body posture. The discussion has been limited to the uncomplicated weak foot, valgus relation, this abnormality being taken as the starting point in a large number of the pathological conditions of the foot, such as flat foot, callous, arthritis with true or false ankylosis, etc., that result from maladaptation of the weight bearing mechanism to the superstructure. Briefly, the sequence of events appears to be as follows: slouch posture with a forward shift of the line of gravity of the botly, lumbar lordosis, increased pelvic tilt, internal femoral rotation, internal astragalar rotation, valgus relation. The effect of valgus relation on the efficiency of the foot is discussed. It is pointed out that there are five therapeutic factors concerned in readapting the weight bearing mechanism to the superstructure and that all of these factors—postural correction, correct usage of the feet, exercises, proper shoes and arch supports—must be employed simultaneously. Absolute cooperation of the patient is essential since the plan of treatment has as its goal the development in the individual of a consciousness of posture that is followed eventually by a posture reflex. This necessitates first of all the instruction of the patient in the elements of correct posture. The “wall and chair maneuvers” are described in this connection. Development of neglected muscles through exercises enables the patient to pull himself into correct posture and to stay there. This act in time becomes reflex. An exercise routine is given and explained. It is obvious that the foot cannot function efficiently when the shoe covering it is not properly constructed and correctly sized. The elements of a good shoe are discussed. The arch support is considered from the mechanical and clinical points of view. Patients for postural correction must be selected with care since readjustment of a posture that has been maintained for years is a serious matter. In patients over fifty years of age the weak foot is almost invariably accompanied by various pathological sequels. Palliative treatment of these complications should be undertaken immediately and followed while postural correction is in progress. This latter correction must be slow and extended over a period of many months or even several years. The author wishes to express his appreciation for the valuable assistance and criticism of Mr. W. Gordon Garretson, Division of Architecture and Engineering, State of Illinois.

Bipedal chimpanzees reorient the pelvis to achieve an upright posture but retain the same pattern of femoral flexion and extension as in quadrupedal walking. Major differences from human gait are the abducted, relatively more flexed excursion of the femur and the timing of pelvic tilt, which raises during the swing phase. The femoral head morphology in the fossil hominid Australopithecus robustus is evidence of an approximately vertical excursion of the femur in contrast to the adducted pattern of modern man and the abducted pattern of chimpanzees.

To the Editor:— Often the diagnosis of herniated lumbar intervertebral disk is questioned unless there is some difficulty with the straight leg raising test. Normal straight leg raising maneuvers in patients with classical herniated disk symptoms and abnormal myelograms indicating herniated intervertebral disk have occasionally been seen. In three patients that we have seen, clinical and pathological correlation was made and an explanation for the normal straight leg raising maneuver in this circumstance is postulated. Report of Cases Case 1.— A 59-year-old man with intermittent low back pain of many years duration complained of severe right lower extremity pain for two months. The pain radiated down the posterolateral aspect of the right leg and was increased by cough and sneeze. Despite conservative treatment, consisting of bed rest and pelvic traction, pain continued. There was paravertebral muscle spasm or pelvic tilt. Straight leg raising was full on each side. The ankle

Low back pain, in most cases, is due to a strain which causes an inflammation in the region of the lumbosacral and sacroiliac articulations. Strain is the result of an imbalance between the capacity of the structures of the back and the physiologic demands made on them. This imbalance is called a functional decompensation. A decompensation of the back gives rise to certain symptoms and findings. The symptoms are low back pain and tiredness ; this fatigue of the back is often associated with a general fatigue. The first pain noted is usually generalized and is in the muscles, with associated stiffness on arising after rest. Later the pain localizes and may involve the lumbosacral angle or the sacroiliac joint. In the acute phase of this condition there is a sudden "catch," associated with lumbar muscle spasm, loss of the lumbar curve, a protective list with a pelvic tilt, limitation of motion

The title of this book is misleading. Actually, Dr. Kraus considers the treatment of back and neck pain resulting from muscle weakness, poor posture, or muscle imbalance and not that associated with any identifiable lesion such as a herniated intervertebral disk, osteoarthritis of the spine, the sequela of trauma, mechanical abnormalities such as spondylolisthesis, abnormalities of the spinal cord or peripheral nerves, or diseases of the gastrointestinal, genitourinary, or cardiovascular systems. The method of examination given by Dr. Kraus stresses structural measurements such as chest expansion, scapulaspine distance, angle of pelvic tilt, elasticity of muscles, and the determination of muscle strength and holding power. The Kraus-Weber test for minimal muscular fitness is outlined in detail. A thorough description of exercises for the spine is given. The technique of injecting "triggerpoints" within ligaments and muscles is described in detail. Techniques of "supportive physical therapy" such as use of ethyl chloride spray

To the Editor:— The routine measurement of leg length is both tedious and time-consuming for trained personnel. At the present time there are few devices in common use for the rapid determination of pelvictilt leg shortening. A simple device, the pelvic tiltometer, is proposed for the rapid evaluation of patients suspected of pelvic-tilt leg shortening. If pelvic tilt is found, an accurate determination of leg lengths by conventional methods is indicated. The construction of this device is both simple and inexpensive (total cost $2.50). Materials needed consist of (1) one 9-inch bullet level, (2) rigid (outside) 8-inch caliper (both blades), (3) two 1/4-inch bolts, and (4) two 1/2-inch springs. The device may be constructed by boring and threading a 1/4-inch hole on the upper surface of each end of the bullet level. Each caliper is cut to a length of 5 1/2 inches (or it may be 8 inches in

One of the most intractable sequelae of poliomyelitis is a complex deformity involving the knee, the hip and the lumbosacral portion of the spine. The hip deformity is characteristically one of flexion and abduction. The knee may be in flexion and valgus with external torsion of the lower leg on the femur. The lumbosacral region of the spine is in lordosis, and if only one extremity is involved there will be in addition to the lordosis a pelvic tilt, the contralateral iliac crest being high (fig. 1 A ). The affected leg is abducted, the unaffected leg is adducted, and there is a lumbar scoliosis convex toward the affected side. These deformities are by no means uncommon in poliomyelitis, and they also occur in connection with congenital malformations such as spina bifida and more infrequently after paraplegia due to trauma, infection or tumor. Growth plays an important role, for these deformities