Podcast 169: Foot muscles, core strength and more

Podcast 167: Foot muscles, core strength and more

Join us each month on the Masterclass in Gait, link below

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The Masterclass is a formal LIVE presentation of slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

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_______________________________________________________________________________
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Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
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Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

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Podcast links:

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https://thegaitguys.libsyn.com/pod-foot-muscles-core-strength-and-more

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Irene Davis, PhD, PT

@IreneSDavis

Numerous studies demo foot muscle hypertrophy when removing support of the arch. While it seems intuitive, this is the first published study to demo that adding support results in foot muscle atrophy after only 12 weeks of orthotic use! Nice work!! #strengtheningoverbracing

https://journals.sagepub.com/doi/abs/10.1177/0363546520969205

Foot Core Training to Prevent Running-Related Injuries: A Survival Analysis of a Single-Blind, Randomized Controlled Trial
Ulisses T. Taddei, PhD, PT, Alessandra B. Matias, MSc, PT, Marcos Duarte, PhD,

https://twitter.com/IreneSDavis/status/1306033740020408320/photo/1

https://pubmed.ncbi.nlm.nih.gov/32521283/

2020 Aug;78:105063. clinbiomech.2020.105063.
The effect of a 12-week custom foot orthotic intervention on muscle size and muscle activity of the intrinsic foot muscle of young adults during gait termination
Katrina Protopapas 1 , Stephen D Perry 2

_______

hip abduction

https://www.tandfonline.com/doi/abs/10.1080/02640414.2020.1820183?journalCode=rjsp2

Inter-limb strength asymmetry in adolescent distance runners: Test-retest reliability and relationships with performance and running economy
Rich Blagrove

Summary: Key finding: Larger hip abduction asymmetry associated with worse running economy in female runners (r = 0.85).

____________

Developing neurplasticity

SPlit treadmills , limping,

https://pubmed.ncbi.nlm.nih.gov/23312637/

_____________

quick talk on bone density

https://twitter.com/rwilly2003/status/1303526386846461952?s=1

https://journals.physiology.org/doi/abs/10.1152/jappl.1992.73.3.1165

Relationship among running mileage, bone density, and serum testosterone in male runners: J. D. MacDougal

Genu varum ? Maybe

It’s subtle, do you see it?

While standing in line at Copper to make a few turns with my wife, I snapped this shot of the gentleman in front of me. Can you see the tibial varum present bilaterally? We see this often in the office and it puts people on the outside edge of their ski. This makes it difficult to initiate a turn with the inside edge and makes transitions occur very quickly as they are already on the outside edge. It can also create patellofemoral tracking problems.

The idea is to create enough motion of their first ray to help them to get the head down to the ground (or the ski). Sometimes, building up underneath the medial side of the foot and hallux (varus wedge or Morton’s toe extension) if they don’t have that range of motion available to them can work as well.

#Tibialvarum #Genuvarum #Skiing #FootProblem #Varuspost #varuswedge

A case of chronic hip pain. ?

We figured out why you have chronic hip pain....This is what happens when they use the wrong size cup...

Chronic dislocation...

#Chronic #Hip#pain #dislocation

Podcast 168: Gait Speed, hip extension, and A New Dawn

Podcast 168: Gait Speed, hip extension, and A New Dawn

Join us each month on the Masterclass in Gait, link below

https://www.patreon.com/thegaitguys

Join at the $40 monthly level and get the masterclass each month, bonus material and the detailed monthly content we only share on Patreon.

The Masterclass is a formal LIVE presentation of slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

Or, you can get less for your money (why would you do that?) and just buy our Monthly $40 Masterclass at our VIMEO on demand page: https://vimeo.com/ondemand/thegaitmasterclass


Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".

https://traffic.libsyn.com/secure/thegaitguys/pod_169_March_12_-_32821_10.19_AM.mp3

https://thegaitguys.libsyn.com/gait-speed-hip-extension-and-a-new-dawn

https://directory.libsyn.com/episode/index/id/18496787
_______________________________________________________________________________
Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Dual decline in gait speed and cognition is associated with future dementia: evidence for a phenotype
Age Ageing. 2020 Oct 23;49(6):995-1002. doi: 10.1093/ageing/afaa106.
Manuel Montero-Odasso et. al


Walking in humans: how much brain function is needed?
Kressig RW.
Age Ageing. 2020 Oct 23;49(6):930-931

Correlations Between Hip Extension Range of Motion, Hip Extension Asymmetry, and Compensatory Lumbar Movement in Patients with Nonspecific Chronic Low Back Pain

Med Sci Monit. 2020 Sep 24;26:e925080. doi: 10.12659/MSM.925080
Won-Deuk Kim 1 , DooChul Shin 2

Prolonged sitting and physical inactivity are associated with limited hip extension: A cross-sectional study
Musculoskelet Sci Pract. 2021 Feb;51:102282. doi: 10.1016/j.msksp.2020.102282. Epub 2020 Oct 28. Abderrahmane Boukabache 1 , Stephen J Preece 1 , Nathan Brookes 2

Independent muscle of extensor hallucis capsularis: a cadaveric case report
Surg Radiol Anat. 2020 Oct 13. doi: 10.1007/s00276-020-02592-7. Online ahead of print.
Jeong-Hyun Park , Yu-Jin Choi, Kwang-Rak Park , Digud Kim , Hyung-Wook Kwon , Mijeong Lee, Jaeho Cho

Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: a randomized control trial
J Musculoskelet Neuronal Interact. 2020 Jun 1;20(2):234-248.
Irshad Ahmad , Shalini Verma , Majumi M Noohu , Mohd Yakub Shareef , M Ejaz Hussain

Why does it feel so good to stretch?

-We are sure you have read many articles, some written by us, about the good the bad and the ugly about stretching. Regardless of how you slice the cake, we think we can all agree that stretching “feels” good. The question of course is “Why?”

-Like it or not, it all boils down to neurology. Our good old friends, the Ia afferents are at least partially responsible, along with the tactile receptors, like Pacinian corpuscles, Merkel’s discs, Golgi tendon organs, probably all the joint mechanoreceptors and well as a few free nerve endings.

-What do all of these have in common? Besides being peripheral receptors. They all pass through the thalamus at some point (all sensation EXCEPT smell, pass through the thalamus) and the information all ends up somewhere in the cortex (parietal lobe to tell you where you are stretching, frontal lobe to help you to move things, insular lobe to tell you if it feels good, maybe the temporal lobe so you remember it, and hear all those great pops and noises and possibly the occipital lobe, so you can see what you are stretching.

-The basic (VERY basic) pathways are:Peripheral receptor-peripheral nerve-spinal cord-brainstem-thalamus-cortex; we will call this the “conscious” pathway: and peripheral receptor-peripheral nerve-spinal cord-brainstem-cerebellum- cortex; we will call this the “unconscious” pathway.

-Of course, the two BASIC pathways cross paths and communicate with one another, so not only can you “feel” the stretch with the conscious pathway but also know “how much” you are stretching through the unconscious pathway. The emotional component is related through the insular lobe (with relays from the conscious and unconscious pathways along with collaterals from the temporal lobe to compare it with past stretching experiences) to the cingulate gyrus and limbic cortex, where stretching is “truly appreciated”.

-As we can see, there is an interplay between the different pathways and having “all systems go” for us to truly appreciate stretching from all perspectives : )
#stretch #stretching #stretchingexercises #neurology

metatarsus adductus

Metatarsus adductus or metatarsus varus/forefoot adductus as it is also known is a congenital deformity occurring one in about every 1000 to 2000 live births. It can be due to genetics, intrauterine positioning and occasionally the sleeping position of a baby.

-If you draw a line bisecting the heel forward through the foot it should pass through the second metatarsal or between the second and third metatarsal. If the foot is medial to this line, the condition is present.

-It sometimes can resolve without treatment however this case persisted into adulthood.

It often results in the individual having greater amounts of supination in the foot, less flexibility and is often present with a cavus arch along with internal tibial torsion. In this particular case, the adductus combined with his internal tibial torsion was causing patellofemoral tracking issues

#metatarsusadductus #metatarsus #adductus #forefoot #forefootadductus #supination

They often occur in threes

-Congenital abnormalities that is…

-For whatever reason, when you see one of these things, there are usually at least two more to go along with it. Take this gentleman for example. We looked at his forefoot adductus on the 29th. Can you also see how he has a cavus arch as well as internal tibial torsion?

-The cavus arch means that his weight will most likely be on the lateral aspect of his foot. The internal tibial torsion and forefoot adductus will both cause him to bear weight laterally as well. This results in an over supinated foot which is an excellent lever but poor shock absorber.

-For these folks we like to improve the range of motion in the feet intersegmentally, Ensure that they have adequate extension and internal range of motion of the hips and will sometimes employee of August post if there are patella femoral tracking issues to get the knee back to midline

#valgus#forefootadductus#InternalTibialTorsion #CongenitalAbnormalities #cavusarch #Gait #gaitguys #gaitabnormalities

Making your stretching more effective

-Whether you agree that stretching is good or not, you or your client still may decide to do so possibly because of the “feel good” component. More in that in another post.
-If you do decide to stretch, make sure you take advantage of you or your clients neurology. One way we will discuss today is taking advantage of what we call myotatic reflex.
-The myotatic reflex is a simple reflex arc. The reflex begins at the receptor in the muscle: the muscle spindles (nuclear bag or nuclear chain fibers). This sensory (afferent) information then travels up the peripheral nerve to the dorsal horn of the spinal cord where it enters and synapses in the ventral horn on an alpha motor neuron. The motor neuron (efferent) leaves the ventral horn and travels back down the peripheral nerve to the contractile portion of the myfibrils (muscle fiber) from which the the sensory (afferent) signal came. This causes the muscle to contract. Think of a simple reflex when somebody taps a reflex hammer on your tendon. This causes the muscle to contract and your limb moves.
-Nuclear bag and nuclear chain fibers detect length or stretch in a the muscle whereas Golgi Tendon organs tension. With this in mind, slow stretch of a muscle causes it to contract more, through the muscle spindle mechanism.
- Another reflex that we should be familiar with is called reciprocal inhibition. It states simply that when one muscle contracts it’s antagonist is inhibited.
-Try this:
-do a calf stretch like this: put your foot in dorsiflexion, foot resting on the side of the doorframe.
-Keep your leg straight
-Grab the the door frame with your arms and slowly draw your stomach toward the door frame.
-Feel the stretch in your calf? this is a slow stretch. Can you feel the increased tension in your calf? You could fatigue this reflex if you stretched long enough. If you did, then the muscle would be difficult to activate. This is one of the reasons stretching seems to inhibit performance.
-Now for an added stretch, dorsiflex your toes and try to bring your foot upward. Did you notice how you can get more stretch your calf and increased length? Reciprocal Inhibition!

Why is that muscle so tight?

We often think of neurological reasons (increased facilitation of the agonist, decreased reciprocal inhibition of the antagonist, increase gamma drive, etc), but how about the series elastic element (ie the connective tissue)? Or perhaps the sarcomere (individual contractile unit of the muscle)? How can we fix that? It is easier than you thought!

An oldie but a goodie. A great FREE FULL TEXT paper on sarcomere loss and how to prevent it. Yep, would you have guessed static stretching? Yes, this study was on mice and it seems plausible that it would be applicable to humans as well.

“When muscle is immobilised in a shortened position there is both a reduction in muscle fibre length due to a loss of serial sarcomeres and a remodelling of the intramuscular connective tissue, leading to increased muscle stiffness. Such changes are likely to produce many of the muscle contractures seen by clinicians, who find that such muscles cannot be passively extended to the full length, which normal joint motion should allow, without the production of muscle pain or injury.

…These experiments show that in addition to preventing the remodelling of the intramuscular connective tissue component daily periods of stretch of ½ h or more also prevent the loss ofserial sarcomeres which occurs in mouse soleus muscles immobilised in the shortened position.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004076/pdf/annrheumd00439-0044.pdf



link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004076/pdf/annrheumd00439-0044.pdf

#stretching #stretch #stretchingexercises #neurology

More stetching tricks

More Tricks for stretching

-Take a look at the picture above and note the posturing of the baby in the 2 positions. These neurological reflexes (or postures) are called symmetrical tonic neck reflexes or responses (STNR’s for short).

-You next question is “Do these persist into healthy adulthood”? and the answer is a resounding YES!

-Take a look at the picture above again and note the following:

-When the neck is flexed, the fore limbs flex (and the muscles facilitating that, bicep, brachialis, anterior deltoid are contracting) and the hind limbs are extending (relatively), with the glutes maximus, quadriceps, foot dorsiflexors contracting.

-Note that when the head is extended, the forelimbs are extended and the hind limbs flexed. Think about the muscles involved. Upper extremity tricep, anconeus, posterior deltoid, lower back extensors, hamstrings and foot plantar flexors facilitated.
The reflex is based on the mechanoreceptors in the neck articulations and muscles and are frequently used by us and many others in the rehabilitation field. Generally speaking, looking up facilitates things which make you extend above T12, and flex below T12. Looking down facilitates flexion above T12 and extension below.

-We would encourage you at this point to “assume” these positions and feel the muscles which are active and at rest.

-So, how can we take advantage of these while stretching?

-Think about your head position:

-If you are standing up and hinging at the hips to stretch your hamstrings (notice we did not say “bent at the waist”; there is a BIG difference in shear forces applied to your lumbar spine) you would probably want your neck bent forward, as this would fire your quads which would in turn ALSO inhibit your hamstrings, in addition to the STNR inhibiting the hamstring.
-If you were in a hip flexor stretch position, you would want you head up, looking at the ceiling to take advantage of the reflex.
We are confident you can think of many more applications of this reflex and trust that you will, as it can apply to both upper and lower extremity stretches. Just remember that this reflex is symmetrical and will affect BOTH sides.

More effective stretching

-Another way to get muscles to the end range of motion is to utilize a technique called “post isometric relaxation”. Notice I did not say to lengthen the muscle; to actually add sarcomeres to a muscle you would need to use a different technique.

-Contracting a muscle before stretching is believed to take advantage of a post isomteric inhibition (sometimes called autogenic inhibition), where the muscle is temporarily inhibited from contracting for a period immediately following a isometric contraction. This has been popularized by the PNF stretching techniques, such as “contract hold” or “contract relax” . EMG studies do jot seem to support this and actually show muscle activation remains the same or increased after contraction. Perhaps it is due to an increased stretch tolerance.

-The technique was 1st described by Mitchell, Morgan and Pruzzo in 1979. These gents felt it was important to utilize a maximal contraction (using 75-100% of contractile force) to get to have the effect. It was later shown by Feland and Marin that a more minimal, submaximal contraction of 20-60% accomplished the same thing. Lewit felt that a less forceful contraction offers the same results, and combined respiratory assists (inspiration facilitates contraction, expiration facilitates relaxation) with this technique. Interestingly, there are bilateral increases in range of motion with this type of stretching, indicating a cross over effect. Regardless of the mechanism, the phenomenon happens and we can take advantage of it.

-This is how you do it:

-Bring the muscle to its end range (maximum length) without stretching, taking up the slack. This should be painless, as this will elicit a different neurological reflex that may actually increase muscle tone.
resist with a minimal isometric contraction (20-60%) and hold for 10 seconds. You can inspire to enhance the effect.
- relax and exhale slowly. It is important to wait and feel the relaxation. Stretch through the entire period of the relaxation. You should feel a lengthening of the muscle.
-repeat this 3-5 times

#stretching #stretchingexercises #postisometricrelaxation

More on stretching.

-If there is a symmetrical tonic neck reflex, then there must be an asymmetrical one as well, eh? That is the topic of today's discussion.

-The asymmetrical tonic neck reflex was 1st described by Magnus and de Kleyn in 1912. Like in the pictures above, when the head is rotated to one side, there is ipsilateral extension of the upper and lower extremity on that side, and flexion of the contralateral (the side AWAY from where you are rotating) upper and lower extremity. Take a few minutes to see the subtleness of the reflex in the pictures above. Now think about how this occurs in your clients/patients. The reflex is everywhere!

-The reflex persists into adulthood and is modulated by both eye movement and muscular activity. When there is neurological compromise, the reflex can be more prevalent, and it seems to arise from the joint mechanoreceptors in the neck and its connection to the reticular formation of the brainstem. It may modulate blood flow and cardiovascular activity as well.

-So, how can we take advantage of this? We could follow in the footsteps of Berta Bobath and incorporate these into our rehabilitation programs, which we have done, quite successfully. But rather than read a whole book, lets talk about how you could incorporate this into your stretching program.

-Let’s say you want to stretch the right hamstring:

-actively rotating the head to the right facilitates the right tricep and right quadricep AND facilitates the left bicep and left hamstring
through reciprocal inhibition, this would inhibit the right bicep and hamstring AND left tricep and left quadricep

-To get a little more out of the stretch, you could actively contract the right tricep and quadricep (MORE reciprocal inhibition), amplifying the effect

-We encourage you to try this, both on yourself and your clients. It really works!

Wow, isn’t neurology cool? And you thought it was only for geeks!

The Gait Guys. Giving you info you can use in a practical manner, each and every post. Be a geek. Spread the word.

#tnr #tonicneckreflex #stretch #stretching #assymetricaltonicneckreflex

Want more stability when trail running (through snow)? Try this… snow running

When running through about 6-8” of fresh snow, something may occur to you, especially if you lose your balance: Improve your proprioception!

Here is what you can do:

First, I spread your toes. Maximize the real estate available to your feet in your shoes?

Next, widen your stance (or base of gait). Your weight spread over a larger surface area will be more stable and provide stability being distributed over a larger surface area.

Third, raised your arms out from your sides (no, don't try to fly) to provide more input from your upper extremities to your proprioceptive system (more input from peripheral joint and muscle mechanoreceptors = more input to cerebellum = better balance)

Lastly, slowed down from your blistering pace. Though this will not improve your surface area, it will give your aging nervous system more time to react.

These actions were all “primitive” reactions of the nervous system when learning to walk.

Want to have better balance?

Spread your toes
Widen your stance
Raise your arms
Slow down
Notice I didn’t say this would make you faster. Who is more likely to fall on a corner when being chased by a predator; the tortoise or the hare?



A little practical neurology for you this morning brought to you by the geeks of gait.

#gait#running#balance#proprioception#neurology#workout#practicalneurology

more tibial torsion = a change in progression angle.

How does tibial torsion impact the development of the foot progression angle?

Stratifying the data by Foot Progression Angle (FPA) revealed there were significant differences in tibial torsion among the groups and provided evidence that tibial torsion influences the direction and magnitude of the FPA. Offsetting torsions between the tibia and femur were more common in people with higher and lower FPA and had clearer patterns where the tibia tended to follow the direction of the FPA.

So, got that? The foot progression angle follows the tibial torsion...

Why do we care?

the greater the “kickstand” angle to the foot, the more we progress through the mid foot (rather than from the lateral aspect of the heel, up the lateral column, across the transverse metatarsal arch and through the 1st ray). This causes more mid foot pronation and more medial knee fall, resulting in gait inefficiency and often times in our experiences, increased knee pain.

Gait Posture. 2016 Sep;49:426-30. doi: 10.1016/j.gaitpost.2016.08.004. Epub 2016 Aug 3.
The rotational profile: A study of lower limb axial torsion, hip rotation, and the foot progression angle in healthy adults.
Hudson D1.

#foot #progression #angle #internal #tibial #torsion #external #gait

-Lateral knee pain in a Nordic skier

Take a good look at these pictures and what do you see?

-In the first picture, when his knees are in the sagittal plane, note the position of his feet. He has very cavus arches and a steep first metatarsal angle. There is a mild forefoot varus present.

-In the second set of pictures, note the position of the knee when the feet point straightahead, like they would be when skiing or slightly angled outward like they would be with Nordic skate skiing. Can you see how the knee points way outside of the sagittal plane? Can you imagine somebody pushing off in a skating motion and trying to push off of this knee? Talk about patello femoral discomfort and tracking issues!

-Of other significant note, he has an anatomically short left leg which is tibial.

-Remediation included making sure he could get his first ray down to the ground along with a 3mm full length valgus post in his left boot which will push the knee somewhat medially as he pushes off, as well as compensating partially for his leg length discrepancy. We will see how he does…

#internal#tibial#torsion#internaltibialtorsion#kneepain#crosscountryskiing#valgusposting

Snow pedographs: part 2

Part 2. from Terry B !
Picture 2 is the result of three teenagers jogging past me. Bad habits start early – all three crossing over, with a couple feet turned out. And this was uphill, so I assume it’s worse (if anything) on a flat surface?

Take care guys – appreciate all you do!

It is nice to have our students write posts for us. ! Come join us and Terry B weekly for Masterclasses, case discussions, videos, etc. The stuff we do not share here, frankly, the real juicy stuff !
Brillant. Terry !
love ya. !

Foot progression: snow pedographs

Simply fine work from one of our non-medical followers on patreon. Terry B from Northern Virginia, he calls himself an armchair enthusiast, is clearly learning serious stuff from us on Patreon. He has been with us since 2013 ! He is the bomb ! Here is what he sent us yesterday, a 2 part post.

"Thought you guys might find this interesting: The early part of a snowstorm gave me a window into how some neighbor gait tendencies.

Picture 1 is what caught my eye first – a progression angle of upwards of 45 degrees. I’ve seen people walking this way and it’s still always hard to believe that every step isn’t causing knee pain. (Those fresher prints on the left are me – I tend to feel like I’m on the borderline in terms of crossover. Trying to work on it.)
Take care guys – appreciate all you do!

Increased Proprioception

Last night we did our monthly lecture on onlineCE.com. We discussed shoes and biomechanics and we even inserted some neurology like we always do. In this slide you will see joints and tissue receptors. When we were socks and shoes we mute the sensory input into the CNS. Alter input means altered output. And that might mean altered functional stability. It’s always important to remember these things when considering the most appropriate footwear for a person and their problems. Obviously in discussing minimalistic shoe WHERE LAST NIGHT WE DISCUSSED THE BENEFITS AND DRAWBACKS. THERE IS NO FREE LUNCH. SOME PEOPLE CANNOT AND SHOULD NOT GO INTO MINIMALISTIC SHOES. WE DISCUSSED THESE ISSUES AND RISKS IN THE SEMINAR. AS ALWAYS OUR COURSES ARE CATALOGUED OVER ON ONLINECE.com.

The valgus orthotic posting

Sometimes we employ a valgus post to assist people in getting the head of the first Ray down to the ground when they have adequate range of motion but don’t appear to use it. We would caution that you would not want to use this with somebody with a rigid forefoot Varus or forefoot supinatus as this would cause excessive forefoot pronation.

Note how the post runs from just behind the tail of the fifth metatarsal up to the distal aspect of the phalanx on the fifth and tapers from lateral to medial under the head of the first.

Consider using a valgus post if you were not able to adequately train somebody to get the head of the first down as a temporary measure and physical cue.

#valgus #valgusposting #valguspost #1stray #orthotic #orthotics #orthoticmodifications #orthoticmodification

Can you guess why she has knee pain?

Take a good look at the two photos. In the second photo you can see that when her knee is straight in the sagittal plane her foot is externally rotated. Yes, she has external tibial torsion to a pretty severe degree. The normal angle is 12 to 18° and hers is 45. When you try to line the feet up, and knee falls to the inside and creates patellofemoral problems.

In orthotic with an aggressive arch and support under the sustentaculum tail can make a big difference with her progression angle.
#ett #externaltibialtorsion #kneepain #tibialtorsion

Knee pain when skiing ?

Why does this dude have knee pain when he skis?

-This patient presented with knee pain, right greater than left when skiing both cross country and downhill as well as knee pain with walking long distances. Can you figure out why?

-This patient has external tibial torsion. Drop a plumbline from the tibial tuberosity and you’ll see that it passes medially on the foot increasing his progression angle. When his feet are straight (2nd picture) his knees fall to the inside creating patellofemoral discomfort and problems.

-have trouble spotting this?
-Join us tonight on onlinece.com for biomechanics 301. This lecture will cover the basics of gait and evaluation helping you to determine normal from abnormal.

#gait #gaitanalysis #ett #externaltibialtorsion #tibialtorsion #clinicalexam #kneepain

Can you guess why this patient has lateral heel pain?

This gal presented with pain on the lateral aspect of her heel, as opposed to the medial calcaneal facet, after hiking, longer than four hours. The discomfort comes on, stays with her for the next few days and then dissipates

Take a good look at her foot. She has a moderate hallux abductovalgus which tells you that she has either a forefoot supinatus or forefoot varus. This means that she cannot get The head of her first ray to the ground which means that she will have to overpronate through her midfoot; this will cause tension in the plantar fascia. She also has limited ankle dorsiflexion and hip extension on that side that compound the pronation problem

OK, so why lateral rather than medial pain?

As you can see, she has weakness of the long extensors and extensor hallucis brevis and very little promontory control. She has to get into her long flexors to try to control pronation in her foot which is a common strategy. The quadratus plantae, which takes its origin from the lateral calcaneal facet as well as attaching to the flexor tendons to augment their pull. They will be called into action and hers is overactive. She had tenderness to palpation at the quadratus insertion deeply with little palpable activity during active testing of flexion of the toes

The fix?

She was given shuffle walk exercise along with toe waving exercises in an attempt to increase extensor activity as well as for the sink the head of the first Ray. Peroneal activities will be added. We did acupuncture of the quadratus plantae and long extensor origin/insertions.

#FootPain#PlantarFasciitis #PlantarFascialPain#QuadratusPlantae #Gait#GaitAnalysis #FootExam