Excessive Supination in a marathoner: Shoe Photos !
Simple visual case today.
Look at the right shoe, can you see how it is canted laterally? Can you see the inversion of the rear foot ? Without a foot in that shoe it means that “the last”, the heel counter and the EVA foam are all destroyed and deformed into this great runner’s compensation pattern.
They did not have pain however can you determine the problem here from the photos ? We hope your answer is no. We did a teleseminar last night on www.onlineCE.com on pedograph foot mappings and we talked long and hard about the possible limitations of determining foot problems from foot pressure mappings from things like pedographs and pedobarographs. Do you use foot scanners ? If so, user beware ! They gather vital and valuable information that you absolutely need but you need the critical clinical information from the client examination to bring the foot issue info full circle.
In this case there was a significant limitation in hip rotation. Which one ? Can you theorize ? If you said internal rotation you are right. There was a notable loss of internal right hip rotation in his marathoner. And it is represented in his shoe photo above. Someone who has a loss of internal hip rotation will often (but not always) have difficulties achieving the normal foot pronation required for clean foot mechanics, they will be stuck in a supination tendancy. If loss of internal rotation can mean loss of pronation then in this case ample external rotation meant excessive supination (or at the very least rear foot inversion). Hence the shoe presentation described at the beginning of this post. (Note: this is what we would refer to as a “Flexible” Rear foot Varus posturing).
So, is this the wrong shoe prescription for this runner ? No, the shoes were prescribed correctly. This is a biomechanical breakdown of a shoe because of a hip functional problem.
Solution: Dump the shoes for a new pair and quickly restore hip function. Keeping these shoes in the mix will promote the bad pattern. In this case, functional movement and muscle tested assessments revealed specific weakness of the right lower transverse abdominus, right internal abdominal oblique, right TFL, right vastus lateralis and coccygeal division of the g. max. Yes, all INTERNAL HIP ROTATORS or stabilizers or synergists of internal hip rotation. Immediate post treatment remedy revealed near full internal hip rotation and homework was prescribed to ramp those said muscles up further to support the new movement.
If he had remained in this shoe, the breakdown in the shoe would continue to promote the biomechanical deviations into the previously engrained faulty motor compensatory pattern.
Shoes, sometimes they are the problem, sometimes the solution and sometimes caught somewhere in between.
Need to get better at this stuff ? Just follow us daily here on The Gait Guys or consider adding the National Shoe Fit Program to your repertoire ! Email us if you are interested or need some help with your interesting cases !
Shawn and Ivo, The Gait Guys