Foot orthoses and landing mechanics
In Part 1 of this two part series (Part 1, link here) we wrote about the need to not omit observations of gluteal function when it came to the utilization of foot orthotics to control the knee. We felt that a tunnel vision perspective on just the foot was only telling half the story. Admittedly, we made the comment that research articles can look at isolated issues if it pleases them, but that it was our mission not to let tunnel visioned biases enter into things. Tunnel vision leads to assumptions that some problems have simple solutions. Our clients get evaluated through the entire kinetic chain when looking at foot and knee issues. Heck, even arm swing and opposite leg swing impact the function of the stance phase knee.
Here is again is the original article by Katie Bell over at LER (Lower Extremity Review) that brought up the initial PART 1 dialogue back in January and that is spurring Part 2 here today. It was good information but left some gaps in theory and application in our opinion.
The gap in our opinion is in failing to mention that perhaps this landing mechanics problem is present because of intrinsic foot weakness and kinetic chain cooperation of the entire limb and pelvis-core. One must remember that if the foot can be corrected or merely strengthened in a more functionally neutral manner that it should be a first line intervention. Merely inserting an orthotic, custom or off the shelf pre-fab does nothing to correct intrinsic and extrinsic weaknesses. They are an external device to correct alignment issues. Just because you put an orthotic in a shoe does not mean that the foot must function properly afterwards. A flat weak foot might just sit flat and weak upon the orthotic and nothing more. Sure it will be on a new platform and with different alignment, but there are no guarantees it will function better. The foot might just figure out a new way to compensate in another manner. Even worse, the foot and lower limb might be completely foreign in strategy, skill, endurance and strength in this new position and thus at even greater increased risk for injury than the one you tried to correct with the device in the first place. Just because you toss an intervention at something that should make a difference or create a result, does not mean it will occur. Just because you put a beer in someone’s mug does not guarantee they will drink it. That is the intention, but the outcome is not guaranteed, they might drink it but they also might not. Heck, they could even spill it (ie. compensation … undesirable outcome !). Just because the platform is different, new and possibly more optimal does not guarantee they will have the Skill, Endurance or Strength (S.E.S. - the mantra of The Gait Guys) to function any differently than before. This is why, when we choose to reach for an orthotic, that we educate the client on what it is doing, and how to treat it like any other piece of therapy. Meaning that it is to help reach an end goal, and when possible it is weaned away or minimalized to the new levels of S.E.S.
Now, back to the topic at hand.
This article talks about the hip adduction in females and mentions that it is not present in males but fails to even talk about possible reasoning behind this gender specific finding. Why wasn’t changed Q-angle in females talked about here ? Perhaps that was a discussion in the studies and merely not mentioned here.
The article also fails to talk about failed landing mechanics at forefoot load. When we load returning to the ground from a jump, we first load the forefoot. If the peronei and lateral calf are not strong enough to hold the rearfoot and forefoot in eversion at landing, making sure that the forefoot bipod is squared up at initial contact, the foot will be at a huge risk of inverting and spraining ligamentous tissues (esp. lateral restraints) as the load transitions from forefoot to rearfoot upon landing.
Think about all of this the next time your foot is in the air and quickly approaching the ground. If you are into a forefoot landing technique in your running, how is your forefoot landing platform ? is it flat ? Are you hitting laterally and risking injury or faulty mechanics ? Is your foot landing too medially and challenging the foot tripod prematurely ? Are you falling into the orthotic if you are using one ? Or are you merely using it as a crutch to improve your landing mechanics ? And……. do you even truly need an orthotic at all ? Or did your $ 500+ merely make for a nice mortgage payment on someone’s new boat ?
Orthotics …. they have value at times. Do you know when and how to implement them and when to hold off ? It is a tough game, you have to know the rules.
Shawn and Ivo