What can we glean about this person from this pressure sensitive foot scan ? Remember, no examination possible here so lets see what we can assume is happening. These kinds of mental aerobics help keep us clinically sharp and help us pick out subtle patterns in someone gait when we do gait assessments …. so that we can prove them or disprove them on the table during our exam. Remember, for this case, the person is standing, not moving through the gait cycle like in a normal pedograph mapping or F-Scan (hence making an orthotic or true and accurate assumptions from this type of static scan would be really silly … but alot of people and companies do it ! Sadly.)We are presenting this case for the means of mental stimulation and observation only.
Increased foot pressures on the lateral aspect of the right foot. One possibility here is that there could be a short right leg here (anatomic or functional) and the person is supinating to lengthen the limb. Remember, supination creates a lift in the talus height because the foot is in relative plantarflexion, adduction and inversion and the limb is moving into external rotation, this will all increase the length from foot to pelvis. In contrast the flat foot has internally spun the limb and the foot is dorsiflexed, abducted and everted.
Both feet have reduced medial plantar pressures but remember this is a person standing and not moving through the gait cycle so do not make too many functional assumptions. Some people who have weaker feet and slightly incompetent arches will often stand on the outsides of the feet because the foot is more supinated and rigid, hence more stable from a joint “lock out” perspective. People with weakness will always opt for FORM closure (closed packed joint) over FORCE closure (muscular joint compression stabilized joint).
Increased flexor hallucis brevis and longus (FHL and FHB) use of the big toe on the right. This appears to be balanced. If FHB dominated the red would be more proximal on the digit. If FHL were more dominant, the red would only be at the tip. This imbalance is easy to pick out on a pedograph and in callus patterns on the big toe (do not mistake this callus pattern we are talking about with a medial pinch callus on the inner edge of the big toe, this is from something different … that is another post another day). In contrast, this person has little left FHL or FHB use. This doesn’t bother us too much, but the increased right lateral foot pressures and the increased forward forefoot pressures (more RED on more of the toes on the right) tells us this person is supinating the foot and increasing overall plantar grip-type pressures. Remember Newtons 3rd Law…… for every force there is an equal and opposite reactive force, so more plantar pressure means more upward force into the limb. This could possibly be to help increase more gluteal activity. This leads us to #4.
Newton’s 3rd Law. The increased right plantar and supinatory pressures are going to likely activate more gluteal function. Get up from your chair and take a few steps. And when you do, push your right foot into the ground more firmly than normal. Do you feel the glute function increase ? You should. Especially note the gluteus medius drive the pelvis medially (this is one of our tricks to help people arrest the frontal plane drift and reduce cross over gait in running).
We would have normally said that the increased right toe pressures (RED) would have meant more forefoot loading in this stance but we do not see a reduced heel pressure so that means they are actively using more flexor dominated strategy. Increased digit flexion will help to drive the arch upwards from the bottom (as opposed driving the arch up from lift (tibialis anterior & posterior).
Otherwise this is a pretty normal looking foot. IF you measure the width of the foot at the narrowest part of the waist you will see that the right is a little wider (and there is more blue). This could mean that this foot is a little weaker intrinsically and could be one that pronates more in gait or is just a little more pronated here (hence the supination evidence as layed out above). Thus, this could give us good reason to assume the right RED plantar increases … meaning, this person is working harder on the right to work out and avoid pronating. Everything we said above seems to fit this ASSUMPTION.
Hope this was a nice little exercise in observation and mental juggling.
By the way, Juggling is a great mental exercise….. A Princeton researcher, Les Fehme suggested we can optimize our overall performance in life by broadening our focus. Juggling is one excellent way to do that. He claims most people have a narrow focus, a lack of awareness of their own body sensations or emotions. A recent CNN report suggested juggling increases the amount of grey matter in areas of the brain that process and store visual information, proving what was not thought possible – that new stimuli can alter the brain’s structure. A comparison of brain-imaging scans of non-jugglers and other volunteers before they learned to juggle and three months later, revealed an increase in grey matter in certain areas of the newly trained jugglers’ brains.
And so … thanks for juggling with us today. We hope you did not choose to use chainsaws or Ron Popeil knives (“Wait, there’s more! We’re going to double your order!”). Wanna get a little crazy driving more brain grey matter integration ? Try running while juggling, if you dare ! We recently heard of a guy that broke a record running a recent marathon juggling 3 balls the entire time. Who has time for this shenanigans ?! We have troubles getting our laundry done.
Ivo and Shawn ….. your jugging court jesters. Jester, hmmmm … perhaps a good label for us. Sounds like it was a fun job.
(define: A jester, joker, jokester, fool, wit-cracker, prankster, or buffoon was a person employed to tell jokes and provide general entertainment. Jesters are stereotypically thought to have worn brightly colored clothes and eccentric hats in a motley pattern. Other things distinctive about the jester were his laughter and his mock sceptre, known as a bauble or marotte.)
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