READY

The Gait Guys Case of the week: What do you see?

This individual presents with Right achilles tendonitis, bilateral foot pain and a history of plantar fascitis. What do you think?

Take a look at his foot type, particularly the forefoot to rearfoot orientation. Hmmm….Asymmetrical. Notice the dropped 1^st metatarsal on the left that is not present on the right. He has a forefoot valgus on the left with a quasi flexible 1^st ray (1^st ray = medial cuneiform, 1^st metatarsal and associated phalanges) which is dropped and an uncompensated forefoot valgus on the right, with an inflexible 1^st ray.

He has bilateral external tibial torsion (which you cannot see in these pictures) right greater than left (OK, you can see that), as well as a Left anatomically short leg (tibial) of approximately 7mm.

Now look at the pedographs. BIG difference from left to right. Good tripod on right with clear markings over the calcaneus, the head of 5^th metetarsal and the head of 1^st metatarsals.  But I thought you said he had an UNCOMPENSATED forefoot valgus ?  Look at the shape of the forefoot print. It is very different from right to left. Remember, with a forefoot valgus, the medial side of the foot hits the ground before the lateral side most of the time,

How about the left? Look at all that metatarsal pressure. Looks like a loss of ankle rocker. Think that might be causing some of that left sided foot pain? Notice the print under the 1^st metatarsal is even greater; and look at all that printing of the 5^th metatarsal head. Remember, this is the shorter leg side, so this foot will have a tendency to supinate more, thus he increased pressures laterally.

Achilles tendonitis?  Stand on one leg on your foot tripod and rock between the head of your 1^st metatrsal and head of the 5^th.  Where do you feel the strain? The gastroc/soleus and peroneals. Now put all your weight on the lead of the 1^st metatarsal. What do you notice? The foot is everted. What everts the foot? The peroneals. So, if the foot is everted (like in the forefoot valgus), what muscle is left to shoulder the load? Remember also, that the gatroc/soleus group contracts from mid to late stance phase to invert the heel and assist with supination of the foot.

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All material copyright 2012 The Gait Guys/The Homunculus Group.