Stage 1 of Correcting a flat foot, video demonstration.
Here is a case of a young man that was brought into us by his parents. Their concern was that their son was displaying what they thought was foot weakness.
At the beginning of the video you can see that his foot progression angle is significant. Certainly greater than the 10-15 degree “so called” normal range. His arches are also somewhat collapsed. His knees were also displaying some hyperextension which is quite common with flat foot posturing.
This was his third visit into our office. He was given the corrective neuromuscular strategy that you see here and some specific exercises to help him get to this stage of correction. The first stage of any correction is developing the awareness of what you are doing wrong (ie. become consciously aware of your incompetence). That was session one. Session two focused on developing this corrective pattern, helping him find the skills to develop some conscious competence with a more normal foot stability skill pattern (endurance and strength still need to be added).
Here you will see that, when queued, he immediately moves into a narrower base of stance (this will always happen when they can form a competent foot tripod, as you can see here). In other words, the worse the foot collapse, the wider the feet will be positioned. In his case, he now positions his feet under his hips and knees.
You will also see the early success (after just 2 visits !) of a critical neuromuscular pattern. He is showing some competence in holding the arch up and letting the toes move into flexion onto the ground. Most flat footed children cannot separate “maintaining arch up, and moving into toes down”, rather they are into the pattern of “when the toes drop to the floor, the arch drops as well”. This is a critical pattern (ability to hold arch up) to recognize and develop. The child must develop the ability to independently flex and extend the toes on a static arch, while holding tripod, before gait retraining can ensue. This is mainly because the speed of gait and difficulty of single leg stance while displaying the correct pattern is just too much of a skill mastery issue. Often these pupils do not have enough hip frontal plane stability nor pelvic stability as well.
Also, note that he uses the skill of toe extension to help with arch height determination. This goes right back to our blog posts last week on the Windlass Mechanism. He is using the power of the windlass effect (toe extension) to take up the slack in the plantar fascial around the great toe metatarsal joint and thus pull the rear foot towards the forefoot (ie. raising the arch via this mechanism ! ). Without a competent windlass a competent arch cannot be obtained (thus the ridiculousness of plantar fascial release surgery !). Additionally, understanding the windlass and the effects of this simple video should give you insight into our success in quickly treating plantar fascitis.
(addendum: also note at the end of the video that i ask him to collapse into his old pattern, this was after 30 minutes of corrective motor pattern exercises. I laugh because in a solid posture that he shows at the end of the video, plus 30 minutes of new patterning, he found it difficult to find his old collapsed pattern. This is a frequent occurance ! It gives you and the patient confidence that headway is being made.)
You must develop isometric, eccentric and concentric strength of the plantar intrinsic muscles that stabilize, raise, and control the lowering of the arch (as well as the arch controlling extrinsic muscles such as tibialis anterior and posterior among others) if you are going to make a difference in someones foot mechanics. Just putting someone into a pair of ANY minimalist shoe (let alone barefoot) doesn’t guarantee strengthening of the foot or a remedy for a pair of feet like in this video. The process is a little more complicated than slipping on a pair of low ramp angle “shoes” and wearing them all day long…….in these types of cases all it does is raise their risk of injury or further foot incompetence down the road.
For our fellow clinicians out there who are following us and trying to learn more about this kind of stuff……. wouldn’t your clinical world be nice if just prescribing a minimalist shoe would strengthen the foot in the correct pattern !? We argue that, as in this kids foot, they would strengthen his foot in his poor postured patterns. So, we guess these companies are not lying when they say their shoes “strengthen” your feet, they just leave out the word “correctly”.
So, we do not argue with the point that going minimalist will strengthen your foot…… the question is “do you want to strengthen the correct pattern or a compensated one?”.
here at The Gait Guys…….we know which pattern we want to strengthen.
We remain strong advocates that not all feet belong in minimalist shoes…… at least not initially, and some, never. It would be nice if just slipping on a shoe could fix all of your foot problems, but it just isn’t that easy. This is the topic no one is talking about, except The Gait Guys ……… because it doesn’t sell shoes.
There is much more to it than this video shows……. but we have to start somewhere. Educating you with the issues we feel passionate about is the first step sometimes.
We remain…….obviously passionate………..
Shawn and Ivo….. The Gait Guys