A foot bump. What might this be, and mean?

Screen Shot 2019-02-23 at 7.27.35 AM.png

A foot bump.
We see this kind of thing all the time. This is a fixed pes planus (flat foot). When we dorsiflex the big toe, the arch does not go up as you see in the photo. That is passive dorsiflexion, if the arch does not go up passively, there is no way you are actively going to achieve this. And, using an orthotic to "attempt" to raise this arch is not only pointless, but it is futile and it will likely cause them pain. This arch does not rise, no matter how hard you put up into it. The bump, that is the navicular bone, and its associated arthritic build up at the adjacent joints, and likely soft tissue accomodation/hypertrophy. You can't needle, ultrasound, tape, adjust or rub this bump away, so stop wasting your and your patient's time selling them that wasteful thinking. It ain't gonna happen.
This is what happens when someone earns a collapsed longitidinal arch, the 1st metatarsal no longer plantarflexes (arch up) and it becomes fixed in dorsiflexion, thus affecting the mechanics at the proximal aspect of the 1st ray complex (navicular-cuneiform-met intervals).
Why? This happened because this client has significantly compromised ankle mortise dorsiflexion, and they chose to find it at the next joint complex distally, as mentioned above. So, they are finding pseudo-ankle rocker at arch collapse? Yes, we discuss this often, more pronation will advance the tibia forward. It is not desirable, but moving forward has to occur, and some people have no choice but to find it from excessive internal rotation and pronation of the limb. And this is what happens when it happens over years. Now the deformity is painful itself in the shoe, it is a new set of problems for this client.
Can this problem occur in reverse ? Yes, a loss of hallux dorsiflexion can afford the same end result.
We have a rule, at the very VERY least, check the joint above and below the area of problem/symptom. Often you will find another piece of the puzzle causing your client's pain.

Right arch pain, can you see a possible reason in this video?

Do you see a possible reason for right foot pain? There is something not kosher to be seen. It doesnt mean it is valid, or the cause, or that it is primary or secondary, but it should be something that cues up a clinical exam focus to rule in/rule out.
Answer below (don;'t read further, test yourself)
.
.
.
.
.
.
.
.
.
.
.
the right hallux does not fully extend. And we know that hallux dorisflexion at the 1st MTP joint engages the windlass, and helps to plantarflex the 1st MET and raise the arch and prepare the foot for loading and for forefoot transition. If the hallux doesn't extend sufficiently (like in a hallux rigidus, painful turf toe etc) then we can have some loading issues. Just something to think about. In this case, it was the cause and answer. But might not always be such.

The knee follows the arch/ankle.

*in the video, watch the left knee
Hopefully this video and post will make you think deeper about patellofemoral tracking, runners knee, meniscal issues and anterior knee pain syndromes as a whole.

This is subtle, but in this case, this is relevant to the LEFT knee complaints of this client.
When the foot complex is a little weak, the arch can collapse more than it should, rendering too much pronation, this means the talus will adduct, plantarflex and medially rotate more than it should. Since the tibia sits on top of this talus it must follow. This will allow more internal tibia spin (medial rotation) and this will drag the knee medially (it appears in the video to be a valgus load but it is more internal/medial rotation than valgus).
So, what the foot-ankle complex does, the knee follows. Conversely, when the knee moves medially or valgus because of a hip weakness (poor external rotation control) the foot will move medially.
So, are you going to "fix" this with an orthotic ? A stability shoe? Or are you going to actually help the client gain better control ?
You can see that our "raise the toes, to raise the arch" helps the client find the more appropriate arch posture with the help of more anterior compartment engagement and windlass effect at the 1st MPT-hallux joint. This is where our reteaching of the component parts via "motor chunking" via the Shuffle Walk (see our youtube channel) can help them control the rate and amount of arch "collapse" and thus control the rate of medial knee spin.
i say it on our podcast all the time, the knee is a simple sagittal hinge joint between 2 multiaxial joints. It is often a follower, not a leader.
Or you can bandaid this client with an expensive orthotic and never fix their problem. This keeps them coming back over and over for symptom management. It is a good business model (insert sarcasm), but helping this client learn and remedy their deficiency is a better one. Happy people talk to their friends, even strangers.

Shawn Allen, the other gait guy

#gait, #gaitproblems, #gaitanalysis, #ovepronation, #archcollapse, #valgusknee, #tibialspin, #internalhiprotation, #thegaitguys, #kneepain, #runnersknee, #patellapain, #anteriorkneepain

You need toe extension, more than you might think.

Screen Shot 2018-07-20 at 9.24.08 AM.png

There is a major difference in these 2 photos.One foot is ready for foot loading, the other has one foot over the starting line, and is going to possibly have the risks related to inappropriate loading.

In clients with one of several possible issues related to poor control of the arch during weight bearing loading, it is not all too uncommon for us to bring to their attention that not only do they NOT utilize toe extension appropriately, and at the right time, they just simply have poor strength and endurance of the toe extensors (we will not be bringing up the complicated orchestration of the long and short toe extensors today, lets just keep it loosely as looking at them as a whole for today).

We know we say it an awful lot, that clients need more toe extension endurance and strength. But more often than not, they need more awareness of how little they are actually using their toe extensors during foot loading. This is why we despise flip flops and foot wear without a back strap on them, the flexors have to dominate to keep the footwear on the foot.  And, if you are into your toe flexors, you are definitely not into your toe extensors.

Screen Shot 2018-07-20 at 9.23.54 AM.png

You can easily see in this photo that there is a major difference in the integrity and preparation of the foot arch prior to foot loading in these 2 sample photos. One the toes are up in extension, the other the toes are lazy and neutral.  The toe up photo demonstrates well that when the toes are extended, the Windlass mechanism draws the forefoot and rearfoot together and raises the arch. Go ahead, lift your toes, it will happen on you as well (unless your arch is so collapsed that the first metatarsal actually dorsiflexes during toe extension, in this case, you are a whole different management tier). From this arch raised position, the first metatarsal is adequately plantarflexed, this means the joint complexes proximal and distal to the metatarsals are all in the right position to load and cope with loads. In the toe neutral picture, these components are not prepared, the arch is already getting ready to weight bear load from a half-baked position. One cannot expect the foot complex to load well when it is starting from a position of "half way there". One should start the loading of the foot from the starting line, not 3 steps over the line and not 3 steps before the starting line.  There is no athletic or mechanical endeavor that does well when we start the challenge too soon or too late, timing is everything.

How you choose to prep your foot for contact loading, and yes, there is some conscious choice  here, one is lazy the other is optimal, can determine to a large degree if you or your client is about to fall into the long list of problems related to poorly controlled pronation (too much, too soon, too often, too fast). Any of those bracketed problems lead to improper loading and strains during time under tension.

We will almost always start our clients on our progressing protocol of arch awareness and we will loosely say arch restoration, and attempts at better optimizing the anatomy they have, with toe up awareness.  Many clients will have poor awareness of this component issue, on top of poor endurance and frank weakness. The arch is to a great degree build from a lifting mechanical windlass effect, from the extensors and foot dorslflexors, not from the foot flexors. This is one of our primary beefs with the short foot exercise of Janda, there needs to be a toe extensor component in that exercise (search our blog for why the short foot exercise is dead). The short foot exercise is not actually dead, all exercises have some value when placed and performed properly, but the short foot exercise is based off of the toes being down and utilizing the plantar intrinsics to push the arch up and shorten the foot, this is a retrograde motion and it is not how we load the foot, but, it does have value if you understand this and place it into your clients repertoire appropriately.  This is also why we have some conceptual problems in stuffing an orthotic under someones arch to "lift it up", ie. slow its fall/pronation.  There are times for this, but why not rebuild the proper pathways, patterns and mechanics ?

Teach your clients about toe extension awareness. TEach them that they need to relearn the skill that when the toes drop down to the ground that the arch does NOT have to follow them down, that the client can relearn, "toe up, arch up . . . . . then toes down, but keep the arch up".  IT is a mantra in our office, "don't let your arch play follow the leader".  Reteach the proper neurologic disassociation between the toes and arch.

Perhaps the first place you should be starting your clients with foot and ankle issues, is regaining awareness of proper toe extension from the moment of toe off, maintaining it through swing, and then keeping it until the forefoot has purchase on the ground again, and not any time sooner than that ! If their toes are coming down prior to foot contact, it is quite likely their arch is following the leader.

So, if your client comes in with any of the following, to name just a few:  tibialis posterior tendonitis, plantar fascitis, heel pain, forefoot pain, painful bunions, arch pain, hallux limitus, turf toe, . . . . and the list goes on. Perhaps this will help you get your client to the starting line.

Shawn & Ivo, thegaitguys.com

 

Ankle stiffness and foot collapse, correlation ?

A client who comes in with calf tightness and ankle stiffness can't be clumped into the catch all group that they need more ankle rocker or to just stretch out the posterior mechanism.

Screen Shot 2017-03-02 at 7.57.05 AM.png

In all likelihood they probably don't have a stable enough foot/arch and are passing their body mass over that unstable structure, collapse ensues before ankle rocker is completed during stance phase of gait. Thus, the body goes into a strategy the next joint complex up the chain and attempts to gain stability at the ankle complex and the most available tools, the posterior mechanism. The foot should be stable and the ankle should be mobile through sagittal ankle rocker. When the foot is unstable, things often switch; the once mobile ankle rocker shifts towards stability attempts. Not everyone needs ankle rocker work ! Don't force it, make them earn it once you find the root of the problem. In a huge chunk of the population, that stiffness and loss of ankle rocker is there as a coping mechanism to find stability. Don't take it away from them ! 
PS: raising someones arch with an orthotic doesn't earn any stability, it is borrowed, it is false, so keep that in mind. Not that it doesn't have value or a purpose, but nothing has been intrinsically fixed, only extrinsically and that cannot be forgotten. Someone has to pay for these loads coming into the system.
-Dr. Allen's rant of the day

Eliminating the fake out of ample ankle rocker through foot pronation in the squat and similar movements:  How low can you go ? 

This is a simple video with a simple concept. 

* Caveat: To avoid rants and concept trolling, am blurring lines and concepts here today, to convey a principle. Do not get to tied up in specifics, it is the principle I want to attempt to drive home.  What you see in this video is clearly more lunge/knee forward flexion rather than hip hinge movement. However, keep in mind, that this motion does occur at the bottom of many movements, including the squat. 

You can achieve or borrow what “appears” to be more ankle dorsiflexion, a term we also loosely refer to as ankle rocker, through the foot, foot pronation to be precise. Do not mistaken this extra forward tibial progression range as ankle rocker mobility however. When you need that extra few degrees of ankle dorsiflexion deep in your squat, or similar activities, you can get it through your foot. Often the problem is that you do not think that is where it is coming from, you might just think you have great ankle mobility.  Many deep squatters are borrowing those last few degrees of the depth of the squat from the foot. This is not a problem, until it is a problem.  Watch the video above.  Why ? Because when the foot pronates and begins to collapse (hopefully a controlled collapse/pronation) the knee follows. Forcing the knees outward in a squat like some suggest is a bandaid, but I assure you, the problem is still sitting on the table. 

Go do a body weight squat with the toes up like in this video. Toes up raises the arch from wind up of the windlass and increased activity of the toe extensors and some assistance from the tibialis anterior and some other associated “helper” muscles.  When the arch is going up, it cannot go down. So, you raise your toes and do your squat. This will give you a better, cleaner representation of how much mobility in your squat/lunge/etc is from ankle dorsiflexion, knee flexion and  hip flexion. You can cheat and get some from the foot. The foot can be prostituted to magnify the global range, and like I said, this is not a problem until it IS a problem.   We know that uncontrolled and unprotected increases in foot pronation can cause a plethora of problems like plantar tissue strain, tibialis posterior insufficiency and tendonopathies, achilles issues, compression at the dorsum of the cuneiform bones (dorsal foot pain) to name a few. This dialogue however is not the purpose of this blog post today. You can read more about these clinical entities, proper foot tripod skills and windlass mechanics on other blog posts on this site. 

Today, we just wanted to bring this little “honesty” check to your awareness. Has been a staple in my clinic for over a decade, to help me see where limitations are and to show folks how they can cheat so much through the foot. Go ahead, try it yourself, see how much you use your foot to squat further if you have end range mobility issues in the hips, knees or ankles.  The foot is happy to give up the goat, it just doesn’t know the repercussions until they show up. 

So, lift your toes, do a full squat. Go as low as you can with good form with the toes up.  Then, at the bottom of the squat or the bottom of  your clean mobility, suddenly drop your toes and let the arch follow if it must. Here is the moment of truth, at that moment the toes go down, feel what happens to the foot, ankle, tibial spin, knee positioning, pelvis posture changes. Careful, these are subtle. You may find you are using foot pronation more that you should, more than is safe.  Now try this, bottom out your cleanest squat as you regularly would, and at the bottom, raise your toes and try to reposition the foot arch and talus height. In other words, reposture your foot tripod, see how difficult this is if you can do it at all. Perhaps you will find your toe extensors are too weak to even get there.  This is how we cheat and borrow. We should not make it a habit, it should be used when we need it, but it should not be a staple of your squatting diet, it should not be a regular event where you prostitute sound biomechanics.  Unless you wish to pay for it in some way.  What should happen is that you should be able to bring your toes down and not let the arch follow, but that is a skill most have not developed. It is a staple move in your clients’ movement diets.

Does all this mean you should squat with your toes up ? No, but it may serve you well in awareness, evaluation, and looking for potholes and power leaks. At the very least, give it some thought and consideration. You may see some smiles and have some lightbulb moments between you and your athletes and clients. 

Plan on blocking this foot pronation range with an orthotic ? How dare you ! At least try to do it through reteaching this and the tripod skill first. Give your a client a chance to improve rather than a bandaid to cope. 

Dr. Shawn Allen, one of the gait guys


Why alignment of the big toe is so critical to gait, posture, stabilization motor patterns and running.

There are two ways of thinking about the arch of the foot when it comes to competent height.  One perspective is to passively jack up the arch with a device such as an orthotic, a choice that we propose should always be your last option, or better yet to access the extrinsic and intrinsic muscles of the foot (as shown in this video) to compress the legs of the foot tripod and lift the arch dynamically.  Here today we DO NOT discuss the absolute critical second strategy of lifting the arch via the extensors as you have seen in our “tripod exercise video” (link here) but we assure you that regaining extensor skill is an absolute critical skill for normal arch integrity and function.  We like to say that there are two scenarios going on to regain a normal competent arch (and that does not necessarily mean a high arch, a low arch can also be competent….. it is about function and less about form): one scenario is to hydraulically lift the arch from below and the other scenario is to utilize a crane-like effect to lift the arch from above. When you combine the two, you restore the arch function.  In those with a flat flexible incompetent foot you can often regain normal alignment and function.  But remember, you have to get to the client before the deforming forces are significant enough and have been present long enough that the normal anatomical alignments are no longer possible. For example, a hallux valgus with a large bunion (this person will never get to the abductor hallucis sufficiently) or a progressively collapsed arch that is progressively becoming rigid or semi-rigid.

Think about these concepts today as you watch your clients walk, run or exercise.  And then consider this study below on the critical importance of the abductor hallucis muscle after watching our old video of Dr. Allen’s competent foot.  

CONCLUSIONS AND CLINICAL RELEVANCE:

The abductor hallucis muscle acts as a dynamic elevator of the arch. This muscle is often overlooked, poorly understood, and most certainly rarely addressed. Understanding this muscle and its mechanics may change the way we understand and treat pes planus, posterior tibial tendon dysfunction, hallux valgus, and many other issues that lead to a challenge of the arch, effective and efficient gait. Furthermore, its dysfunction and lead to many aberrant movement and stabilization strategies more proximally into the kinetic chains.

*From the article referenced below,  “Most studies of degenerative flatfoot have focused on the posterior tibial muscle, an extrinsic muscle of the foot. However, there is evidence that the intrinsic muscles, in particular the abductor hallucis (ABH), are active during late stance and toe-off phases of gait.“

We hope that this article, and the video above, will bring your focus back to the foot and to gait for when the foot and gait are aberrant most proximal dynamic stabilization patterns of the body are merely strategic compensations.

Study RESULTS:

All eight specimens showed an origin from the posteromedial calcaneus and an insertion at the tibial sesamoid. All specimens also demonstrated a fascial sling in the hindfoot, lifting the abductor hallucis muscle to give it an inverted ‘V’ shaped configuration. Simulated contraction of the abductor hallucis muscle caused flexion and supination of the first metatarsal, inversion of the calcaneus, and external rotation of the tibia, consistent with elevation of the arch.

http://www.ncbi.nlm.nih.gov/pubmed/17559771

Foot Ankle Int. 2007 May;28(5):617-20.

Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study.

Wong YS. Island Sports Medicine & Surgery, Island Orthopaedic Group, #02-16 Gleneagles Medical Centre, 6 Napier Road, Singapore, 258499, Singapore. 

External Tibial Torsion as expressed during gait.

So, last week we watched this young lad doing some static ankle and knee bends, essentially some mini squats.  Here was what we found (LINK). It is IMPERATIVE that you watch this LINK first before watching today’s video above.

Now that you have watched that link here is what you should be seeing today.

You should see that the left foot is extremely turned out. We talked about why in the linked post from last week. It is because of the degree of external tibial torsion.  When it is present the knee rides inside the foot progression line (the knee bends into the forward / sagittal plane when the ankle bends into its more lateral /coronal / frontal plane (they all mean the same thing) ie. when the foot points outwards.

Remember, the knee has only one choice of motion, to hinge forward and backward. When the knee is asked to hinge in any other direction once the foot is locked to the ground there is torque placed upon the knee joint and thus shear forces.  Menisci do not like shear forces, nor does articular joint cartilage.

So, once again we see the rule of “you cannot beat the brain” playing out. The brain took the joint with the least amount of tolerance, the knee, and gave it the easy job.  The foot was asked to entertain another plane of motion as evidenced here in this video with significant increased foot progression angle. 

When the foot progression angle is increased but the knee still must follow the forward body progression (instead of following the foot direction) the motion through the foot will be directly through the medial longitudinal foot arch.  And as seen here, over time this arch will fail and collapse. 

Essentially this lad is hinging the ankle sagittally / forward through the subtalar and midtarsal joints, instead of through the ankle mortise joint where ankle hinging normally should occur.

This is a recipe for disaster. As you can see here.  You MUST also know and see here that there is an obvious limp down onto that left limb. It appears the left limb is shorter. And with this degree of external tibial torsion and the excessive degree of foot pronation, the limb will be shorter. You need to know that internal limb spin and pronation both functionally shorten the limb length.  This fella amongst other functional things is going to need a full length sole lift. We will start with 3mm rubber infused cork to do so. And let him accomodate to that to start.

We will attempt to correct as much foot tripod (anti-pronation) control as possible to help reduce leg shortness as well as to help reduce long term damage to the foot from this excessive pronation. We will also strengthen the left gluteus medius (it was very weak) to help him engage the frontal/lateral/coronal plane better. This may bring that foot in a little. But remember, the foot cannot come in so far that it drives the knee medially. Remember who is ruling the roost here !…… the knee.  It only has one free range, the hip and foot have 3 ! 

Shawn and Ivo

How to (and how not to) do a single leg squat, CORRECTLY !

Here Dr. Allen has one of his elite marathon and triathletes demonstrate how to correctly and incorrectly do a single leg squat. The single leg squat can show many of the pathologic movement patterns that occur in a lunge. The single leg squat is more difficult however because it requires balance and more strength. Many people do not do the single leg squat correctly as you will see in this video. Many drop the opposite hip which means that there is an inability to control the frontal plane pelvis via the stance leg gluteus medius and the entire orchestrated abdominal core. Most folks will drop the suspended hip and pelvis and thus collapse the stance phase knee medially. This can lead to medial knee pain (tracking disorder in the beginning) , a driving of the foot arch into collapse and impingement at the hip labrum. We know that when the knee moves medially that the foot arch is under duress. This problem is often the subliminal cause of all things foot arch collapse in nature, such as plantar fascitis to name a common one. Remember, optimal gluteus medius is necessary here. And the gluteus maximus is working to eccentrically lower the pelvis through hip flexion. So, if you do not consider the gluteus maximus a hip flexor then you are mistaken. Everyone thinks of it as a powerful hip extensor and external rotator. But do not be mistaken, in the closed chain it is a powerful eccentric controller of hip flexion and internal hip rotation.

Tomorrow we will look at this same case and look at her feet and discuss those as a problem, predictor and limiting factor to long term optimal function.

We are The Gait Guys,

Shawn and Ivo (visit our blog daily at www.thegaitguys.tumblr.com)

Follow up post on yesterdays FOOT TRIPOD VIDEO   
 Good Day Fellow foot geeks ! 
 Yesterday we posted a quick video  of a young  teenager who came to us for orthotic prescription.  As you  can see in the early part of the video he had a flat foot posturing and  increased foot progression angle (feet pointing too much east and  west).  
 The increased foot progression posturing can be a  problem, and accentuate pronation strategies,  particularly if it is  outside the normative values of 5-15 degrees. This is because during  midstance the limb is internally rotating.  If the foot progression  angle is increased as the limb internal rotation occurs while the body mass  is progressing over the foot in midstance, the positioning of the medial  tripod of the foot is far off the forward/sagittal progression line  (the direction of walk). When the tibia and femur internally rotate on  such a foot posturing the degree of pronation is accelerated and  accentuated. In another way of explaining it, the subtalar joint is  almost falling medially outside of the tripod boundaries and thus cannot  be controlled by the tripod. It would be like placing a camera directly on the letter “c” in the triangle diagram above, where the points of the triangle represent the positions of the camera tripod legs. The camera is at risk of tipping over because the mass of the cameral is not within the solid boundaries of the triangle.  In the foot, these tripod leg points would be represented by the 1st and 5th Metatarsal heads and the heel forming a triangle.  The goal is to stabilize the tripod on level ground and place the camera  (foot) in the middle of the tripod for maximal stability.  But, when the foot progression angle is increased, the triangle and foot position take on the triangle appearance above, risking pronation excesses. 
 The problem is that  many folks do not know they have developed this problem posturing until  symptoms occur.  This young lad was brought into our offices by an aware  mom who had heard of similar successes we have had with other children  and adults.  
 It took all of 10 minutes to retrain his awareness of the foot tripod and posturing of the feet underneath the body (where he noticed that he could not pronate as much as seen at the end of the video clip).  HE did awesome as you can see.  For the first time in his life he saw an arch and knew how to correct his foot posturing. He became aware of the use and need for good toe extension to raise the arch (a phenomenon known as The Windlass Mechanism of Hicks).  The last stage would be to help  him retrain these strategies in gait and various movements.  
 We will see if we can find that video somewhere. 
 Bottom line, …….did this kid need an orthotic……. NO !  It would have kept absent the strength development of the muscles needed to make the correction you see in the video.  This kid now has a fighting chance to develop normally. 
 Hope this helps to explain what was going on in yesterdays video. 
 We are………foot nerds……. 
 Shawn and Ivo

Follow up post on yesterdays FOOT TRIPOD VIDEO

Good Day Fellow foot geeks !

Yesterday we posted a quick video of a young  teenager who came to us for orthotic prescription.  As you can see in the early part of the video he had a flat foot posturing and increased foot progression angle (feet pointing too much east and west). 

The increased foot progression posturing can be a problem, and accentuate pronation strategies,  particularly if it is outside the normative values of 5-15 degrees. This is because during midstance the limb is internally rotating.  If the foot progression angle is increased as the limb internal rotation occurs while the body mass is progressing over the foot in midstance, the positioning of the medial tripod of the foot is far off the forward/sagittal progression line (the direction of walk). When the tibia and femur internally rotate on such a foot posturing the degree of pronation is accelerated and accentuated. In another way of explaining it, the subtalar joint is almost falling medially outside of the tripod boundaries and thus cannot be controlled by the tripod. It would be like placing a camera directly on the letter “c” in the triangle diagram above, where the points of the triangle represent the positions of the camera tripod legs. The camera is at risk of tipping over because the mass of the cameral is not within the solid boundaries of the triangle.  In the foot, these tripod leg points would be represented by the 1st and 5th Metatarsal heads and the heel forming a triangle.  The goal is to stabilize the tripod on level ground and place the camera  (foot) in the middle of the tripod for maximal stability.  But, when the foot progression angle is increased, the triangle and foot position take on the triangle appearance above, risking pronation excesses.

The problem is that many folks do not know they have developed this problem posturing until symptoms occur.  This young lad was brought into our offices by an aware mom who had heard of similar successes we have had with other children and adults. 

It took all of 10 minutes to retrain his awareness of the foot tripod and posturing of the feet underneath the body (where he noticed that he could not pronate as much as seen at the end of the video clip).  HE did awesome as you can see.  For the first time in his life he saw an arch and knew how to correct his foot posturing. He became aware of the use and need for good toe extension to raise the arch (a phenomenon known as The Windlass Mechanism of Hicks).  The last stage would be to help  him retrain these strategies in gait and various movements. 

We will see if we can find that video somewhere.

Bottom line, …….did this kid need an orthotic……. NO !  It would have kept absent the strength development of the muscles needed to make the correction you see in the video.  This kid now has a fighting chance to develop normally.

Hope this helps to explain what was going on in yesterdays video.

We are………foot nerds…….

Shawn and Ivo