Yep, these shoes stink for this gal...

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Look at the left shoe and compare it to the right. See how the upper is canted on the outsole? This “varus cant” can create lots of problems or could actually be beneficial, believe it or not, depending upon the pathology.

In this particular persons story, it was NOT a good thing. They have an anatomical short leg on the left-hand side. If you remember from following us here in the past, generally speaking, the shorter leg tide tends to be more supinated and the forefoot tends to be in more varus. This means more of a “reach” with that foot during the contact phase of gait, Whether that’s running or walking. This generally means that the forefoot will pronate more on the long leg side.

This shoe “defect“ may actually be benefit for someone who has too much rear or mid foot pronation as it would “delay” pronation by starting to rearfoot in an inverted position at heel strike.

The Fix?

You could grind the sole into varus an equal amount to equal the varus cant. In our opinion, not a good idea.

You could return the shoe (that’s what this person is doing) and get another one

In addition, you could…

Give the person a 3 mm sole lift to correct for the leg length discrepancy

Make sure they have adequate range of motion in the first ray on the short leg side to be be able to plantar flex the 1st ray and reach the ground

Make sure they have adequate control of the core musculature as well as foot intrinsic musculature during stance phase.

Dr Ivo Waerlop, one of The Gait Guys

#badshoes #theshoeistheproblem #forefootvarus #leglengthdifference
#gaitproblem

Shoe causing knee pain? You decide… 

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This gentleman presented with left-sided knee pain at the medial collateral ligament. His left foot was planted when he rotated to the left. Take a close look at the shoes in the picture. If you look closely, you will notice the right shoe is tilted on its axis due to a rear foot to forefoot deformity (forefoot supinatus)and the left shoe upper was assembled canted on its axis, Most likely in manufacturing defect. Can you see the subtle valgus in the left shoe rearfoot?

Think of the implications of a shoe with this orientation. Putting the rearfoot in valgus “prepronates“ the foot, causing medial rotation of the tibia and femur and increase valgus stress on the knee, stressing the medial collateral ligament and stabilizing complex. This will most likely manifest itself as anterior rotation of the ilium on the left-hand side with relative posterior rotation on the right and a clockwise Pelvic distortion pattern. With the foot planted on the left side and it being pre-pronated, can you see how the rotation to the left leaves a greater amount of external rotation that must occur to just get the foot to neutral, never mind supination for stability and pushoff?
What about the popliteus having to work on time to assist and extra rotation and the appropriate femoral/tibial rotation ratios to spare the medial meniscus?

These are the kind of things to keep us awake at night…

And why does this guy have hip pain?

line up the center of the heel counters with the outsoles, and what do you see?

line up the center of the heel counters with the outsoles, and what do you see?

can you see how the heel counter is centered on the outsole, like it is supposed to be

can you see how the heel counter is centered on the outsole, like it is supposed to be

notice how the heel counter of the shoe is canted medially on the outsole of the shoe, creating a varus cant

notice how the heel counter of the shoe is canted medially on the outsole of the shoe, creating a varus cant

Take a guy with lower back and left sided sub patellar pain that also has a left anatomically short leg (tibial) and bilateral internal tibial torsion and put him in these baby’s to play pickleball and you have a prescription for disaster.

Folks with an LLD generally (soft rule here) have a tendency to supinate more on the short leg side (in an attempt to make the limb longer) and pronate more on the longer leg side (to make the limb shorter). Supination causes external rotation of the lower limb (remember, we are trying to make the foot into a rigid lever in a “normal” gait cycle). this external rotation with rotate the knee externally (laterally). Folks with internal tibial torsion usually rotate their limb externally to give them a better progression angle (of the foot) so they don’t trip and fall from having their feet pointing inward. This ALSO moves the knee into external rotation (laterally), often moving it OUTSIDE the saggital plane. In this case, the knee, because of the difference in leg length AND internal tibial torsion AND the varus cant of the shoe, has his knee WAY OUTSIDE the saggital plane, causing faulty patellar tracking and LBP.

Moral of the story? When people present with a problem ALWAYS TAKE TIME TO LOOK AT THEIR SHOES!