When you see this, you should be thinking one of 3 possible etiologies...

Cardinal sign of either a forefoot supinatus/forefoot varus or collapsing midfoot

I was hiking behind this young chap over the weekend along with my son and friends. Note the amount of calcaneal eversion present on the right side that is not present on the left. Also note the increased progression angle of the right foot and subtle circumduction of the extremity.

In my experience, you would generally see this much calcaneal diversion and one of three scenarios:

1. Moderate leg length discrepancy with the increased calcaneovalgus occurring on the longer leg side. This would support the amount of circumduction were seeing on the right side.

2. When there is a forefoot supinatus present and and inadequate range of motion available in the midfoot and/or forefoot. This is most likely the case here.

3. In moderate To severe midfoot collapse. This is clearly not the case as the medial aspect of the shoe is usually “blown out”.

Next time you see an everting rearfoot, think about these three possible etiologies.

Dr Ivo Waerlop, on of The Gait Guys

#evertedrrarfoot #calcanealvalgus #shortleg #forefootsupinatus #forefootvarus #gaitanalysis #thegaitguys

Barefoot vs Shoes...It's about the strike pattern


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“The influence of strike patterns on running is more significant than shoe conditions, which was observed in plantar pressure characteristics. Heel-toe running caused a significant impact force on the heel, but cushioned shoes significantly reduced the maximum loading rate. Meanwhile, although forefoot running can prevent impact, peak plantar pressure was centered at the forefoot for a long period, inducing a potential risk of injury in the metatarsus/phalanx. Plantar pressure on the forefoot with RFS was lesser and push-off force was greater when cushioned shoes were used than when running barefoot.”


takeaways from the study?

  • forefoot strike reduces heel impact

  • rear foot strike reduces forefoot impact

  • forefoot strike increases and prolongs pressures (in shoes) on the forefoot which could potentially cause forefoot problems

  • cushioned shoes do not really change impact force but change (reduce) the rate of loading

  • in a forefoot strike, pressures are shifted more to the mid foot

want to know more? Join us this Wednesday, December 19th on online.com: Biomechanics 303







Sun XYang YWang LZhang XFu W. Do Strike Patterns or Shoe Conditions have a Predominant Influence on Foot Loading? J Hum Kinet. 2018 Oct 15;64:13-23. doi: 10.1515/hukin-2017-0205. eCollection 2018 Sep.

link to FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231350/





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Flat Dogs

Take a look at these pedographs. Wow!

  • No rear foot heel teardrop.
  • No midfoot arch on left foot and minimal on right.
  • An elongated 2nd metatarsal bilaterally and forces NOT getting to the base of the 1st metatarsal and stalling on the 2nd: classic sign of an uncompensated forefoot varus.
  • increased printing of the lateral foot on the right

Knowing what you know about pronation (need a review? click here) Do you think this foot is a good lever? Do you think they will be able to push off well?

What can we do?

  • foot exercises to build the intrinsic and extrinsic muscles of the foot (click here, here, here, and here for a few to get you started)
  • perhaps an orthotic to assist in decreasing the pronation while they are strengthening their foot
  • motion control shoe? Especially in the beginning as they are strengthening their feet and they fatigue rather easily

The prints do not lie. They tell the true story of how the forces are being transmitted through the foot. For more pedograph cases, click here.

The Gait Guys. Teaching you more about the feet and gait. Spreading gait literacy throughout the net! Do your part by forwarding this post to someone who needs to read it.

Midfoot Striking Monsters.  That’s right, a gorgeous HD video for you today. Reminds us of a Joseph Campbell storyline.  A beautiful video and an Angus Young-ish young boy with perfect midfoot strike, along with his monster buddies.

Something a little lighter today for the gait brethren here on The Gait guys.  Proof that it doesn’t always have to be cerebral here on the Gait Guys. Today just sit back, go full screen HD on this one, and turn it up loud !

This kid should give form running clinics. Its simply a beautiful running form.

Shawn and Ivo.

___________________

credits:

RUN BOY RUN EP ON I-TUNES : itunes.apple.com/fr/album/run-boy-run-remixes-ep/id522665628

WOODKID - RUN BOY RUN - Video directed by Yoann Lemoine

Produced By ICONOCLAST with the help of Picseyes
Produced by Roman Pichon 
Art director / Chef Decorateur : Pierre Pell 
Post Production by OneMore Prod
VFX SUPERVISOR : Gregory Lanfranchy
FLAME ARTIST : Herve Thouement
FLARE ARTISTS : Laura Saintecatherine & Romain Leclerc
3D : Olivier Junquet & Priscilla Clay
MATTE PAINTING : Arnaud Philippe Giraux
POST PRODUCER : Raminta Poskute
Label & Video commissioner Pierre Le Ny

P & C 2012 GREEN UNITED MUSIC ICONOCLAST / GREEN UNITED MUSIC / SEIZE ZÉRO TROIS
label-gum.com/

Midfoot strike 5 year old running barefoot in grass.

So, heel strike you say ?  Have  a closer look.  This is a near perfect midfoot strike. What you cannot see is his torso progression. As long as the torso has enough forward lean heel strike cannot occur. Heel contact can occur, but not heel strike or impact.

We have talked about this on many occasions here on The Gait Guys Blog. No one else is talking about this fine line difference between heel strike and heel contact.  Everyone still seems hell bent on talking about forefoot strike. Forefoot strike in distance running is not normal, midfoot strike like you see here in this young child is natural and normal. This 5 year old was likely just asked to run barefoot, he was not likely coached. This is because midfoot strike is natural and normal.  As we said, as long as the torso is directly above or in front of the foot contact position there is no way that heel STRIKE can occur, rather heel CONTACT can only occur (unless you have hamstrings like cirque du soleil acrobats and do not mind going into a posterior tilted pelvis at contact). 

We tell our runners to:

  • lift the chest and lean
  • raise the toes and dorsiflex the ankle  (engage the anterior lower leg compartment) so that the arch is maximally prepared
  • a heel KISS of the ground is fine, just no impact
  • you do not need to forefoot strike to run naturally
  • * and, here is one more reason why we like a midfoot strike over a forefoot strike…. because a midfoot strike means that the body continues forward whereas a forefoot strike that then allows into a heel kiss/touchdown means that there is a posterior progression and eccentric lengthening of the posterior chain (hamstrings and calf muscles). This posterior directed motions is not exactly wise when forward progression is the goal of running !

This little fella is doing it right. Largely because he has not been in shoes long enough to corrupt the natural tissues and mechanisms (both the body parts and the natural neuromotor patterns).

* Addendum: after a really productive FAcebook dialogue with some readers we felt we needed to be more clear on some of our unspoken assumptions here.  If the heel hits first, it will be a STRIKE and not a KISS and the load will be high. The only way the heel can kiss the ground like we mention above is if the heel is absolutely contacting at the same time as the forefoot, one could say that there is a more dominant load on the mid-forefoot but the heel can still strike at this same time.  Striking clearly on the forefoot and then touching down the heel is satisfactory but there is still a retrograde movement which we believe is not as economical yet certainly better than heel impact/strike.  To get the perfect midfoot strike with barely a subtle heel CONTACT (not impact or strike) requires greater skill and more mastery as a runner.  And if you are wearing a shoe that is not minimalist or zero drop developing this skill will be a challenge and you will be misleading yourself.    This ammendment added 1 hour post blog post launch.

Shawn and Ivo…….. the Devil is in the Details. 

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Time for a quick pedograph case:

This person presented with arch pain and occasional forefoot pain.

Note the increased size (length) of the heel print with blunting at the anterior most aspect. The midfoot impression is  increased, revealing collapsing medial longitudinal arches. The forefoot print has increased pressures over the 2nd metatarsal heads bilaterally, and the 1st on the left. She claws with toes 2-4 bilaterally.

This demonstrates poor intrinsic stability of the foot (as evidenced by the increased heel impression and midfoot collapse) and well as decreased ankle rocker (as evidenced by the increased forefoot pressures).

We also see increased ink under the distal second digit (esp on the right). This suggests some possible incompetence of the first ray complex and big toe, which is represented by the medial ink presentation under the great toe (suggesting a pinch callus, which is seen when there is spin of the foot and insufficient great toe anchoring and push off).  When the great toe function is compromised, we tend to see increased activity of the 2nd digit long flexors, represented well here by increased ink under the 2nd toe.

The pedograph truly does provide a window to the gait cycle!

We remain: Gait Geeks