You might think your shoe is doing more to control motion of your foot than it is actually doing.

You might think your shoe is doing more to control motion of your foot than it is actually doing.

"The measurement of rearfoot kinematics by placing reflective markers on the shoe heel assumes its motion is identical to the foot’s motion."
The results of this study revealed that "calcaneal frontal plane ROM was significantly greater than neutral and support shoe heel ROM. Calcaneus ROM was also significantly greater than shoe heel ROM in the transverse and sagittal planes. No change in tibial transverse plane ROM was observed."

It is easy to underestimate the calcaneal ROM across all planes of motion. Motion is going to occur somewhere, hopefully you can help your client control the excessive ROMs that are occurring and causing their symptoms. But just do not think that a shoe is going to markedly help, it might, but let your interventions and your client's feedback on pain lead you.

Calcaneus range of motion underestimated by markers on running shoe heel.
Ryan S. Alcantara'Correspondence information about the author Ryan S. AlcantaraEmail the author Ryan S. Alcantara
, Matthieu B. Trudeau, Eric S. Rohr
Human Performance Laboratory, Brooks Running Company, 3400 Stone Way N, Suite 500, Seattle, WA 98103 United States

Do you have dorsal (top) foot pain? Think you are tying your shoes too tightly?

Do you have dorsal (top) foot pain, at the peak of the arch? Think you are tying your shoes too tightly and that is the cause? Do you have pain over the dorsal or plantar mid foot on heel rise or jumping/landing or going up stairs ?

Just because you raise your heel and load the ball of the foot does not necessarily mean you have adequately plantarflexed the 1st metatarsal and loaded it soundly/stable with the medial tarsal bone. Heel rise, and thus loading onto the medial foot tripod, must be met with ample, stable, durable, 1st metatarsal plantarflexion and the associated medial tarsal bones. Also, without this, loading of the sesamoids properly cannot occur, and pain may ensue.

The first ray complex can be delicate in people who are symptomatic. In some people who do not have a good tibialis posterior-peroneus sling mechanism working harmoniously, in conjunction with a competent arch tripod complex to achieve a compentent arch complex (ie, EDL, EHL, tib anterior and some of the other foot intrinsics) this tarsometatarsal interval can become painful and instead of the 1st ray complex being stable and plantarflexing as the heel departs and the 1st ray begins taking load, it may not do so in a stable plantarflexed posturing. In some people it can momentarily dorsiflex as the arch subtly collapses (when it should be stable and supinated in heel rise).

"Subtle hypermobility of the first tarsometatarsal joint can occur concomitantly with other pathologies and may be difficult to diagnose. Peroneus Longus muscle might influence stability of this joint. Collapse of the medial longitudinal arch is common in flatfoot deformity and the muscle might also play a role in correcting Meary's angle."-Duallert et al

Soon, I hope to show you a video of how to watch for this problem, how to train it properly, how we do it in my office.
Dr. Allen

https://www.ncbi.nlm.nih.gov/pubmed/27015031

Clin Biomech (Bristol, Avon). 2016 May;34:7-11. doi: 10.1016/j.clinbiomech.2016.03.001. Epub 2016 Mar 10.

The influence of the Peroneus Longus muscle on the foot under axial loading: A CT evaluated dynamic cadaveric model study.

Dullaert K1, Hagen J2, Klos K3, Gueorguiev B4, Lenz M5, Richards RG6, Simons P7.

How hallux valgus and bunions can affect the shoe toe box space.

Bunions and hallux valgus can change the toe box volume and shoe choice, so be careful, don't be fooled.
This photo shoes how a change in the forefoot width and length can be a result of a bunion or hallux valgus. Notice both feet are aligned the same, but the length of the foot is different in the hallux valgus foot.

Screen Shot 2018-11-16 at 6.23.31 PM.png


The old Brannock device use to help us all see this more clearly. You may recall that the device measured "heel to toe" (True foot length) and ALSO "heel to ball" length (the functional length and more important one. This length measured heel to the metatarsophlanageal joint line. This concept is important to know because we want the shoe "break point" or "bend point" at the forefoot to occur where the foot bends. Not all shoes have the flex lines (the creases on the bottom of the shoe were it is most likely to bend) in the same place, there is no standard. And if your client has shorter toes, longer toes or a long or short "heel to ball" length they man needs some help from a knowledgeable person like yourself making sure that their current forefoot complaints are not from a mis-fitted shoe.
Bottom line, the "heel to ball" length of a foot is far more important than the global foot length "heel to toe". So stop judging your shoe fit by pinching the front of the shoes to "make sure you have plenty of room"! Doh ! Face palm !

Because despite what many of the "experts" online are saying, that being "shoes don't matter". The fact is "sometimes they do". Period.

WAnt to learn this stuff? Got our website and buy the National Shoe Fit program. Hours of deep shoe, anatomy and biomechanics fun with ivo and shawn, in your own home over the holidays ! Give yourself the "gift" of ivo and shawn this year ! LOL

And for all of you who joined us last night on onlineCE.com for the 55 minute condensed nuclear version of the 3+ hours shoe fit program, we hope you have recovered with a good nights sleep !

Podcast #140: Running, hallux amputation, building deeper gait concepts.

Topics:

hallux amputation, achilles tendon, achilles tendinopathy, rehab achilles, bursae, marathons, vapourfly, shoes, shoe fit, gait, gait problems, gait correction, gait retraining, running, foot strike, heel strike, midfoot strike, rearfoot strike, heel strike, loading responses, gait rehab, muscle strength, isotonics

Links to find the podcast:

Look for us on iTunes, Google Play, Podbean, PlayerFM and more.

Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com

doctorallen.co

summitchiroandrehab.com

shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:

iTunes page:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Direct download URL: http://traffic.libsyn.com/thegaitguys/pod_140real_-_10618_9.18_AM.mp3


Permalink URL: http://thegaitguys.libsyn.com/podcast-140-running-hallux-amputation-building-running-concepts


Libsyn Directory URL:http://directory.libsyn.com/episode/index/id/7135745


Topics and links:


The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound. Nuri L, et al. J Exp Biol. 2017.

https://www.ncbi.nlm.nih.gov/m/pubmed/28620014/

Good tip to decrease loading and help decrease injury risk in runners: See study by Chan et al.:
http://journals.sagepub.com/doi/abs/10.1177/0363546517736277?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

Vapourfly shoe
https://www.nytimes.com/interactive/2018/07/18/upshot/nike-vaporfly-shoe-strava.html

Men’s marathon:
https://twitter.com/chrisbramah/status/1019481750039343104/photo/1


fun facts:

Foot strike patterns of the World Championships Marathon:
Women’s race:
73% rearfoot, 24% midfoot, 3% forefoot
Men’s race:
67% rearfoot, 30% midfoot, 3% forefoot
pic.twitter.com/iWRzjImQBZ
https://www.iaaf.org/about-iaaf/documents/research#biomechanical-research-projects

Foot structure and stiffness is critical
https://www.nature.com/articles/srep29870

Tendons can change
Progressive calf strength training led to increased achilles stiffness @ 4 weeks & increased tendon cross sectional area @ 8 weeks
https://link.springer.com/article/10.1007/s00421-018-3904-1

Bursae can thicken painlessly as a normal adaption to activity... just like skin calluses!
https://www.ncbi.nlm.nih.gov/pubmed/24907190

Between 63-72% of participants were wearing incorrectly sized footwear. review of the literature here from @LTPodiatry team:
https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z

How Neuroscientists Explain the Mind-Clearing Magic of Running -- from the Science of Us
https://www.huffingtonpost.com/science-of-us/how-neuroscientists-expla_b_9787466.html

Podcast 123: The Rear foot: Understanding your RearFoot type

Key tag words:
foot types, rearfoot, forefoot, pronation, supination, shoe fit, forefoot varus, forefoot supinatus, rearfoot inversion, ankle rocker, injuries, rehab, corrective exercises

Rearfoot varus and Rearfoot valgus. Knowing the anatomy of your rear foot and its anatomic and functional posturing can lead to many problems in anyone. If you do not know the rearfoot type and posturing, you will not understand the rest of the foot mechanics. Without this knowledge, you will not know the reason for midfoot or forefoot problems, not understand what shoe you are in, or even why the shoe, footbed, orthotic you have chosen is either not fixing your problems, or causing them.  Join us on a journey down the rearfoot rabbit hole over the next hour.  Plus a few funny stories to lighten the biomechanics-heavy dialogue.
 

Show links:
http://traffic.libsyn.com/thegaitguys/pod_123final_cut.mp3

http://thegaitguys.libsyn.com/podcast-123-the-rear-foot-understanding-your-rearfoot-type

Show sponsors:
www.newbalancechicago.com

www.thegaitguys.com
That is our website, and it is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

https://www.ncbi.nlm.nih.gov/pubmed/27134364

https://www.ncbi.nlm.nih.gov/pubmed/25364132

RearFoot positions:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588658/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990938/

Powers CM, Maffucci R, Hampton S. Rearfoot posture in subjects with patellofemoral pain. J Orthop Sports Phys Ther. 1995 Oct;22(4):155-60.

Power V, Clifford AM. The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic Individuals with a Pronated Foot Type. J Hum Kinet. 2012 Mar;31:5-15. doi: 10.2478/v10078-012-0001-0. Epub 2012 Apr 3.

Shultz SP, Song J, Kraszewski AP, Hafer JF, Rao S, Backus , Mootanah R, Hillstrom HJ. An Investigation of Structure, Flexibility and Function Variables that Discriminate Asymptomatic Foot Types. J Appl Biomech. 2016 Dec 19:1-25. [Epub ahead of print]

 

Can you spot the problem?

Take a look at the pictures before proceeding, knowing that this gal presented with L sided outside knee pain and see if you can tell what may be wrong. She does wear orthotics. 

Take a good look at the lateral flare on each of these shoes. Yes, it is a Brooks Pure series with a 4mm drop. Yes the shoe has a medial (sl larger) and lateral flare, posteriorly and anteriorly.

Do you see the discoloration and increased wear on the lateral heel counter on the left compared to the left? There is also increased wear of the lugs on the outside of this left shoe. The forefoot is also worn into slight varus, but this difficult to see. The shoe, especially in combination with her orthotic, is keeping her in varus (ie inverted) for too long, taking her knee outside the saggital plane and contributing to her knee pain. 

ROTATE YOUR SHOES!

Yes, you are looking INSIDE this toe. That IS a screw and metal plate in that toe.    What kind of stuff finds its way into your office ? I get all kinds of things it seems, at least once a day something comes in that makes me scratch my head.   This client just wanted my opinion and thoughts on their toe and their gait once they are ambulating again. They have had multiple surgeries to this poor foot. You can see multiple scars over multiple digits and metatarsals.  This is the 3rd surgery to the big toe, the last 2 have been attempts at correcting failed prior surgeries. This is obviously the last straw surgery, total fusion of the metatarsophalangeal joint.  What is interesting in this case is that this plate was taken out about 4 weeks ago, and the skin was stretched back over and the wound closed up (forgot to take update photo for you). I saw it yesterday, and I was amazed at how healed up the area was. They are months post op now, and they can load the toe heavily now, that is always amazing to me. The body’s healing ability is a miracle. Of course, if you have been with us here long enough you will know that my “concern button” immediately got pushed but the client was proactive and asked the question before my  oral diarrhea of concerns  started.  So, they wanted to know about their gait and what to watch out for.  Off the top of your head, without thinking, you should be able to rattle off the following:   impaired toe off   premature heel rise   watchful eye on achilles issues   impaired hip extension and gluteal function   impaired terminal ankle plantar flexion (because they cannot access the synergists FHL and FHB)   impaired terminal ankle dorsi flexion (because they cannot access the synergists EHL and EHB)   lateral toe off which will promote ankle and foot inversion, which will challenge the peronei   frontal plane hip-pelvis drift because of the lateral toe off and lack of glute function   possible low back pain/tightness because of the  frontal plane pelvis drift and from altered hip extension motor patterning (and glute impairment)   possible knee pain from tracking challenges because they cannot complete medial tripod loading and thus sufficient pronation to internally spin the limb to get the knee to sagittal loading   impaired arm swing, more notable contralaterally    There is more, but that is enough for now. You need to know total body mechanics, movement patterns, normal gait cycle events (you have to know normal to know abnormal) and more. You have to know what normal is to understand when you are looking at abnormal.  * So, dial this back to something more simple, a “stubbed toe”, a painful sesamoid, painful pronation or a turf toe or hallux limitus.  They will all have the same list of complications that need to be evaluated, considered and addressed. This list should convey the importance that if your client has low back pain, examining the big toe motion is critical. Also, if you are just looking at the foot and toe in these cases, pack your bags … .  you don’t belong here. If you are just adjusting feet and toes and playing with orthotics while the list above does not constantly file back and forth through your brain, again, pack all your bags, grab your cat and leave town (just kidding, try reading more and get to some seminars).     If you know the complicated things, then the simple things become … … . . simple.     Your local treadmill gait analysis guru should know all of this if they are going to recommend shoes and exercises. Shame on them if there is no physical exam however. The data roadmap from the gait analysis software print out is not going to get you even out of the driveway let alone down the street. The data is going to tell you what you are doing to compensate, not tell you what is wrong. You must know anatomy, biomechanics, neurology, orthopedics and how to apply them to get the recipe right, not just which shoe in a store will unload the medial tripod of the foot or which exercise will lengthen your stride on the left.   … .  sorry for the rant, too much coffee this morning, obviously.  Shawn Allen, one of the gait guys

Yes, you are looking INSIDE this toe. That IS a screw and metal plate in that toe. 

What kind of stuff finds its way into your office ? I get all kinds of things it seems, at least once a day something comes in that makes me scratch my head. 

This client just wanted my opinion and thoughts on their toe and their gait once they are ambulating again. They have had multiple surgeries to this poor foot. You can see multiple scars over multiple digits and metatarsals.  This is the 3rd surgery to the big toe, the last 2 have been attempts at correcting failed prior surgeries. This is obviously the last straw surgery, total fusion of the metatarsophalangeal joint.  What is interesting in this case is that this plate was taken out about 4 weeks ago, and the skin was stretched back over and the wound closed up (forgot to take update photo for you). I saw it yesterday, and I was amazed at how healed up the area was. They are months post op now, and they can load the toe heavily now, that is always amazing to me. The body’s healing ability is a miracle. Of course, if you have been with us here long enough you will know that my “concern button” immediately got pushed but the client was proactive and asked the question before my oral diarrhea of concerns started.

So, they wanted to know about their gait and what to watch out for.  Off the top of your head, without thinking, you should be able to rattle off the following:

  • impaired toe off
  • premature heel rise
  • watchful eye on achilles issues
  • impaired hip extension and gluteal function
  • impaired terminal ankle plantar flexion (because they cannot access the synergists FHL and FHB)
  • impaired terminal ankle dorsi flexion (because they cannot access the synergists EHL and EHB)
  • lateral toe off which will promote ankle and foot inversion, which will challenge the peronei
  • frontal plane hip-pelvis drift because of the lateral toe off and lack of glute function
  • possible low back pain/tightness because of the  frontal plane pelvis drift and from altered hip extension motor patterning (and glute impairment)
  • possible knee pain from tracking challenges because they cannot complete medial tripod loading and thus sufficient pronation to internally spin the limb to get the knee to sagittal loading
  • impaired arm swing, more notable contralaterally

There is more, but that is enough for now. You need to know total body mechanics, movement patterns, normal gait cycle events (you have to know normal to know abnormal) and more. You have to know what normal is to understand when you are looking at abnormal.

* So, dial this back to something more simple, a “stubbed toe”, a painful sesamoid, painful pronation or a turf toe or hallux limitus.  They will all have the same list of complications that need to be evaluated, considered and addressed. This list should convey the importance that if your client has low back pain, examining the big toe motion is critical. Also, if you are just looking at the foot and toe in these cases, pack your bags … .  you don’t belong here. If you are just adjusting feet and toes and playing with orthotics while the list above does not constantly file back and forth through your brain, again, pack all your bags, grab your cat and leave town (just kidding, try reading more and get to some seminars).

If you know the complicated things, then the simple things become … … . . simple.

Your local treadmill gait analysis guru should know all of this if they are going to recommend shoes and exercises. Shame on them if there is no physical exam however. The data roadmap from the gait analysis software print out is not going to get you even out of the driveway let alone down the street. The data is going to tell you what you are doing to compensate, not tell you what is wrong. You must know anatomy, biomechanics, neurology, orthopedics and how to apply them to get the recipe right, not just which shoe in a store will unload the medial tripod of the foot or which exercise will lengthen your stride on the left. 

… .  sorry for the rant, too much coffee this morning, obviously.

Shawn Allen, one of the gait guys

Podcast 95: Head tilt while squatting or running.

We have a strong show for you today. Ankle instability from a neurologic perspective, shoe wear, head tilt and the neurologic and functional complications… we also talk about Efferent Copy and motor learning.

A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_95final.mp3

Direct Download:  http://thegaitguys.libsyn.com/pod-95

-Other Gait Guys stuff
B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx

Show notes:

Human exoskeletons: The Ekso
http://www.thedailybeast.com/articles/2015/08/03/the-mechanical-exoskeleton-shaping-the-future-of-health-care.html

Ankle muscle strength influence on muscle activation during dynamic and static ankle training modalities
http://www.tandfonline.com/doi/abs/10.1080/02640414.2015.1072640?rfr_id=ori%3Arid%3Acrossref.org&url_ver=Z39.88-2003&rfr_dat=cr_pub%3Dpubmed&#.VcYWR-1VhBc

Chronic ankle instability:

http://tmblr.co/ZrRYjx1akudcm

http://tmblr.co/ZrRYjx1ah6ThV

http://thegaitguys.tumblr.com/post/68785250796/just-because-a-muscle-tests-weak-doesnt-mean-it
http://thegaitguys.tumblr.com/post/117109093439/last-week-we-ran-an-archived-piece-named-just

the future of footwear and orthotics ?
http://lermagazine.com/special-section/conference-coverage/the-future-of-footwear-and-orthoses-is-here-now-what

squats- head posture-gait vision-gravity
http://thegaitguys.tumblr.com/search/vision

Music: brain rhythm
http://www.kurzweilai.net/the-brains-got-rhythm

Podcast 94: The Shoe & Motor Control Podcast

Shoes, Minimalism, Maximalism, Motor fatigue, Brain stuff and more !

A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_94final.mp3

Direct Download:  http://thegaitguys.libsyn.com/podcast-94

-Other Gait Guys stuff
B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx

Show notes:

movement and brain function; based on your piece: http://www.vancouversun.com/touch/story.html?id=11237102\

shoe fit:
http://running.competitor.com/2015/07/shoes-and-gear/sole-man-the-pros-and-cons-of-buying-cheap-running-shoes_129297

http://www.runresearchjunkie.com/relevant-gems-from-the-2015-footwear-biomechanics-symposium/

Clin Biomech (Bristol, Avon). 2006 Dec;21(10):1090-7. Epub 2006 Sep 1.

The effect of lower extremity fatigue on shock attenuation during single-leg landing.

Coventry E1, O'Connor KM, Hart BA, Earl JE, Ebersole KT.

Dr. Ted Carrick podcast

http://thewellnesscouch.com/bc/bc-07-professor-frederick-ted-carrick-on-the-past-of-functional-neurology

https://itunes.apple.com/au/podcast/backchat/id972497993?mt=2

movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture

http://lermagazine.com/issues/june/balance-data-suggest-somatosensory-benefit-of-minimalist-footwear-design
Wilson SJ, Chander H, Morris CE, et al. Alternative footwear’s influence on static balance following a one-mile walk. Med Sci Sports Exerc 2015;46(5 Suppl);S562.

http://lermagazine.com/issues/june/running-shoe-reveal-study-links-max-cushioning-higher-load

movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture

If you plan to live that long, you better start thinking about preservation:
http://www.cnbc.com/id/102730128  

Music piece/ Bass players:
http://mentalfloss.com/article/64955/science-proves-supreme-power-bassists

tumblr_nj46ukTd3o1qhko2so1_1280.jpg
tumblr_nj46ukTd3o1qhko2so2_500.jpg

All about Toe Break.

No, this is not a post about fractures phalanges, but rather where your shoe bends, or should bend.

Toe break is where the shoe bends anteriorly. Ideally, we believe this to be at the 1st metatarsal phalangeal joint and metartarsal phalangeal articulations. This allows for the best “high gear” push off as described by Bojsen-Moller (1) High gear push off means that the pressure goes to the base of the great toe (1st MTP joint) for push off. (for an interesting post on this, see here 

If we think about rockers of the foot during the gait cycle (need a review? click here), it seems best that we accommodate each of them to the best of our abilities. Since most of us wear shoes, it would make sense that it flex in the right places. With regards to the forefoot, it should (theoretically) be under the 1st metatarsal phalangeal joint. This should provide both optimal biomechanical function (distribution of force to the 1st metatarsal phalangeal joint for push off/ terminal stance) and maximal perceived comfort (2).

If the shoe bends in the wrong place, or DOES NOT bend (ie, the last is too rigid, like a rockered hiking shoe, Dansko clog, etc), the mechanics change. This has biomechanical consequences and may result in discomfort or injury.

If the axis of motion for the 1st metatarsal phalangeal joint is moved posteriorly, to behind (rather than under) the joint, the plantar pressures increase at MTP’s 4-5 and decrease at the medial mid foot. If moved even further posteriorly, the plantar pressures, and contact time in the mid foot and hind foot (3). A rocker bottom shoe would also reduce the plantar pressures in the medial and central forefoot as well (4). It would stand to reason that this would alter gait mechanics, and decrease mechanical efficiency. That can be a good thing or a bad thing, depending on what you are trying to accomplish.

Take home messages:

  • Where a shoe flexes will, in part, determine plantar pressures
  • Changes in shoe flex points can alter gait mechanics
  • More efficient “toe off” will come from a shoe flexing at the 1st metatarsal phalangeal joint and across the lesser metatarsal phalangeal joints
  • examine the “toe break” in your clients shoes, especially of they have a foot problem

1. F Bojsen-Møller Calcaneocuboid joint and stability of the longitudinal arch of the foot at high and low gear push off. J Anat. 1979 Aug; 129(Pt 1): 165–176.

2. Jordan C1, Payton C, Bartlett R Perceived comfort and pressure distribution in casual footwear. Clin Biomech (Bristol, Avon). 1997 Apr;12(3):S5.

3. van der Zwaard BC1, Vanwanseele B, Holtkamp F, van der Horst HE, Elders PJ, Menz HB Variation in the location of the shoe sole flexion point influences plantar loading patterns during gait. J Foot Ankle Res. 2014 Mar 19;7(1):20.

4. Schaff P, Cavanagh P Shoes for the Insensitive Foot: The Effect of a “Rocker Bottom” Shoe Modification on Plantar Pressure Distribution Foot & Ankle International December 1990 vol. 11 no. 3 129-140

plantar pressure image above from : Dawber D., Bristow I. and Mooney J. (1996) “The foot: problems in podiatry and dermatology”, London Martin Dunitz Medical Pocket Books.

Podcast 84: Toe Walkers, Hip Impingment & Olympic Lifting Shoes

Plus: pulmonary edema syndrome in Triathlete swimmers, truths about olympic lifting shoes and more !

Show sponsors:

www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_84f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-84

Other Gait Guys stuff

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

Monthly lectures at : www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Show notes:

Are Triathletes Really Dying of Heart Attacks?

 
We had some stuff on FB last week about head positioning during running.  Alot of people tried to simplify it.  There is more to it. Here is another perspective.
 
Toe Walking children
 
Olympic lifting shoes ? or Converse Chuck Tailors ?
 
Journal of Foot and Ankle Research | Abstract | The associations of leg lean mass with foot pain, posture and function in the Framingham foot study
http://www.jfootankleres.com/content/7/1/46/abstract
 
Hip Impingements
 
Achilles oddity: Heeled shoes may boost load during gait | Lower Extremity Review Magazine
http://lermagazine.com/news/in-the-moment-rehabilitation/achilles-oddity-heeled-shoes-may-boost-load-during-gait
 

pronation

Here is an abstract you should look at.
Br J Sports Med. 2014 Mar;48(6):440-7. doi: 10.1136/bjsports-2013-092202. Epub 2013 Jun 13.

Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study.

http://www.ncbi.nlm.nih.gov/pubmed/23766439
And then there is this article we came cross at Runner’s World online. Here is the article “Five things i learned about buying running shoes”.
In all fairness we do not think the article was meant to teach or say much, but we do feel like it robbed 2 minutes of our productive life, at least it was entertaining.
So it is our turn now, let us serve you some real meat.  Here are some loose thoughts on why shoe fit and research has limitations in our opinion, mostly commentary on the first article and why you need to takes its commentary with a grain of salt.
The problem lies in the knowledge base. Most researchers just do not seem to know enough about the foot types , osseous torsions, the kinetic chain, and the like, to do an ALL ENCOMPASSING study. Plus, such a study would be an infinite nightmare. This is where a clinician is needed, to draw upon all of the issues at hand, not just some of the issues.  
For example, in this study, they just looked at arch heights and their determination as to whether the foot was pronating to a degree  (foot-posture index and categorized into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18).)
No where did they talk about foot types such as the very common forefoot variants of varus and valgus let along their compensated and uncompensated forms. No where were there discussions of tibial or femoral torsion or the possibly necessary foot pronation needs to bring the knee joint back to the sagittal plane. Plus, just because a foot is flat, doesn’t truly mean it is over pronated. It may be flat because of genetics, we have talked about genetic trends here in previous blog posts.  We see plenty of flat competent feet in our clinics. The may appear flat or over pronated , but that is not the case for many people. The FUNCTION must be examined, and this does not come from visual inspection or from gait analysis video. We always say “what you see in someones gait or foot function is often their compensation around other issues, it is not their problem”.
Shawn and Ivo, the gait guys
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Part 2: “Standing on Glass” Static Foot/Pedograph Assessment

* note (see warning at bottom): This is a static assessment dialogue. One cannot, and must not, make clinical decisions from a static assessment. The right and left sides are indicated by the R and L circled in pink. There are 4 photos here today.

Blue lines: Last time we evaluated possible ideas on the ORANGE lines here, it would be to your advantage to start there. 

We can see a few noteworthy things here in these photos. We have contrast-adjusted the photo so the pressure areas (BLUE) are more clearly noted. There appears to be more forefoot pressure on the right foot (the right foot is on the readers left), and more rearfoot pressure on the left (not only compare the whiteness factor but look at the displacement of the calcaneal fat pad (pink brackets). There is also noticeably more lateral forefoot pressure on the left. There is also more 3-5 hammering/flexion dominance pressure on the left.  The metatarsal fat pad positioning (LIME DOTS represent the distal boundary) is intimately tied in with the proper lumbrical muscle function  (link) and migrates forward toward the toes when the flexors/extensors and lumbricals are imbalanced. We can see this fat pad shift here (LIME DOTS). The 3-5 toes are clearly hammering via flexor dominance (LIME ARROWS), this is easily noted by visual absence of the toe shafts, we only see the toe pads. Now if you remember your anatomy, the long flexors of the toes (FDL) come across the foot at an angle (see photo). It is a major function of the lateral head of the Quadratus plantae (LQP) to reorient the pull of those lesser toe flexors to pull more towards the heel rather than on an angle. One can see that in the pressure photos that this muscle may be suspicious of weakness because the toes are crammed together and moving towards the big toe because of the change in FDL pull vector (YELLOW LINES). They are especially crowding out the 2nd toe as one can see, but this can also be from weakness in the big toe, a topic for another time. One can easily see that these component weaknesses have allowed the metatarsal fat pad to migrate forward. All of this, plus the lateral shift weight bearing has widened the forefoot on the left, go ahead, measure it. So, is this person merely weight bearing laterally because they are supinating ? Well, if you read yesterday’s blog post we postulated thoughts on this foot possibly being the pronated one because of its increased heel-toe and heel-ball length. So which is it ? A pronated yet lateral weight bearing foot  or a normal foot with more lateral weight bearing because of the local foot weaknesses we just discussed ? Or is it something else ? Is the problem higher up, meaning, are they left lateral weight bearing shift because of a left drifted pelvis from weak glute medius/abdominal obliques ?  Only a competent clinical examination will enlighten us.

Is the compensation top-down or bottom up, or both in a feedback cycle trying to find sufficient stability and mobility ? These are all viable possibilities and you must have these things flowing freely through your head during the clinical examination as you rule in/rule out your hands-on findings.  Remember, just going by a screen to drive prescription exercises from what you see on the movement screen is not going to necessarily fix the problem, it could in fact lead one to drive a deeper compensation pattern. 

Remember this critical fact.  After an injury or a long standing problem, muscles and motor patterns jobs are to stabilize and manage loads (stability and mobility) for adequate and necessary movement. Injuries leave a mark on the system as a whole because adaptation was necessary during the initial healing phase. This usually spills over during the early movement re-introduction phase, particularly if movement is reintroduced too early or too aggressively.  Plasticity is the culprit. Just because the injury has come and gone does not mean that new patterns of skill, endurance, strength (S.E.S -our favorite mnemonic), stability and mobility were not subsequently built onto the apparently trivial remnants of the injury.  There is nothing trivial if it is abnormal. The forces must, and will, play out somewhere in the body and this is often where pain or injury occurs but it is rarely where the underlying problem lives.

Come back tomorrow.  We will try to bring this whole thing together, but remember, it will just be a theory for without an exam one cannot prove which issues are true culprits and which are compensations. Remember, what you see is often the compensatory illusion, it is the person moving with the parts that are working and compensating not the parts that are on vacation.  See you tomorrow friends !

Shawn and ivo, the gait guys

* note: This is a static assessment dialogue. One cannot, and must not, make clinical decisions from a static assessment. As in all assessments, information is taken in, digested and then MUST be confirmed, denied and/or at the very least, folded into a functional and clinically relevant assessment of the client before the findings are accepted, dismissed and acted upon. As we always say, a gait analysis or static pedograph-type assessment (standing force plate) is never enough to make decisions on treatment to resolve problems and injuries. What is seen and represented on either are the client’s strategies around clinical problems or compensations.  Today’s photo and blog post are an exercise in critical clinical thinking to get the juices flowing and to get the observer thinking about the client’s presentation and to help open up the field to questions the observer should be entertaining.  The big questions should be, “why do i see this, what could be causing these observances ?”right foot supinated ? or more rear and lateral foot……avoiding pronation ?

Shoe lacing problems, things you need to know (that you don't).

How you lace your shoes does truly matter (according to this study).
We have talked about shoe lacing on more than one occasion. Everyone has played around with different laces and lacing strategies at one time or another. And, every shoe seems to lace just a little differently. Some shoes lace far into the forefoot, some have the potential to lace high up into the ankle.  But just because there are eyelets there, doesn’t mean  you have to thread a lace through the hole. It is about fit the majority of the time.  Some of our runners will use “skip” lacing to avoid pressure over the dorsum of the foot, especially if they have a saddle exostosis or hot tendon in that area, much of the time this works to alleviate the pain and pressure there. Just remember, impaired ankle rocker often via weakness of the anterior compartment muscles (toe extensors, tibialis anterior, peroneus tertius) will force dorsiflexion moments into the midfoot and can cause some joint-related compressive pressure on the dorsal foot which can seemingly (and mistakenly) come from shoes tied too tight across the top of the foot. Be sure to consider this fact before you “skip lace” your shoes, it is a big player, one we see all of the time.
In today’s journal article found below, we discover some other factors in a controlled study.  Here they look into the effects of lacing on biomechanics in running, specifically rearfoot runners. The results of the study showed reduced loading rates and pronation velocities as well as lowest peak pressures under the heel and lateral midfoot in the tightest and highest laced shoes. Whereas, the lower laced shoes resulted in lower impacts and lower peak pressures under the 3rd and 4th metatarsal heads (they proposed that this was from forward foot slide in the shoe because of this lacing). The study authors concluded 

 A firm foot-to-shoe coupling with higher lacing leads to a more effective use of running shoe features and is likely to reduce the risk of lower limb injury.

Remember, this is just data for you to cogitate over. It can help you work through some possible issues with your feet and your sport, however it does not translate to everyone as a standard protocol. Remember this, we have been known to say, “your problem is not often the shoe, it is the thing in the shoe (you and your faulty biomechanics)”. However, blaming your problems on you is not good shoe manufacturer advertising, so many shoe companies will offer a plethora of shoes choices for you to accommodate to your variables. This does not necessarily mean the problem is solved, rather it is often managed by a “better” shoe choice that seems to work for your variables. This is a good thing most of the time, if you understand shoes, shoe anatomy, and human anatomy (foot types) so that you can pair them up for a best outcome. The problem may lie in the fact that your shoe fitter is not likely to have all of the necessary pieces to put your perfectly matched picture together, including understanding your total body biomechanics and possibly understanding why a weak glute is impairing hip extension and thus limiting ankle rocker motion, causing premature heel rise, and thus forcing too much dorsiflexion into the arch of the foot and premature forefoot loading causing what seems to be too tightly tied shoes.  
What we truly need an e-Harmony for matching shoes and feet ! But since that perfect scenario doesn’t often exist at the shoe store level or gait analysis level, here at The Gait Guys we have put together the next best thing, The National Shoe Fit Certification Program if you care to take this all to the next level. 
Shoe fitting is an art, and lacing is just another paint brush you can  use to get the job done. You just have to know what brush to use for each given piece of art (ie. the athlete). 
Shawn and Ivo, The gait guys
J Sports Sci. 2009 Feb 1;27(3):267-75. doi: 10.1080/02640410802482425.

Effects of different shoe-lacing patterns on the biomechanics of running shoes.

 

Podcast 74: Cross Fit: More on Squatting and Hip Torsions, Part 2

Lots of great hip, squatting and biomechanics in this weeks show !

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_75.f_74.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-74

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

Diving deeper into crossfit’s squatting, lunges, leg press.

 Walking in sync makes enemies seem less scary

 
 

The Next Big Thing In Sports Data: Predicting (And Avoiding) Injuries

http://m.fastcompany.com/3034655/healthware/the-next-big-thing-in-sports-data-predicting-and-avoiding-injuries

“LER editor’s pick: Hip internal and external rotation are associated with shoulder mechanics in collegiate baseball pitchers. http://ow.ly/zULpO

Michael August 27 at 7:49pm I’m curious to hear some thoughts on this, too. I listened to the podcast and read the blog post by the Gait Guys. I’ve coached CrossFit since 2009 and have owned my own affiliate for the last three years and follow Starrett closely. The cue “knees out” originated in powerlifting and the purpose is to keep people from ending up compensating with a valgus knee position during a squat, which is the most common compensation. Also, CrossFit did a special “Offline Episode” with Starrett, Kilgore, Russel Berger (he represented CrossFit) and two other coaches in which the sole topic was the “knees out” cue. It’s very illuminating for this topic. One interesting thing is that CrossFit does not tell people who go through the level 1 to tell others as a law, knees out. It’s merely a cue to fix a common compensation.

Podcast 73: Cross Fit and Squatting. Knees out ?

Podcast 73: Femoral and Tibial Torsions and Squatting: Know your Squatting Truths and Myths

*Show sponsor: www.newbalancechicago.com

Lems Shoes.  www.lemsshoes.comMention GAIT15 at check out for a 15% discount through August 31st, 2014.

A. Link to our server: http://traffic.libsyn.com/thegaitguys/pod_74f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-73-cross-fit-squatting-knees-b. out

iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

1. Bioengineers create functional 3D brain-like tissue   http://www.nih.gov/news/health/aug2014/nibib-11.htm

2.  A Novel Shear Reduction Insole Effect on the Thermal Response to Walking Stress, Balance, and Gait
 
3.  Hi Shawn and Ivo, There is a lively debate in the Crossfit community about “knees out” during squatting. I have attached a blog post. It might be a good blog post or podcast segment. 
 
4. Shoe Finder ?
 
5.  Michael wrote: “I know this is too broad a topic for facebook, but I was wondering what your general recommendation would be for someone with flat feet and exaggerated, constant over-pronation. I’ve tried strengthening my calves and ankles, but have seen no noticeable reduction in the automatic "rolling in” of my feet whenever walking or standing. I can consciously correct the over-pronation, of course, but as soon as I stop tensing my arch muscle, everything flops back down.“

Podcast 72: Neuroplasticity, EVA Shoe Foam, and Shoe Trends

Maximalist shoes and the death of Minimalism ? Could this be true ?

*Show sponsor: www.newbalancechicago.com

Lems Shoes.  www.lemsshoes.comMention GAIT15 at check out for a 15% discount through August 31st, 2014.

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_73f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-72

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

1. Neuroplasticity: Your Brain’s Amazing Ability to Form New Habits
new link (does not have the old photo ivo mentioned that he loved)
 
2. Last week we pounded the sand on EVA foam and maximalist shoes. There was alot of attention, emails and good social media discussion on the topic.  
LETS REVIEW IT
file:///Users/admin/Downloads/p142_Heel_shoe_interactions_and_EVA_foam_f_web_150dpi.pdf
 
3. Then there just last week there was an article in LER on “the death of minimalist shoes” ? 
READ THIS: 
The rise and fall of minimalist footwear | Lower Extremity Review Magazine
http://lermagazine.com/cover_story/the-rise-and-fall-of-minimalist-footwear
 

4.  Physical Therapy as Effective as Surgery for Meniscal Tear

Kathleen Louden

March 20, 2013
Torn Meniscus? Thinking about surgery? Think again…

5. Cast study: the broken foot tripod

Podcast 62: Foot Strengthening and Lumbar/Glute Endurance

A. Link to our server:

Direct Download: http://traffic.libsyn.com/thegaitguys/pod_62final.mp3

Permalink: 

http://thegaitguys.libsyn.com/podcast-62-foot-strengthening-and-lumbarglute-endurance 

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

1. Neuromuscular Fatigue Alters Postural Control and Sagittal Plane Hip Biomechanics in Active Females With Anterior Cruciate Ligament Reconstruction

Podcast 61: Sweating, Ankle Rocker and Free Radicals & Exercise

A. Link to our server:

Direct Download: 

http://traffic.libsyn.com/thegaitguys/pod_61final.mp3

Permalink: 

http://thegaitguys.libsyn.com/podcast-61-sweating-ankle-rocker

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

1. Free Radicals, Exercise and Nutritional Supplements
Free Radic Biol Med. 2011 Jul 15;51(2):327-36. doi: 10.1016/j.freeradbiomed.2011.05.010. Epub 2011 May 14.

Extending life span by increasing oxidative stress.

 
_____________
3. we thank Will, one of our faithful followers for sending this article
 
________
 
 
4. Jack rabbit sports running shoe company in New York !
 
__________

Gabe 11:03am Apr 21

5. Hello Gait Guys,
My name is Gabriel and I am a former patient of Dr. Ivo. I am also a quasi gait geek in the sense that I have read about 90% of your posts and listened to about 80% of your podcasts. I am messaging you today because I am now employed in the REI shoe Department and I would like to get shoe fit certified. If you could explain the shoe fit certification in more detail to me and testing locations, I would greatly appreciate it.
______________
The neurologist with a right short leg from a lower leg reconstruction , barely 90° right ankle dorsiflexion and severe LEFT OA hip
 
Gave him a right to millimeter sole liftft. He doubled the sole lift without telling me. Came in with a raging hot extensor digitorum dorsal foot pain.
 
6. New Balance fresh foam shoes:
weighs 9.1oz

25mm in heel; 21mm in forefoot w/ 4mm drop