The answer is " yes, often times".
Did you miss our 3rd Wednesdays presentation last week on foot types and obligate biomechanics (and pathomechanic) that ensue? Here is the video feed that you can watch and get ce credits for:
https://www.chirocredit.com/course/Chiropractic_Doctor/Biomechanics_214
#foottypes #biomechanics #thegaitguys
forefoot varus: note how the forefoot is inverted with respect to the rear foot
Foot type. You know what we are talking about. The relation in anatomically and in space of the rear foot to the forefoot. We believe that this anatomical relationship holds key clinical insights to predictable biomechanics in that particular foot type.
Simply put, the rear foot can be either inverted, everted or neutral; Same with the forefoot. If the rear foot is inverted we call that a rearfoot varus. If the foot is inverted we call that a forefoot varus. If the rear foot is everted we call that a rear foot valgus and if the forefoot is inverted we call that a forefoot valgus.
Now think about the simple motions of pronation and supination. Pronation is dorsiflexion, eversion and abduction; supination is plantar flexion, inversion and adduction. If it remains in eversion, we say that it is in vslgus and that means they will be qualities of pronation occurring in that foot while it is on the ground. If the foot is inverted, it will have qualities of supination.
We think of pronation as making the foot into a mobile adapter and supination is making the foot into a rigid lever.
During a typical gait cycle the foot is moving from supination at initial contact/loading response to full pronation at mid stance and then into supination from mid stance to terminal stance/pre-swing. I know that if the foot remains and pronation past mid stance that it is a poor lever and if it remains in supination prior to mid stance it will be a poor shock absorbers. Foot type plays into this displaying or amplifying the characteristics of that particular foot type during the gait cycle: if this occurs at a time other than when it supposed to occur, then we can see predictable biomechanics such as too much pronation resulting in increased rear foot eversion, midfoot collapse, abduction of the forefoot and internal rotation of the knee with most often medial knee fall. Now, consider these mechanics along with any torsions or versions in the lower extremity that the patient may have.
This Wednesday night we will be discussing foot types and their biomechanics. Join us on onlinece .com for Biomechanics 314 6:00 MST
Dr Ivo Waerlop, one of The Gait Guys
Dr Ivo discusses a pediatric case and some treatment modalities
What foot type do we have here?
OK, so this gentlemen comes in with knee pain, L > R and an interesting “jog” in his gait from midstance to toe off (ie, the 2nd half of his gait cycle).
A few questions for you:
Q: What foot type does he have?
A: Forefoot valgus, L > R. The forefoot is everted with respect to the rear foot. Need to brush up? click here and here for a refresher
Q: What is the next question you should be asking?
A: Is it a rigid deformity (ie the 1st ray is “stuck” in plantar flexion or flexible (ie, the 1st ray can move into dorsiflexion. Hint: look for a callus under the base of the big toe in a rigid deformity
Q: Which is the best type of shoe for this person? Motion control, guidance or neutral?
A: most likely, neutral. A motion control shoe will usually keep the foot in more relative inversion, and that may be a bad thing for this person. Mobility is key, so a flexible shoe would probably be best.
Q: Would a conventional or zero drop shoe be appropriate?
A: A conventional shoe, with a higher ramp delta, will most likely accentuate the deformity (especially if it is a rigid deformity). This is for at least 2 reasons: 1. plantar flexion is part of supination (due to the higher heel; remember plantar flexion, inversion and adduction) and this will make the foot more rigid. 2. The medial side of the foot will be hitting the ground 1st; if the 1st ray is in plantar flexion, this will be accentuated.
The Gait Guys. Foot Nerds to the max. Convincing you to join forces with us in spreading the word and gait literacy. LIke this post? tell others! Don’t like this post? Tell us!
Need to know more? Take our National Shoe Fit Program and get certified! email us at thegaitguys@gmail.com for details.
Too much pressure for the holidays? Take a look at that midsole of yours…
In the vein of last weeks post on plantar pressures, we find that midsoles DO DECREASE plantar pressures, especially across the midfoot (30% less pressure in this study), again dependent on foot type (In this study, low vs high arched individuals). They also INCREASE plantar contact area. Contact area can be useful for helping to influence biomechanics of different foot types (often more contact area = more force attenuation)
We also saw that they increase pressures LATERALLY (see our post here).
Bottom line? You need to look at foot type and remember that “shoes are medicine”. Watch what you are prescribing and think about what you are trying to accomplish. There is no substitute for good biomechanics.
We are The Gait Guys. Bringing you the best of gait, each week.
US Army-Baylor University Doctoral Program in Physical Therapy, Ft Sam Houston, TX 78234-6138, USA. Joseph.Molloy@amedd.army.mil
Abstract BACKGROUND:Research addressing the effect of running shoe type on the low- or high-arched foot during gait is limited. We sought 1) to analyze mean plantar pressure and mean contact area differences between low- and high-arched feet across three test conditions, 2) to determine which regions of the foot (rearfoot, midfoot, and forefoot) contributed to potential differences in mean plantar pressure and mean contact area, and 3) to determine the association between the static arch height index and the dynamic modified arch index.
METHODS:Plantar pressure distributions for 75 participants (40 low arched and 35 high arched) were analyzed across three conditions (nonshod, motion control running shoes, and cushioning running shoes) during treadmill walking.
RESULTS:In the motion control and cushioning shoe conditions, mean plantar contact area increased in the midfoot (28% for low arched and 68% for high arched), whereas mean plantar pressure decreased by approximately 30% relative to the nonshod condition. There was moderate to good negative correlation between the arch height index and the modified arch index.
CONCLUSIONS:Cushioning and motion control running shoes tend to increase midfoot mean plantar contact area while decreasing mean plantar pressure across the low- or high-arched foot.
all material copyright 2012 The Gait Guys/ The Homunculus Group. Please ask before using our stuff or Santa will bring you athletes foot this holiday season.
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The Gait Guys Case of the week: What do you see?
This individual presents with Right achilles tendonitis, bilateral foot pain and a history of plantar fascitis. What do you think?
Take a look at his foot type, particularly the forefoot to rearfoot orientation. Hmmm….Asymmetrical. Notice the dropped 1st metatarsal on the left that is not present on the right. He has a forefoot valgus on the left with a quasi flexible 1st ray (1st ray = medial cuneiform, 1st metatarsal and associated phalanges) which is dropped and an uncompensated forefoot valgus on the right, with an inflexible 1st ray.
He has bilateral external tibial torsion (which you cannot see in these pictures) right greater than left (OK, you can see that), as well as a Left anatomically short leg (tibial) of approximately 7mm.
Now look at the pedographs. BIG difference from left to right. Good tripod on right with clear markings over the calcaneus, the head of 5th metetarsal and the head of 1st metatarsals. But I thought you said he had an UNCOMPENSATED forefoot valgus ? Look at the shape of the forefoot print. It is very different from right to left. Remember, with a forefoot valgus, the medial side of the foot hits the ground before the lateral side most of the time,
How about the left? Look at all that metatarsal pressure. Looks like a loss of ankle rocker. Think that might be causing some of that left sided foot pain? Notice the print under the 1st metatarsal is even greater; and look at all that printing of the 5th metatarsal head. Remember, this is the shorter leg side, so this foot will have a tendency to supinate more, thus he increased pressures laterally.
Achilles tendonitis? Stand on one leg on your foot tripod and rock between the head of your 1st metatrsal and head of the 5th. Where do you feel the strain? The gastroc/soleus and peroneals. Now put all your weight on the lead of the 1st metatarsal. What do you notice? The foot is everted. What everts the foot? The peroneals. So, if the foot is everted (like in the forefoot valgus), what muscle is left to shoulder the load? Remember also, that the gatroc/soleus group contracts from mid to late stance phase to invert the heel and assist with supination of the foot.
The Gait Guys. Your guiding light to gait literacy and competency.
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All material copyright 2012 The Gait Guys/The Homunculus Group.
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