What do you see? A pedograph analysis
You have heard us time and time again talking about pedographs. When our site finally relaunches, we will have a link for you to be able to purchase one if you like. They really are indispensable and are a window to the gait cycle. In a retail setting, they are an excellent sales tool. With practice, they are a valuable asset to your skill set. As you look at more and more of them, they become easier to interpret in light of what you are seeing when you evaluate the individual.
So what do we see here?
Let’s divide the foot into 3 sections: the rear foot, the mid foot and the fore foot.
First of all, are they symmetrical? Look carefully at the fore foot on each side. NO! the right foot looks different than the left, so we are looking at asymmetrical pathology.
Let’s start at the rear foot: Left looks relatively normal; Right shows some artifact from either the sock, pants being stepped on, or perhaps a heel smudge. More pressure at the medial calcaneal facet on the right as well (more ink = more pressure). The shapes are relatively symmetrical, so equal amounts of rear foot pronation (or motion)
Next up, the mid foot. similar shapes, more pressure and printing on the right. Why? Increased weighting, maybe a leg length deficiency.
How about the fore foot? Lots going on here.
Let’s start with the right foot.
The forces should be coming across from right to left (lateral to medial). See the gap in printing between the lesser metatarsal heads and the big toe? Can you see how the printing under the great toe is further back than you would expect? This tells you the force is behind the head of the 1st metatarsal, not on it. This is a cardinal sign of a partially compensated forefoot varus (in other words, the individual can only partially get the head of the 1st metatarsal down to the ground). this printing is due to the soft tissue around the toe being pressed into the ground.
How about those toes? See the dark printing at the most medial aspect of the great toe? this is most likely caused by a callus. See how it spreads laterally? This is the area of the flexor hallucis brevis insertion, and ink here means it is firing. Now look at the increased printing of the 2nd and 4th toes. They are gripping (via flexor digitorum longus) to attempt to stabilize the foot.
How about the left foot? Different than the right. A similiar pattern for mets 2-4 that we saw on the right BUT look at the at 1st metatarsal! WOW, is it printing alot! This means that 1st met head is being driven into the ground pretty hard. It is probably accompanied by pain. This persons 1st metatarsal is making a medial tripod, but perhaps too much so. You usually see this type of printing in someone who has an uncompensated fore foot valgus (forefoot everted with respect to rear foot) or a plantar flexed 1st ray deformity (in other words, the 1st metatarsal is “stuck:” in a downward position).
How about the gripping of the 4 lesser toes? Trying to stabilize that foot, no doubt, as it will be trying to tip to the outside (rather than the inside, like we often see).
What about that big toe? This results from the foot being turned outward and the individual rolling off of the medial aspect of the great toe. It is too far medial and toward the edge of the big to for the flexor hallucis brevis tendon.
Lots of info. Were you able to see most of what we were talking about? Perfect practice makes perfect!
Want to know more? Get a pedograph! Want to find out more about interpretation? We literally wrote the book. Get your copy by clicking here.
The Gait Guys. Spread the feet, spread the word! Increasing the understanding of gait, one post at time.
all material copyright 2012 The Gait Guys/The Homunculus Group. If you want to use our stuff, please ask and give us credit.