What does sustained rearfoot and forefoot inversion look like in terms of shoe wear ?

This is a client who came to us with a history of several months of big toe pain (specifically 1st metatarsophalangeal joint pain). The pain was dorsally located (ie. top of the big toe joint).  It was clear that on examination the pain was being caused by osseous and soft tissue dorsal impingement due to a progressing hallux rigidus/limitus. 

This painful status obviously is creating both a conscious medial toe off pattern during the propulsive phase of late stance phases.  The client is more than obviously steering push off laterally as can be seen in this photo. The grey lateral pods are almost obliterated. This means the foot is perpetually supinated during the entire stance phase of gait and this means that pronation shock absorption is not present.

Remember, a perpetually supinated foot means the talus and arch never descend as part of the pronation/shock absorption cycle and so the same side limb will always remain longer than the other limb which is seeing the internal rotation/pronation effects which functionally shorten the leg during stance phase.  So in this case, we have a pelvic unlevelling and a frontal plane shift to the functionally shorter leg during its stance phase.  It should not surprise you that this client has hip pain contralateral to this abnormal shoe wear/hallux limitus side. 

There are plenty of other issues here to be discussed, like eccentric weakness of the same side g.maximus, patellar tracking issues, lack of hip extension and thus weakening of the glutes and thus resultant shortness of the quadriceps group which will all often be found in this clinical picture. But we will save that all for another time.

Remember, the longer this client stays in this shoe, the easier it is mechanically on them because the eVA foam and the shoe are broken down into their compensatory avoidance behaviour.  But, this is where the pattern becomes subconsciously embedded and thus when the pattern drives many of the other compensatory patterns off of this one since it is the new norm. The faster you address this problem, the sooner you stop the compensatory cascade.  And on that note, if you read our blog post re-run of the Arm Swing last week you will understand why  these folks will begin altering the opposite arm swing phase.

Shawn and Ivo, The Gait Guys