Subtle clues often tell the story. A case
A young athlete that wants to be faster (he is a 4:17 miler).
In the 1st shot we see he has an anatomically short R tibia (and the gait to match it). You will note the right tibial plateau is lower than the left. The 2nd shot backs this up; look at the malleoli.
The next shot shows a FABER test f the L hip. Compare the range of motion with the right one. Hmmm. Limited external rotation and abduction on the right. It should be noted he had normal and relatively symmetrical internal rotation of both hips.
Now come the feet. 1st the left. A relatively neutral foot. Next the right. What’s different? Note how much more pronounced the right 1st ray (ie 1st metatarsal phalangeal joint).
Think about his short side. Most likely, he will be trying to lengthen it, right? How would he accomplish that? By supinating the foot (making it more rigid) and attempting to lengthen that leg, by anterior rotation of the pelvis. If you anteriorly rotate the pelvis (ie the innominate rotates forward, bringing the ASIS forward), what happens to external rotation of the hip? Stand up, edtend your hip on your pelvis and find out. It limits it.
How else might he try to lengthen that leg? If he supinates the foot (ie planytarflexion, adducion and inversion), the foot will be more inverted. He will be trying to get that medial tripod down to the ground. How might he accomplish that? By plantarflexing the 1st ray!
So how can we make him faster?
- Place sole lift under r foot
- Correct pelvic pathomechanics with manipulation
- Support coorection with appropriate exercise (he had weak R lower external oblique’s)
- Foot mobilization
- R Foot intrinsic exercises to promote rasing of the 1st ray (extensor hallicus longus and flexor hallicus brevis exercises) and lowering of the lesser metatarsal heads (extensor digitorum brevis exercises ).
The answers are often in the details. Be detail oriented. That’s one of the things that makes us foot geeks.
Ivo and Shawn
