Short leg and Pronation

Dr Allen was ON FIRE on tonites onlinece.com lecture Biomechanics 322). Hope you will join us again (or next time if you missed us). We talked about many of the aspects of a static exam and how it effects weight bearing in the foot. The word "short leg" came up more than once, and yes, from Dr Allen : )

Remember, as the foot pronates more on one side, the center of gravity will move medially. You will often see more toe clenching (and resultant quadratus plantae weakness) on the more pronatory side and more toe elongation on the more supinatory side. You will often also see more splay and elongation on the pronatory side, and less elongation and less splay on the supinatory side. Remember, these are guidelines and not rules, and there are ALWAYS exceptions.

Pod 133: Two Gait Cases & their Gait Rehab

Today we discuss a few cases we have seen.  We discuss 2 cases, both involved poorly adapted gaits from injury, adaptations that had become the client's new norm. Once you get past Ivo's case presentation, which is very in depth, the discussions quickly go into very important topics that we all over look, namely gait and gait rehab, gait thresholds, metabolic thresholds, cortical fatigue, and how to use some neurologic principles to restore a problematic gait.

Key Tag words:
gait, concussion, head trauma, cortical fatigue, endurance, strength, gait analysis, gait problems, gait rehab, running, running injuries, run-walk, SCFE, slipped epiphysis, femoral growth plate, hip stress fractures, growth plate injury, hip dysplasia, limping gait, club foot, step length, stride length

Links to find the podcast:

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

http://traffic.libsyn.com/thegaitguys/pod_133final.mp3

http://thegaitguys.libsyn.com/pod-133-two-gait-cases-their-gait-rehab

Libsyn Directory: http://directory.libsyn.com/episode/index/id/6184651

Our Websites:
www.thegaitguys.com

summitchiroandrehab.com doctorallen.co 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.

Club Foot, anyone?

This gent came in to see us for a new orthotic prescription. As you can imagine, or are probably aware, these cases present a challange becuase of both the anatomy and pathomechanics, especially the plantar flexed foot and loss of ankle rocker.

This gent had his left foot is 20 degrees plantar flexion. He has bi-lateral rigid forefoot valgus, bi-lat. femoral retrotorsion and bi-lat. internal tibial torsion.  

We built him an othotic with a modified UCB (deep heel cup) with 20 degrees of plantar flexion (ie ramp delta or "drop") into the left orthotic as well as bilateral forefoot valgus posts.

If you would like to read up on clubfoot (or talipes equino varus, as it is called) , here is a nice, full text review.

Anand A, Sala DA. Clubfoot: Etiology and treatment. Indian Journal of Orthopaedics. 2008;42(1):22-28. doi:10.4103/0019-5413.38576.

link to free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759597/

Congenital clubfoot anyone?

This gentleman, a longtime patient came in for new orthotics, as his old ones were 10 years old. From the pedographs above, you can see it is his LEFT foot. 

Note the following:

• shortened apparent foot length left compared to right (the foot is merely deformed and plantarflexed)
  
• The increased plantar pressures laterally, from the foot being supinated 
  
• increased arch height L > R
  
• clawing of digits 2-4 to provide stability
  

This case made me think about some common issues that you may be wondering about if you see these folks. 

There are several things you should think about:

• People with clubfoot generally have a high arched, rigid, cavus foot. 
  

• These folks generally are fixed in some degree of plantar flexion.
  

• Because of the plantar flexed posture of their foot, they generally have a loss of a ankle rocker
  

• If you utilize an orthotic with these patients, you need to make sure that there is significant ramp delta (heel higher than the 1st metatarsal)
  

• Clubfoot can often be unilateral.
  

• Clubfoot is usually not congenital
  

• Gait training and balance (proprioceptive) work can be especially helpful in these cases. 

Is the "normal foot" normal ?

IF one foot is not normal, the other one cannot be “normal” either.  This is a blog post about symmetry, sort of.

This article just sort of seemed silly to us.

Imagine having a stone in one shoe and walking around in that shoe. Obviously you are gonna alter weight bearing in that shoe to avoid the pain and pressure of the stone. That means that the normal gait cycle of that foot/leg will be distorted somehow, the timed events of the gait cycle will be distorted and even likely the duration of the stance phase, heck, even plantar pressures will be changed.  Thus, the apparently “normal” foot on the opposite side will have an altered loading response and challenge because it will be receiving anything but normal biomechanics from the “stoned” shoe/foot.  Adaptation and compensation will have to occur, and not just in the “normal” foot, the entire body. 

Take another example, a sprained ankle. The brain will abbreviate the painful stance phase and abrupty depart the foot and thus create premature loading on the healthy foot, likely into mid-midstance which is usually met by midfoot strike and catching the body load with the quad thanks to abrupt knee flexion rather than early midstance with glute control during the loading response.  

Thus, if one foot is abnormal, there is just no way the so-called “normal” foot will be unaffected.  As this study suggests, the normal foot will have altered pedobarographic measurements.  Maybe we are missing the point here, but we suppose the words “relatively normal” or an “expected normal” should have been used. Yes, we may be splitting hairs here and discussing a relatively moot point, but our purpose was to just describe that since the two limbs are attached to the same body, if one side is not normal, a compensation has to occur in the other limb.  There is no other option.  We talk more about this concept in podcast 75 which will launch next week.

Shawn and Ivo, the gait guys

The contralateral foot in children with unilateral clubfoot, is the unaffected side normal?

http://www.gaitposture.com/article/S0966-6362(14)00523-2/abstract

Highlights

• •Pedobarographic measurements of unilateral unaffected clubfoot are not same as normal controls.
• •The unaffected foot should not be referred to as normal, nor should it be used as a control.
• •Timings of initiation of stance differ significantly between normal and unaffected clubfeet.
• •Unaffected clubfoot accumulates differences from normal feet due to maturation of gait with age.

Abstract

“Significant differences were identified between the unaffected side and normal controls for the pressure distribution, order of initial contact and foot contact time. These differences evolved and changed with age. The pedobarographic measurements of patients with clubfoot are not normal for the unaffected foot. As such the unaffected foot should not be referred to as normal, nor should it be used as a control.”

Podcast #14: Forefoot Strike & Evolution

Podcast #14

Here is the live link:   http://thegaitguys.libsyn.com/webpage

iTunes will load it likely by the afternoon. Find it on iTunes through this link:

__________________________________________

Payloadz link for our DVD’s and efile downloads: http://store.payloadz.com/results/results.asp?m=80204

1- National Shoe Fit Program and Certification

2- email from a reader
from: Mikkel
I am currently treating a 15-year-old boy who as a child suffered from left sided equinovarus deformity and was operated. His left gastoc/soleus complex is underdeveloped, and he has impaired ankle rocker due to bony limitations anteriorly in the mortise joint causing anterior ankle pain when running and jumping. He has a distinct limp on the left leg due to decreased ROM and pain. He has an inverted calcaneus and forefoot valgus deformity on both feet (left more than right). He pronates heavily through the mid and forefoot to progress forward. Treatment thus far has had limited effect on the pain symptoms. I’ve manually mobilized the tibiotalar joint with posterior glides of the talus + given him exercises to strengthen the anterior compartment.
Would you consider orthotics? I’m thinking stability shoe with medial arch support maybe with a forefoot drop. Normally I would prefer stability and strength training and foot tripod exercises, but due to bone structure I have started to think, this isn’t enough. The pain limits him from running and playing soccer.
How would acupuncture fit into a treatment program in this case? which points could you recommend?
Any additional info and inspiration is welcomed.
kind regards - Mikkel

 http://en.wikipedia.org/wiki/Club_foot

2- Know your foot strike
http://sweatscience.runnersworld.com/2012/10/do-you-know-your-footstrike/

3- Caffeine: A PED ?

http://news.menshealth.com/chew-gum-before-races/2012/04/12/

Chew on this: Caffeinated gum can improve your athletic performance—if you start chewing it at the right moment, finds a new study from Kent State University.

 http://www.energyfiend.com/the-caffeine-database

4- DISCLAIMER:We are not your doctors so anything you hear here should not be taken as medical advice. For that you need to visit YOUR doctors and ask them the questions. We have not examined you, we do not know you, we know very little about your medical status. So, do not hold us responsible for taking our advice when we have just told you not to !  Again, we are NOT your doctors !

5: more lectures available  on www.onlineCE.com   Go there and look up our lectures

6- EMAIL FROM A Blog follower: 
Why do some muscles go weak and others not ?
First lets talk about tightness vs shortness. We are getting exhausted from always hearing about tight piriformis, psoas hip flexors and IT Bands.
Now, lets define 2 types of weakness…….
a- physiologic /  disuse
b- neurlogic inhibition

7- Our dvd’s and efile downloads
Are all on payloadz. Link is in the show notes.
Link: http://store.payloadz.com/results/results.asp?m=80204

8 - Creatine:
 http://www.foxnews.com/health/2012/10/11/creatine-myths-and-facts/

9- The one perfect test for a runner ?
 http://news.menshealth.com/find-your-perfect-running-pace/2012/10/14/
The Talk Test
Researchers for the study put 18 well trained cyclists through two identical fitness tests. In one test they measured the above thresholds with traditional medical equipment. In the second test they asked cyclists to say a paragraph while exercising. What they found was that the cyclists’ “out-of-breathness” matched the thresholds. “From our standpoint, the TT is very useful and almost ‘idiot-proof,’” Foster says.