What’s up, Doc?

Nothing like a little Monday morning brain stretching and a little Pedograph action.

This person had 2nd metatarsal head pain on the left. Can you figure out why?

Let’s start at the rear foot:

• limited calcaneal eversion (pronation) L > R. The teardrop shape is more rounded on the left. This indicates some rigidity here.
• note the increased pressure at the  medial calcaneal facets on each side with the increased printing
• very little fat pad displacement overall

Now let’s look at the mid foot:

• decreased mid foot pronation on the L. See how thin the line is going from the rear foot to the forefoot along the lateral column? This indicates a high lateral longitudinal arch

Now how about the fore foot?

• increased printing under the met heads bilaterally; L >> R
• increased printing of 1st met head L >> R
• increased printing at medial proximal phalynx of hallux  L >> R
• increased printing of distal phalanges of all toes L >> R

 Figure it out?

What would cause increased supination on the L?

• short leg on L
• more rigid foot on L
• increased pronation on the R

Did you notice the elongated 2nd metatarsals (ie: Morton’s toe) on each foot?

Here is what is going on:

• there is no appreciable leg length deformity, functional or anatomical
• The Left foot is more rigid than the Right, thus less rear, mid and fore foot pronation, thus it is in relative supination compared to the right foot

do this: stand and make your L foot more rigid than the right; take a step forward with your right foot, what do you notice?

• Can you feel how when your foot is supinated
• can you see how difficult it is to have ankle rocker at this point? remember: supination is plantar flexion, inversion and adduction
• Can you feel the weight of the body shift to the outside of the foot and your toes curl to make the foot more stable, so you do not tip to the left?
• now, how are you going to get your center of mass forward from here? You need to press off from your big toe (hallux)

Wow, does that make sense now?

What’s the fix?

• create a more supple foot with manipulation, massage, muscle work
• increase ankle rocker by training the anterior compartment (shuffle walks, lift/spread/reach exercise, heel walking, Texas walk exercise, etc)
• have them walk with their toes slightly elevated
• we are sure you can think of more ways as well!

The Gait Guys. Increasing your gait literacy with each and every post. If you liked this post, tell others and spread the word. If you didn’t like this post, tell us! We value your constructive feedback.

Footprints in the sand. What do they tell us?

They say that sometimes the silences speak volumes. Take a look at these prints and see if you see the following:

• more pressure on the forefoot, right greater than left
• more pressure on the lateral aspects of the forefeet
• an increased progression angle on the right, compared to the left
• judging from the step length, this person either has really long legs or was running
• the heel seems to hit the ground slightly more on the right
• judging from the sole pattern, they are most likely wearing an Inov8 shoe

Or, we can comment on what WAS NOT seen:

• less pressure on the rearfoot, indicating a forefoot strike, or extremely tight posterior compartments
• less pressure on the medial aspects of the forefeet, indicating inefficient push off, since they are not able to get their weight to the medial tripod
• an more normal progression angle on the left, possibly indicating better mechanics there
• this person IS NOT a heel striker, but seems to have a greater range of dorsiflexion available to them on the right, most likely with more ankle rocker
• judging from the sole pattern, they are most likely wearing an Inov8 shoe

Just like in the movie “Swordfish”, John Traviolta’s character comments that “It’s all about perception”.

So, what can we surmise from our deductions?

• less pressure on the rearfoot, indicating a forefoot strike, or extremely tight posterior compartments

this individual may have a loss of ankle rocker

• less pressure on the medial aspects of the forefeet, indicating inefficient push off, since they are not able to get their weight to the medial tripod

we are probably looking for someone who has a fore foot varus deformity. This is often accompanied by increased tibial varum

• n more normal progression angle on the left, possibly indicating better mechanics there

the difference in progression angle may indicate this person has a torsional deformity and/or limited internal rotation of the hips

• this person IS NOT a heel striker, but seems to have a greater range of dorsiflexion available to them on the right, most likely with more ankle rocker

again, look for someone who has impaired ankle rocker, or limited (at least assymetrical) ankle dorsiflexion

Yes, even when we are on vacation, we are looking at gait, because it is everywhere and affects all forms of human life and behavior.

The Gait Guys. Walking in the sand. Looking for the subtle clues. Teaching you in each and every post