What does a pedograph of a person with hallux limitus look like?

Take a good look at the pedographs above. Can you figure out which side has the hallux limitus from the pictures? 

You would think that with hallux limitus there would be increased printing over the distal phalanx of great toe and possibly over the distal metatarsal as seen in the print of the right foot. This would make sense as if you have limited motion here and the pressure will be more forward. However, often times Hallux limitus is painful and the patient develops a compensation to NOT load the joint, as we see on the print of the left foot. We see the lack of printing under the first metatarsal head and increased printing laterally in the foot from avoidance of that joint. Also notice a slight increased printing in the right heel teardrop (hash marks are more filled in) and slight widening of it anteriorly. He has a right sided leg length discrepancy and we would normally expect an increased amount of pronation on the longer leg side, however because of the weight shift to the left we are seeing increased pronation on the right. Now, with this valgus moment of the right foot do you understand why the printing is so heavy under the first metatarsal and distal phalanx. Note also the increased printing at the distal phalanx of toes number two, three and five on the right hand side in an attempt to stabilize as his center of gravity shifts to the right.

And now you know!

Dr Ivo, one of The Gait Guys

#halluxlimitis, #gaitanalysis, #pedograph, #leglengthdiscrepancy, #LLD

A Tale of 2 Footies

Time for a pedograph, folks. What do we have here?

To review :

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: The heel teardrop is elongated on both sides, slightly more on the right; this means incraesed calcaneal eversion (or rearfoot pronation) bilaterally, R > L. The right heel shows increased pressure (more ink = more pressure).

Next up, the mid foot. Similar shapes, more pressure and printing on the left. Did you notice the “tail” of the 5th metatarsal printing, giving it a wider print? This person is staying on the outside of their foot longer than normal, right (more ink) more than left.

How about the fore foot? Lots going on there.

Lets start on the left

Notice the mild increased printing of the 5th and 4th metatarsal heads. Force should be traveling from lateral to medial here, as the foot goes into supination. A relatively normal amount of pressure on the head of the 1st metatarsal.

Now look at the toes. Notice that space between the 2nd and 3rd? This gal had an old fracture and has an increased space between them.

Now how about the right?

Increased pressure on most of the heads with a concentration on the 1st metatarsal. Hmmm…what would cause that? this is typical of someone who has a 1st ray (cunieform and metatarsal) that is hypomobile, such as with someone with a forefoot valgus (as this person does) or a dropped 1st metatarsal head (which is usually rigid, as is NOT the case here).

Did you see that rpinting at the medial aspect of the proximal phalanyx of the hallux (ie. big toe)? This gal externally rotates the lower extremity to push off the big toe to propel herself forward. This is because the 1st metatarsal head hits the ground BEFORE the 5th (as we would normally expect to see, like in the left foot), and because the weight is now on the outside of the foot, she need to push off SOMETHING.

Getting better at this? We hope so. Keep reading the blog and look at some of our past pedograph posts here.

The Gait Guys. Teaching you about the importance of gait, each and every day!

What’s up, Doc?

Nothing like a little 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. I