Varus anyone?

Varus anyone?

Does patello femoral pain have anything to do with rearfoot varus? Perhaps, according to this study:

" A small but significant increase in rearfoot varus was found in the patellofemoral pain group compared with the control group (8.9 vs. 6.8 degrees; p = .0002). These results suggest that increased rearfoot varus may be a contributing factor in patellofemoral pain and should be assessed when evaluating the events at the subtalar joint and the lower extremity. In addition, it has been demonstrated that consistent rearfoot measurements can be obtained by an individual clinician."


Powers CM, Maffucci R, Hampton S. Rearfoot posture in subjects with patellofemoral pain. J Orthop Sports Phys Ther. 1995 Oct;22(4):155-60.

Do you know SQUAT? Have you seen SQUAT? Have patients/clients that LIKE to squat? Seen a foot that looks like this? Can you say REARFOOT VALGUS?

 "Significant changes in lower limb kinematics may be observed during bilateral squatting when rearfoot alignment is altered. Shoe pitch alone may significantly reduce peak pronation during squatting in this population, but additional reductions were not observed in the subtalar neutral position. Further research investigating the effects of footwear and the subtalar neutral position in populations with lower limb pathology is required."
 
So, what does this study tell us?

when rearfoot aliment changes, so do the kinematics (duh)
the surface (tilted into varus or inversion) or shoes (which are medially posted) can make or break the man (or women) when it comes to "peak" pronation (we knew that already; confirmation is always nice)
inverting the rearfoot can change ankle dorsiflexion (read "ankle rocker"); inverting the rearfoot seems to reduce it
inverting the rearfoot can change knee flexion; inverting the rearfoot seems to increase knee flexion
inverting the rearfoot can change hip abduction (and thus knee valgus); reducing it

Learn about the gait kinematics and clinical findings associated with this foot type, along with video clip examples and always entertaining discussion with us tomorrow night on onlinece.com: Biomechanics 308: Focus on the Rear Foot.  5PST, 6MST, 7 CST, 8EST


Power V, Clifford AM. The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic Individuals with a Pronated Foot Type. J Hum Kinet. 2012 Mar;31:5-15. doi: 10.2478/v10078-012-0001-0. Epub 2012 Apr 3.

#rearfootvalgus #squat #foottype

2012 Mar;31:5-15. doi: 10.2478/v10078-012-0001-0. Epub 2012 Apr 3.

The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic Individuals with a Pronated Foot Type.

Power V1, Clifford AM.

Author information

Abstract

Clinicians frequently assess movement performance during a bilateral squat to observe the biomechanical effects of foot orthotic prescription. However, the effects of rearfoot position on bilateral squat kinematics have not been established objectively to date. This study aims to investigate these effects in a population of healthy adults with a pronated foot type. Ten healthy participants with a pronated foot type bilaterally (defined as a navicular drop >9mm) performed three squats in each of three conditions: barefoot, standing on 10mm shoe pitch platforms and standing on the platforms with foam wedges supporting the rearfoot in subtalar neutral. Kinematic data was recorded using a 3D motion analysis system. Between-conditions changes in peak joint angles attained were analysed. Peak ankle dorsiflexion (p=0.0005) and hip abduction (p=0.024) were significantly reduced, while peak knee varus (p=0.028) and flexion (p=0.0005) were significantly increased during squatting in the subtalar neutral position compared to barefoot. Peak subtalar pronation decreased by 5.33° (SD 4.52°) when squatting on the platforms compared to barefoot (p=0.006), but no additional significant effects were noted in subtalar neutral. Significant changes in lower limb kinematics may be observed during bilateral squatting when rearfoot alignment is altered. Shoe pitch alone may significantly reduce peak pronation during squatting in this population, but additional reductions were not observed in the subtalar neutral position. Further research investigating the effects of footwear and the subtalar neutral position in populations with lower limb pathology is required.

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Flat Dogs

Take a look at these pedographs. Wow!

  • No rear foot heel teardrop.
  • No midfoot arch on left foot and minimal on right.
  • An elongated 2nd metatarsal bilaterally and forces NOT getting to the base of the 1st metatarsal and stalling on the 2nd: classic sign of an uncompensated forefoot varus.
  • increased printing of the lateral foot on the right

Knowing what you know about pronation (need a review? click here) Do you think this foot is a good lever? Do you think they will be able to push off well?

What can we do?

  • foot exercises to build the intrinsic and extrinsic muscles of the foot (click here, here, here, and here for a few to get you started)
  • perhaps an orthotic to assist in decreasing the pronation while they are strengthening their foot
  • motion control shoe? Especially in the beginning as they are strengthening their feet and they fatigue rather easily

The prints do not lie. They tell the true story of how the forces are being transmitted through the foot. For more pedograph cases, click here.

The Gait Guys. Teaching you more about the feet and gait. Spreading gait literacy throughout the net! Do your part by forwarding this post to someone who needs to read it.

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Saturday quickie:

Hmmm…. Rearfoot Valgus 
(Make sure to hover mouse over each image to examine more closely)

When the rearfoot is everted with respect to the fore foot. (wondering what this means? maybe you need to view our upcoming video course on foot types!)

Cardinal signs and pathomechanics
  • Everted (heel is collapsed inward as in the pics above)
  • midfoot/arch collapse: insufficient foot tripod
  • due to midfoot collapse, the foot is in excessive pronation and is poor lever for toe off and propulsion
  • Excessive internal rotation of the limb during gait cycle
 
 Should you give up on fixing this? NO!
Should you put them in orthotics? Maybe
Should you sterilize them so they can’t reproduce? Definitely not!
Is there help for this? Of course! 
 
What would you do?  Think about that this weekend and tune in next week for some  treatment ideas. 
 
See you on the blog next week
 
Have a great Saturday.
 
Ivo and Shawn