Podcast 138 (for real). Are you fighting your own gait/running neurology?

Topics:
1. Running with the extensors. Convergence and divergence of neurons.
2. Fighting your gait neurology. The lies about the Bird dog rehab exercise.
3. ACL and ACL rehab. Surgery or no sugery. Wise? Risks ? How social media discussions might just be getting it wrong.
4. Cross over gait and lateral heel strike and ensuing problems at great toe off. A failure to medial foot tripod high gear toe off ?
5. Are the hip flexors actually hip flexors in gait ? what are your high knee drills doing? Anything good?

Key words: acl, analysis, cross, extensor, flexors, gait, heel, hip, instability, knee, over, plri, pools, problems, running, strike, surgery

Links to find the podcast:

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

Direct Download:http://traffic.libsyn.com/thegaitguys/pod_138_real_-_82818_2.12_PM.mp3

Permalink URL:http://thegaitguys.libsyn.com/podcast-138-for-real

Libsyn URL: http://directory.libsyn.com/episode/index/id/6978817

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.

Surgery vs casting...same results

image source: https://commons.wikimedia.org/wiki/File:Trimalleolar_Ankle_Fracture.jpg

We see many people for all types of fractures and rehab. This study looks at folks who had ankle fractures who either got mhm casted or had surgical management. Looks like conservative is just as good in this case.

"In a pre-specified, 3-year extension of a randomized clinical trial of equivalence, close-contact casting maintained equivalence in function compared to surgery in older adults with unstable ankle fracture. Furthermore, no significant differences were reported in quality of life or pain. The authors concluded that the focus of treatment for these patients should be on obtaining and maintaining reduction until union, using the most conservative means possible.

The study enrolled 461 patients; the control group (n=254) had non-diabetes-related foot complications; the study group (n=207) had diabetic foot pathology (including 61 [32%] with diabetic foot ulcer, Charcot neuropathy, foot infection, or acute neuropathic fractures and dislocations).

Researchers found no significant differences between the 2 groups related to fear of blindness, diabetic foot infection, or kidney failure needing dialysis. When compared to those without diabetic foot problems, the authors found that the 32% of the study group with identified diabetic foot disease were 136% more likely to rate LEA as their greatest fear and that 49% were less likely to rate death as their greatest fear. In their conclusion, the authors noted that the presence of a diabetic foot-related complication, having diabetes for more than 10 years, use of insulin, and having peripheral neuropathy were all variables that subjects associated with identifying LEA as the greatest fear.

Wukich DK, Raspovic KM, Suder NC. Patients with diabetic foot disease fear major lower extremity amputation more than death. Foot Ankle Spec. 2018;11(1):17-21."

source: http://lermagazine.com/issues/may/three-year-follow-up-close-contact-casting-vs-surgery

image source: https://commons.wikimedia.org/wiki/File:Trimalleolar_Ankle_Fracture.jpg

One of life's great mysteries....Some folks will do what they want anyway....

The origins of the species, gravity and women...Just a few of life mysteries. Reading this article (1) made us sad in many ways. It's like smoking. You know it's bad for you but you keep doing it. Why? The mystery remains to us.

Vanity seems to often trump biomechanics, as we see in pencil skirts (see our post here), droopy pants (see here)  and high heels (here).

Yet, here is yet another study about women, heels and bunion surgery. 

"Almost two thirds (31) of the 50 patients who said they wanted to go back to wearing heels after surgery did so, and 24 of these women said their postoperative use equaled or exceeded the frequency of their preoperative wear. There were no differences between pre- and postoperative heel heights.

In the study, women older than 65 years were more likely than younger women to report high-heel use prior to hallux valgus surgery.

However, 58.5% of study participants reported difficulty with heel wear, and 13.9% said they had significant restriction, and couldn’t wear anything without pain but custom orthopedic shoes or slippers. Most women (86%) were able to return to comfortable shoes after surgery with minimal or no discomfort; 27.7% said their footwear choice was unrestricted, meaning they could wear both comfortable shoes and heels with minimal discomfort. The 23 women older than 65 years were twice as likely to report significant restriction as those in the younger cohort; compared by operative type, patients who had the most extensive procedures had the highest rates of restriction. The findings were published in June by the World Journal of Methodology. (2)"

Bunions are believed to be caused by an inability to anchor the 1st ray and the untoward action of the adductor hallucis, acting from the transverse and oblique insertions more proximally on the foot, make the hallux head west. This is under the purview of the peroneus longus, extensor hallucis brevis as well as the short flexors of the lesser toes (see here).

The components of supination are plantar flexion, inversion and adduction. Why would you continue to wear a shoe with a narrow toe box that forces the big toe medially and that puts you in plantar flexion? We won't even begin to talk about the loss of ankle rocker.....

We guess folks will continue to do what they will do....

1. Robinson C, Bhosale A, Pillai A. Footwear modification following hallux valgus surgery: The all-or-none phenomenon. World J Methodol 2016;6(2):171-180.

2. http://lerfoothealth.com/archives/2016/most-women-who-want-to-wear-heels-after-bunion-surgery-do-so/

The death of meniscal surgery?

Here is a big one when it comes to gait and clients in our offices.

Here is a big one when it comes to gait and clients in our offices.
We tell our clients all the time that cartilage, at best, has a tenuous blood supply, and just in the peripheral red zone at that, and so true healing is not likely, at least not to any significant degree … . we tell them that their so called surgical “repair” is likely nothing more than debridement, a mere clean up most of the time.  We tell our clients that meniscal tears are likely a dime a dozen after 40 years in most people. The cartilage loses some resilience and pliability with age and does not resist loading and shear as well as it used to making it more prone to loading damage.  
“greater than 90% of the surgeries on the structure are not repairs, as most patients believe, but are instead excisions, or cutting out, of the torn part of the meniscus.”
“The most common orthopedic surgery in America had it’s final epitaph written this month with a level-1 study showing that surgery for meniscus locking is no better than placebo. ”

Mind you, some tears are massive and do create obstruction to joint function. Large tears like bucket handle tears and large free fragments often do need surgery because they are just too obtrusive to safe joint function. However, perhaps for the others one should consider the following:Stabilize the joint and return full symmetrical, balanced, coordinated function with endurance and strength. It may just be the best you can do…….and it seems it is often more than sufficient. 

Reference:

http://www.regenexx.com/should-i-have-meniscus-surgery/#

More on Bunions: proof we know what we are talking about→

[Sequential lateral soft-tissue release of the big toe: an anatomic trial].

Z Orthop Unfall. 2007 May-Jun;145(3):322-6. Roth KE, Waldecker U, Meurer A.Source: Abteilung für Orthopädie, Universitätsklinik Mainz. roth@orthopaedie.klinik.uni-mainz.de

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Summary:  Dr. Ivo in his brief video today discussed the altering of the origin/insertion effects on the adductor hallucis and the big toe.  When the first metatarsal is not anchored on the ground the lateral toes cannot be pulled towards the medial foot, instead the lateral foot acts as the anchor and the big toe/hallux is pulled laterally towards the anchor rendering the all famous bunion/hallux valgus.

This surgical study pretty much proves this principle.

This study showed that when the soft tissues (capsule, tendon and ligament) are surgically released, the contractile affects on the joint angle of the bunion/hallux valgus are released and the hallux valgus angle was predominantly and significantly improved.  A significant correction of the intermetatarsal angle did not take place however.

Kind of a radical procedure ultimately destabilizing the joint and medial foot structure…….but hey……whatever floats your surgical boat.  To each his own.  We suppose that on a case by case basis all options need to be considered.

……we’re still the gait guys…….. with no scalpels, but with big oars