Podcast 64: Baby Walker Risks, Achilles Asymmetry & Too Much Exercise

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B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

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Today’s Show notes:

1. The post-Oculus boom: Survios raises $4M for free-moving virtual reality

http://venturebeat.com/2014/05/19/the-post-oculus-boom-survios-raises-4m-round-for-free-moving-virtual-reality/

2. This treadmill lets you walk in any direction

http://www.engadget.com/2014/05/20/this-treadmill-lets-you-walk-in-any-direction/?ncid=rss_truncated

3. Dangers of baby walkers in the home:

http://consults.blogs.nytimes.com/2010/02/22/the-dangers-of-baby-walkers/?_php=true&_type=blogs&_r=0
NYTimes:  there are 3 days of neuromotor developmental delay for every day of their use.  Promote upright motor patterns and gait patterns before those neurologic windows are actually open and ready……..this goes back to expression of BDNF 
4.The Influence of Hip Strength on Lower Limb, Pelvis, and Trunk Kinematics and Coordination Patterns During Walking and Hopping in Healthy Women : Journal of Orthopaedic & Sports Physical Therapy
5. Individuals with chronic ankle instability exhibit decreased postural sway while kicking in a single-leg stance
6. Asymmetry of Achilles tendon mechanical and morphological properties between both legs
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Some times there is not an easy answer.

A patient came in with intermittent pain in his feet, bilateral and symmetrical of approximately 1 months duration.  It is bothering him in the arches and the ends of the toes. He can akin it to no singular precipitaIng event. The discomfort is sharp at times, and he can sometimes get cramping. He has been taking good care of his feet, washing his feet as of late. There are no alleviating factors; lots of activity can sometimes cause more pain but not consistently.  It seems to happen in all different types of shoes, so shod or unshod makes no difference. He is unable to reproduce the pain or discomfort.

The feet were normal in appearance. Arches were normal to slightly cavus. He had a mild, uncompensated forefoot varus. No global redness. Mild redness noted at medial and lateral nail beds of the great toe. He had a loss of long axis extension of the metatarsophalangeal arIculaIons and talonavicular arIculaIons bi-­‐lat. No tenderness to palpation of the dorsal or plantar surfaces of the feet are noted. No difference in neurological integrity with respect to sensaIon, motor strength or deep tendon reflex on either side. Nail bed filling was normal. Feet were cool
and moist to touch.  He did have weakness of the short extensors of the great toes, somewhat of the long extensors of the remainder of the digits. Ankle dorsiflexion is 10 degrees on each side.

Gait was tandem with a slight crossover. 

Hmm. Pretty boring, eh?

This is what we thought the differential should include:

1.   Early Gouty arthropathy.  This would be rare in a bilateral situation but possible.
2.   Athlete’s foot. This usually presents with more redness or this could be a variant.
3.   Lack of arch support during the day and his feet are fatiguing.
4.   Lumbar spinal canal stenosis; note that he has no change with squatting or sitting, so this is unlikely.


This is what we recommended:

 He is going to try either TinacIn or Lotrimin on his feet for 2 weeks, twice per day applicaIons, changing his socks between, making his feet wet and moist before application. Will switch to a boot that breathes batter and is more supporIve for work (he is a mason), to see if this works well. Foot strengthening exercises for the muscular deficiencies were prescribed. If this does not alleviate the discomfort, we will consider running labs and imaging looking at the possibility of gouty arthropathy and/or stenosis.

The Gait Guys. Showing that we don’t always have all the answers, but have a pretty good idea of how to get them.

The Naked Foot: The Soft Neurology behind Barefoot.

The Naked Foot: Thoughts for the Shoe Minimalist

This may be one of the very first articles we ever wrote for The Gait Guys. It must be 7-8 years old now, before the barefoot-minimalist craze ever started. It is a bit dated, but we think that it was time to revisit its contents. You will see that many of our early core principles have not changed and you can see the thought process of where the fads and trends were projected to go.  Wind your mind back a near decade, and read on !

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If you want to follow the fad craze these days, just look to companies like Vibram and Nike. Vibram is the company that has brought you the soles and treads of many of the shoes you have worn over the years and of course Nike are the people who first brought you the “running shoe” as we know it today. Nike first brought us the waffle bottom trainer, the cross trainer, air pockets, “shocks” and, the Air Jordan and now their barefoot minimalist series, the Nike Free. Now, we are sure not many of you have heard of the “Vibram Five Fingers” barefoot slip-on ‘shoe’ but virtually everyone who runs in some manner has seen and heard about the Nike Free. What initially stymied us when they first came out was the obvious question of “Why would the same people who sell us the shoes, and give us so many varieties and categories to choose from, now be advocating that we train barefoot, or close to it? ” Or are they ?

  • (Addendum:  this article was originally written long ago, at the start of this fad, the fad that has become a trend.  The article traveled fast around the internet and garnered us much attention including a gig with Vibram as consultants.  But that was then, this is now.  We, and the trend have come a long way, and so has the research.  Some supportive for the trend, some disagreements and plenty of controversy.  The remainder of this article has been unedited, hence its tense and outdated verbiage, shoe types and research.  But we thought it was time to review before moving ahead.)

The Nike version they are pushing, first the Nike Free 5 and now down to the Nike Free 3, has a light weight thin flexible sole and thin vamp top cover material whoís purpose is to merely hold the shoe onto the foot. The Vibram device, which is a fascinating yet simple slipper, is even more simplistic but has some brilliance built right into its heart. It is merely a rubber sock with compartments for each individual toe but that is part of its brilliance. So why would Nike and now Vibram go against their own creations and advocate that we begin walking and running barefoot, or at least become more “shoe-minimalists” after decades of building shoe and sole lines that previously were designed for various conditions, foot types and activities ? There appears to be sound moral reasoning if you delve into the research, but you have to look closely and you have to be careful you do not have one of those foot types that could lead to problems with this type of footwear (but that is a topic for another article to come soon, see Part II).

Barefoot theories are nothing new. In 1960 Abebe Bikila, perhaps the greatest barefoot runner of all time, won the first of his consecutive gold medals without shoes setting a world record of 2:15:17. Englandís Bruce Tulloh was setting overseas records into the 1960’s running unshod, skin to the ground. Today Ken Bob Saxton is one of the most visible barefoot marathoners, long beard and all, and is an advocate of the technique.

With the introduction of the Nike Free, the interest in barefoot running resurfaced at the turn of the century. An article by Michael Warburton, published as an internet paper on barefoot theories, seemed to spark some of the resurgence of the method of running. In his brilliant paper he had some interesting thoughts and pointed out some noteworthy facts. He indicated that research showed that an extra mass of 100 grams attached to the foot diminished the economy of running by one percent. Thus, two 10 ounce shoes (the weight of a lightweight training shoe) could compoundingly cripple you by more than five percent in efficiency. In tangible terms that could be more than six minutes tacked onto a world class marathoner, taking a world record time to a mere first group finishing time. So, it is a question of weight and time, or is there something more ?

To get started with some hard and simple research facts, current research has been conducted showing that plantar (bottom of the foot) sensory feedback plays a central role in safe and effective locomotion, that more shoe cushioning can lead to higher impact forces on the joints and higher risk of injury, that unshod (without shoes) lowers contact time versus shod running, that there are higher braking and pushing impulses in shod versus unshod running, that unshod running presents a reduction of impact peak force that would reduce the high mechanical stress that occurs during repetitive running and that the unshod foot induces a neural-mechanical adaptation which could enhance the storage and restitution of elastic energy at ankle extensor level. These are only some of the research findings but they are some of the more significant ones. These issues will not only support injury management benefits for the unshod runner but increase speed, force and power output.

Stepping backwards in time a little, in the caveman days things were different. The foot was unshod (without shoes) from the moment of the first step until one’s dying day, and thus the foot developed and looked different. The sole of the foot was thicker and callused due to the constant contact with rough and offending surfaces thus preventing skin penetration, the foot proper was more muscular and it may have been wider in the forefoot and the toes were likely slightly separated due to the demands of gripping which would obviously necessitate increase muscular strength and bulk to the foot intrinsic muscles. It was the constant input of uneven and offending surfaces such as rocks, twigs, mud, foliage and debris that stimulated the bottom of the foot, and thus the intrinsic muscles, sensing joint positions and relaying those variations to the brain for corresponding descending motor changes and adaptations to maintain protection and balance. The foot simply worked different, it worked better, it worked more like the engineering marvel that it truly is. The foot was uncovered and the surfaces we walked on were uneven and challenging. However, as time went on, man decided to mess with a good thing. He took a foot that was highly sensitive, a virtual sensory organ with a significant sensory and motor representation in the brain (only the hands and face have more brain representation as represented by the sensory and motor homunculus of the brain) and he not only covered it up with a slab of leather or rubber but he then flattened and then paved not only his world, but also his home, with black hard top, cement, wood or tile thus completing the total sensory information deprivation of the entire foot. Thus, not only did he take away critical adaptive skills from himself and generations to follow, but he began the deprivation of the brain of critical information from which the central nervous system would need to develop and continue to function effectively. It is not unlikely that the man of pre-shod time had a strong competent foot arch (perhaps somewhat flat to increase surface area contact for adaptation), but one that did not need orthotics, stability shoes or rigid shanks and inserts. In other words, the foot and its lower limb muscles were strong with exceptional skills and endurance. But in today’s day and time things are now different. We now affix a shoe to the child’s foot even before he can walk and then when he does, all propriosensory information necessary for the development of critical spinal and central nervous system reflexes is ensured to be virtually absent. Is it any wonder why there are so many people in chronic pain from postural disorders related to central core weakness and inhibition ? Is it any wonder why so many people seem to have flat incompetent feet and arches? Man has done it to himself, but thankfully man has proven that what he can do, he can undo. Thankfully we see modern medical research that has delved into this realm of thought and has uncovered the woes of our ways and to follow, companies like those mentioned earlier are imagining and developing devices that will allow us some protection from modern day offenses such as glass, plastics and metal and thus allow us the slow and gradual return to our healthier foot days, all fashion sense aside.

 Shawn and Ivo, The Gait Guys

Two fellas that were here at the beginning, and two fellas that will be here for the duration.  

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Oh, it is just a simple ankle sprain. It will heal fine. (Not always ! Sometimes we do not know what we should fear, often because we do not even know it exists.)

When an ankle sprain is far more than an ankle sprain.

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Fracture of the Anterior Process of the Calcaneus

We have seen enough of these over our careers that we know they should be on the differential list when an ankle sprain smells fishy. This may be the most frequently missed fracture in the foot because it is not well known and the classic radiographic series often leaves this teeny tiny area poorly laid out on plain film radiographs.  This focal piece of bone, has a critical attachment to the cuboid and navicular so it is critical for stability of the rear-midfoot complex and obviously for mobility of the forefoot on the mid-foot. This Bifurcate ligament (see diagram above) if left unhealed or reattached to its calcaneal base can lead to anatomic instability and serious performance and loading problems. It can be a career ending injury if it is not caught early. This fracture accounts for ~15% of all calcaneal fractures and as we mentioned, it is misdiagnosed as a more severe ankle sprain. The mechanism is a typical inversion sprain mechanism, the most common of ankle sprains, and it can have all of the other typical presentations but with this fracture as a complicating parting gift of the injury. 

Do not miss this one ! When in doubt, refer it out. Don’t leave your client with an unresolving ankle sprain. If you are anxious, as for the imaging and a competent clinical exam. Tenderness over the calcaneocuboid joint that is localized approximately 1 cm inferior and 3 to 4 cm anterior to the lateral malleolus, just distal to the anterior talofibular ligament insertion is of high suspicion.  

This fracture can be serious and lead to prolonged disability and as we said it can be a career ending injury. So do not take that next ankle sprain too lightly. You or your client may pay for it for a lifetime.  

If you do not know it exists, you can’t make the call.  So after today, after reading this short blog post, you are now officially accountable !

Shawn and Ivo

Gait guys and clinical nerds

Saucony: Line Running and Crossing Over
We are big fans of the Saucony line of shoes. We have recommended them to our novice and serious runners for decades now. Currently one of our favorite shoes for our runners is the Saucony Mirage, a beautiful …

Saucony: Line Running and Crossing Over

We are big fans of the Saucony line of shoes. We have recommended them to our novice and serious runners for decades now. Currently one of our favorite shoes for our runners is the Saucony Mirage, a beautiful 4mm ramp shoe with no bells and whistles.  It is as close to a perfect zero drop that  you will find without going zero, in our opinion.  That is not to say there are not other great 4mm shoes out there, the Brooks Cadence and the New balance minimus are other beautiful 4mm’s out there.  The Mirage has never failed a single client of ours.  

This was a photo we screen captured from the Saucony Facebook page (we hope that for the sake of educating all runners and athletes that we can borrow this picture for this blog post, please contact us if you would like us to remove it). It is a good page, you should follow it as well.  This picture shows not only a nice shoe but something that we have been talking about forever.  The cross over; this runner is running in such a line that it could be argued that the feet are crossing the mid line. In this case, is the line queuing the runner to strike the line ? Careful of subconscious queues when you run, lines are like targets for the eyes and brain.  One thing we like to do with our runners is to use the line as training however, a form of behavioral modification.  When you do a track workout, use the line underneath you, but keep the feet on either side of the line so that you learn to create that little bit of limb /hip abduction that helps to facilitate the hip abductor muscles.  This will do several things, (and you can do a search here on our blog for all these things), it will reduce the reflexive tightening of the ITBand (pay attention all you chronic IT band foam rolling addicts !), it will facilitate less frontal plane pelvis sway, optimal stacking of the lower limb joints, cleaner patellofemoral tracking and help to reduce excessive pronation /internal limb spin effects.  

There is really nothing negative about correcting your cross over, IF it truly needs correcting.  That is the key question.  Some people may have anatomic reasons as to why the cross over is their norm, but you have to know  your anatomy, biomechanics and neuromechanics and bring them together into a competent clinical examination to know when the correction will lead to optimal gait and when it will drive suboptimal gait. Just because you see it and think it is bad, does not make it so.  

New to this cross over stuff ? Head over to the search box here on our blog and type in “cross over” or “cross over gait” and you will find dozens of articles and some great videos we have done to help you better grasp it. 

* you will also note that this runner is in an excessive lateral forefoot strike posturing.  This means that excessive and abrupt prontation will have to follow through the mid-forefoot in order to get the medial foot tripod down and engaged.  The question is however, is what you are seeing a product of the steep limb angle from the cross over, or does this runner have a forefoot varus (functional or anatomic, rigid or flexible)?  Are the peronei muscles weak, making pre-contact foot/ankle eversion less than optimal ? This is an important point, and your clinical examination will define that right away … . . if you know what these things are.  And if you don’t ? Well, you have found the right blog, one with a SEARCH box. Type in “forefoot varus”, if you want to open up the rabbit hole and climb down it … . . we dare ya ! :-)

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The case of the focal alopecia. The what?

A focal hair loss. You will see this if you look for it. You will also gain insight into what is (or may be) going on.

Take a good look at these pix. Notice anything about the left anterior lower leg? Besides the varicosity, did you notice the absence of hair? Look again. The devil is in the details, eh?

So, is this a Nair experiment gone wild? No, he never touches the stuff

Shaves just one part of his leg? Really? NOT!

Bad burn resulting in follicular damage? Nice thought, but no.

Weird infection or food allergy? Another good thought but no.

OK. I give up.

So you need to ask the patient a question, what is it?

Do you have a history of chronic low back pain?

Bingo!

Where do you think the problem may be coming from?

Take a look at the dermatomal diagram at the bottom. It represents the area of skin innervated by a spinal nerve. Looks like L5 to us.

How can we confirm it?

muscle test predominantly L5 innervated muscles like the long extensors of the toes and gluteus medius. You could also x ray and look for degenerative changes at the L4-L5 level. Flexion/extension films may reveal some instability at this level as well.

Why does it happen?

Hair growth is influenced by local blood flow and “tropic” influences from the autonomic nervous system and sensory feedback loops, supplied to the area segmentally (ie. by each spinal level). This can be traced back to embryology and development of the musculoskeletal system via the somite and their individual sclerotome (connective tissue elements), dermatome (skin elements) and myotome(muscular elements).

How could this influence his gait?

weakness of the L5 innervated muscles possibly causing:

  • crossover gait
  • lean to one side during stance phase
  • pelvic “cruise” to one side during stance phase on  that limb
  • foot drop and steppage gait (lifting the limb higher on one side to get the foot to clear)

Details, details, details. Pay attention and look carefully. It is all right there if you look hard enough.

The Gait Guys. Balding, yet still neurologically intact

Today on rewind Friday, we salute the glutes! This is in conjunction with this weeks POD topics : )

The gluteus maximus controls:
Flexion / Extension: The Sagittal Plane - the rate and extent of limb flexion at term swing: this is eccentrically con…

Today on rewind Friday, we salute the glutes! This is in conjunction with this weeks POD topics : )

The gluteus maximus controls:

Flexion / Extension: The Sagittal Plane
- the rate and extent of limb flexion at term swing: this is eccentrically controlled
- hip extension: this is concentrically controlled
- hip flexion rate during loading response (eccentric at foot loading): this will help to control the vertical loading response as the body mass loads the limb there must be enough eccentric strength of the glute maximus to control-stop this loading so that hip extension can occur. This will indirectly assist in control some of knee flexion.

Rotation:
- external rotation of the limb: this is concentrically controlled
- assists in controlling the rate of internal rotation: this is eccentrically controlled

Pelvic Posturing:

- controls rate of Anterior Pelvic Tilt (APT): this is eccentrically controlled (this is relative hip extension as discussed in Part 1 last week)

- assists in Posterior Pelvic Tilt (PPT): this is concentrically driven

- controls sacroiliac joint mobility through FORCE CLOSURE (force closure is a compression of the joint surfaces by the contraction of muscles that cross the joint)

Divisions:

- the sacral division of the gluteus maximus is mostly a pure sagittal plane driver at the hip joint
- the coccygeal division is more of an adductor and internal rotator at the hip joint
- the iliac division is more of an abductor and external rotator at the hip joint


The gluteus maximus also has some fascial attachments into the posterior aspect of the TFL-ITBand. Remember, this TFL-ITB complex is an internal rotator of the limb in the gait cycle. You will recall that internal rotation is a precursor to hip extension. The hip must first, and adequately, internally rotate in the gait cycle before hip extension can occur. This means that for correct and complete gluteus maximus contraction to occur in the second half of the stance phase we must have adequate internal hip rotation. Without it, all of the things we talked about last week in our glut maximus blog post cannot occur properly. Now, back to our attachment disucssion of the gluteus maximus to the ITB-TFL mechanism. This attachment allows the gluteus maximus to produce posterior tension on the ITB-TFL mechanism so that it can be anchored to provide it’s internal rotation function on the limb. So, here we have a powerful hip extensor and external rotator providing assisted effects on an internal rotator of the limb. Isn’t the body a beautiful and amazing thing ! (Well it is. But if you will recall from the detailed layout above that the gluteus maximus in the eccentric phase of contraction functions to control the rate of internal hip rotation you will not be surprised or enlightened. Rather you will enjoy the brilliance of how an anchoring muscle is eccentrically giving up length while an agonist muscle is concentrically taking up length). The gluteus maximus-TFL relationship….. it is beautiful teamwork in helping, not exclusively of course, control limb rotation during loading responses.

Next time you see a client’s knee drift too far inwards during a lunge, or walking or running we hope this whole discussion will spring a light bulb moment for you. You must look at the complex function above in controlling the limb during pronation and supination. Merely inserting an orthotic is not going to fix a proximal deficiency, it could modulate it however. But wouldn’t you want to fix it ? Who wants an orthotic if you don’t need one  ? Some people do, don’t get us wrong, but many do not. And then some just need them temporarily to gain the awareness and skill of posturing and function and once that is achieved the device and be weaned.

Just some more functional anatomy talk on a Friday afternoon…….from us, The Gait Guys

Podcast 62: Foot Strengthening and Lumbar/Glute Endurance

A. Link to our server:

Direct Download: http://traffic.libsyn.com/thegaitguys/pod_62final.mp3

Permalink: 

http://thegaitguys.libsyn.com/podcast-62-foot-strengthening-and-lumbarglute-endurance 

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

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Today’s Show notes:

1. Neuromuscular Fatigue Alters Postural Control and Sagittal Plane Hip Biomechanics in Active Females With Anterior Cruciate Ligament Reconstruction

Unilateral heightened toe extensor tone.
What do we have here ? Well, it is obvious. The left foot is showing increased short extensor tone (EDB: extensor digitorum brevis) and heightened long flexor tone (FDL: flexor digitorum longus). This is the …

Unilateral heightened toe extensor tone.

What do we have here ? Well, it is obvious. The left foot is showing increased short extensor tone (EDB: extensor digitorum brevis) and heightened long flexor tone (FDL: flexor digitorum longus). This is the classic pairing for hammer toe development.  We also know from this post (link) and from this post (link) that this presentation is closely related with lumbrical weakness and distal fat pad migration.

So, at an assessment took we like to play games. Mental games to be precise. When we see something like this we immediately begin the mental gyrations of “what could have caused this, and what could this in turn be causing”. Remember, what you see is often not the problem, rather your clients compensation around the problem.  In this case, what goes through your mind ?  Without deep thought, our knee jerk thoughts are:

  • possible loss of ankle rocker dorsiflexion (the increased EDB tone can be recruited to help drive more ankle dorsiflexion indirectly)
  • plantar intrinsic weakness ?
  • flip flops or slip on shoes where the heel is riding up and down inside the shoe/sloppy fit ?  (initiating a gripping response from the FDL)
  • weak tib anterior (recruiting EDB to help)
  • weak peroneus tertius (recruiting EDB again)
  • Ankle /foot instability (more FDL gripping will help gain ground purchase)
  • lateral ankle instablity (same thing, more gripping)
  • Weak gastrosoleus (since the FDL is a posterior compartment neighbor it can kick into high gear and help with posterior comparment function, we have a whole video case based around this issue, check this out ! )
  • premature departure off of the good side leg, and thus an abrupt loading response onto this affected side can challenge the frontal plane of the body and thus require more grip response at the foot level.
  • how about simple weakness of the lumbricals or FDB , the short flexors. The long flexors will have to make up for it and present like this.  
  • the list goes on and on … .

These are just some quick cursory thoughts, and by NO means a complete exhaustive list.  Just some quick thoughts.

But what about hip function ?  if ankle rocker is blocked in terminal stance and the FDL fire like this what will that do to hip extension ? Well, heel rise will be premature because of the limitation and thus hip extension will be abbreviated. Thus glute function will be impaired to a degree.  This can become a viscous cycle, each feeding off of each other.

This diagnostic stuff is a tricky and difficult game. If you think you can diagnose or fix a problem from just changing what you see you are mistaken, unless you like driving compensation patterns and future injuries into your clients.   There must be a hands on examination and assessment with an intact educated brain attached to the process.

Just some mental gymnastics for you today.  

Shawn and Ivo

the gait guys

How much does your Hallux Extend?

Last week, on Mondays post, we introduced potential areas for power leaks.

The common areas for leaks are:

  • great toe dorsiflexion
  • loss of ankle rocker
  • loss of knee flexion/extension
  • loss of hip extension
  • loss of balance/ proprioception


let’s take a look at a video of the 1st one:

Power leak 1: Great Toe Dorsiflexion

The big toe needs to extend AT LEAST 40 degrees and CLOSER TO 60 degrees for normal walking and running gait. If you do not have that available range of motion, then you will need to “borrow” it from somewhere else.

Common compensations include:

  • externally rotating the foot and coming off the inside of the great toe. this often causes a callus at the medial aspect of the toe. This places the foot in more pronation (plantar flexion, eversion and abduction) so it is a poorer lever.
  • internally rotating the foot and coming off the outside of the foot. This places the foot in more supination ( dorsiflexion, inversion and adduction) and it is therefore a more rigid lever. This often causes tripping or stumbling because of a lack of adequate dorsiflexion of the foot.
  • lifting the foot off the ground and avoiding toe off at terminal stance phase
  • abbreviating the step length to accommodate the amount of available great toe dorsiflexion.

Are YOU losing power? Tune in here for more tips on this series in the coming weeks!

The Gait Guys. Increasing your gait literacy with each and every post.

A year ago we produced this short video (link) on how to bring back the EHB (extensor hallucis Brevis muscle). Well, it continues to do its magic on a regular basis. Here is a patient’s foot with clear demonstration of unassisted success of isolated…

A year ago we produced this short video (link) on how to bring back the EHB (extensor hallucis Brevis muscle). Well, it continues to do its magic on a regular basis. Here is a patient’s foot with clear demonstration of unassisted success of isolated engagement of the EHB while simultaneous release of the EHL (ext. Hallucis long us) while engaging the FHL (flexor hallucis long us).  This patient could not isolate any of the long or short hallux muscles on his own. “I can’t find it, my brain doesn’t know what it is supposed to do or how to do it ! (paraphrased)  But after just 24 hours consisting of a few sessions of the exercise here is the result in the photo above.  Success !  And here were his comments: 

Doc, you were right - the brain is an amazingly plastic thing!

I’ll keep working on it, but happy to see such quick progress!

The client’s problem was some medial mid-rear foot pain from the resultant excessive increased pronation because of a forefoot varus.  Well, it is a bit more complicated than that to be precise. There was some true clinical ankle and rearfoot instability because of a lifetime of ankle sprains as well as some highly suspect lower syndesmosis hypermobility from probable distal anterior tib-femoral ligamentous attenuation/tears but the main point is that these were clinically manifesting themselves because of the apparent forefoot varus and the resultant pronatory foot mechanics to get the 1st metatarsal head (medial tripod) to the ground; a typical phenomenon .  Here is the kicker, he did  not have a fixed forefoot varus, it was a mirage, it was functional. What he had was an inability to descend the first metatarsal (plantarflex the Metatarsal) / medial tripod of the foot.  He could not do this because he could not separate ankle dorsiflexion and hallux dorsiflexion.  There was essentially no hallux dorsiflexion at all because he could not descend the 1st MET (head).  So, we knew it was time to break out the nuclear EBH exercise in the video above !  Big problems require big guns !

The rest is history. We fully expect to see a virtual disappearance of the “so called” forefoot varus (because it was never present in the first place). 

“If you have never seen the beast, you will not recognize it when you see it.”-unknown

Podcast 61: Sweating, Ankle Rocker and Free Radicals & Exercise

A. Link to our server:

Direct Download: 

http://traffic.libsyn.com/thegaitguys/pod_61final.mp3

Permalink: 

http://thegaitguys.libsyn.com/podcast-61-sweating-ankle-rocker

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

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Today’s Show notes:

1. Free Radicals, Exercise and Nutritional Supplements
Free Radic Biol Med. 2011 Jul 15;51(2):327-36. doi: 10.1016/j.freeradbiomed.2011.05.010. Epub 2011 May 14.

Extending life span by increasing oxidative stress.

 
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3. we thank Will, one of our faithful followers for sending this article
 
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4. Jack rabbit sports running shoe company in New York !
 
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Gabe 11:03am Apr 21

5. Hello Gait Guys,
My name is Gabriel and I am a former patient of Dr. Ivo. I am also a quasi gait geek in the sense that I have read about 90% of your posts and listened to about 80% of your podcasts. I am messaging you today because I am now employed in the REI shoe Department and I would like to get shoe fit certified. If you could explain the shoe fit certification in more detail to me and testing locations, I would greatly appreciate it.
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The neurologist with a right short leg from a lower leg reconstruction , barely 90° right ankle dorsiflexion and severe LEFT OA hip
 
Gave him a right to millimeter sole liftft. He doubled the sole lift without telling me. Came in with a raging hot extensor digitorum dorsal foot pain.
 
6. New Balance fresh foam shoes:
weighs 9.1oz

25mm in heel; 21mm in forefoot w/ 4mm drop

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The Cheetah man, PART 2: “Bird Dog”, again.

In last week Wednesday’s blog post (link) we discussed the video of this man running amazingly on all 4 limbs at an incredible speed. He was doing it beautifully, most people would have fallen flat on their face after the first leap forward. 

As we discussed on that day, and these 2 screenshot photos will prove, there is ipsilateral interference between the foot and hand in this quadrupedal gait. This is diagonal quadrupedal locomotion (QL); the forward moving lower limb is impaired from further forward progression by the posting up (contact) hand of the same side.  However, in his case, there is such quick removal of the leading hand/limb that he can advance the ipsilateral foot/leg as far forward as he is able without impediment from the same side hand contact. 

As we mentioned in the Bird Dog post last week, (see photo of lady on yoga mat above) the contralateral upper limb will be in the opposite phase of the contralateral lower limb. ie when the left lower limb is in extension, the right upper limb will be in flexion (this is the classic Bird Dog position).

In last weeks blog post (see photos above), the opposite is clearly happening. One can see in the first photo that bird dog is clearly not helping to train a gait pattern, and that is ok, it has other values at times. Rather, in this first photo we see left hip extension and right shoulder extension, just as we see in the baby photo. This contradicts Bird Dog but this does support bipedal gait patterns.  Think about gait. Your right leg and left arm flex until about midstance, when they start to transition into extension; the left leg and right arm are doing the opposite. At no point are the arm and opposite leg opposing one another as in Bird Dog.

As Ivo would say , “if you look at it neurologically, it is a crossed extensor reflex.  It is very similar to a protective reflex called the “flexor reflex” or “flexor reflex afferent”.

The principles remain intact.

More critical thinking today. Hope you enjoyed.

Shawn and Ivo,

The gait guys

This is a slide from a recent teleseminar we delivered on www.onlineCE.com.  You can take any of our dozens of courses/lectures there for a nominal fee.
 
This was an interesting study.  Here the authors seemed to discover that habitually driven sen…
This is a slide from a recent teleseminar we delivered on www.onlineCE.com.  You can take any of our dozens of courses/lectures there for a nominal fee.
 
This was an interesting study.  Here the authors seemed to discover that habitually driven sensory-motor patterns (as compared to optimally controlled patterns) are quite resistant to changes in biomechanics. In the study, when the tested model was compromised, the subject merely increased the recruitment of all of the surrounding muscles to stabilize and direct movement. Basically, there was no great and calculated logical strategy, it was an all out, habitually automated response … . a “just get the job done right now kind of response”.  Perhaps a “living in the moment” response?  
We have often said that the paramount task via the central nervous system is an orchestration at the the joint, it must be stabilized and movement controlled at the moment of the joint challenge. But, the problem lies in that the consequences of a suboptimal strategy cannot be determined in the moment, they come in time. And this is likely what builds these aberrant compensation patterns, they happen slowly, subtly over time little by little. 
Just as in life, the cost of our decisions are not often immediately realized.
Shawn and Ivo
The gait guys