Toe walking

They usually occur in 3’s... sometimes 4’s

This 12 year old obligate toewalker was brought to our office by his mom for an evaluation. Many times with neurological issues people will have concomitant musculoskeletal abnormalities. It probably has something to do with chromosome 6...

Here we explain three common congenital abnormalities occurring together

#gait #gaitevaluation #internaltibialtorsion #femoralretroversion #femoralretrotorsion #forefootadductus #metatarsusadductus #clinicalexam 

Bilateral femoral retro torsion

It’s difficult to see from the angle of the camera that this patient has bilateral femoral retro torsion. It’s pretty obvious he has a difficult time balancing on one leg.  Both of his knees point to the outside when he standing straight. He also has bilateral internal tibial torsion so he needs to turn his feet out to have a normal progression angle for gait.

Notice when he does the one leg standing test how much he has to hike his hips, particularly the right hip when he is weight-bearing on the left side. Also note the position of the knee of the weight bearing side. “Knees pointing out”  is often a telltale sign of femoral retro torsion which often occurs concurrently with internal tibial torsion. This patient also has a Forefoot adductus.

The strategy is he has to get his weight over his hip and it’s very difficult when it has to be externally rotated. Rotate your right foot out and balance on your right leg trying not to lean your torso over the hip and you’ll see what we’re talking about

#gait #gaitexam #internaltibialtorion #femoralretrotorsion #femoralretroversion #forefootadductus #clinicalexam

Flip flops

Flip-flop mechanics are different…

Wearing flip-flops, or open back footwear, changes how we walk. There is increased long flexor tone, often an increased ankle dorsiflexion angle during swing phase, often times increased knee flexion among many other things. The biggest problem is the loss of ankle rocker…

Want to know more? Join us on our monthly “third Wednesdays“ online seminar: biomechanics 329 on onlineCE.com, Tomorrow, September 16 at six mountain time

#flipflops #openbackfootwear #anklerocker #flexortone #gait #gaitanalysis ##thegaitguys 

Leg length discrepancy

Badda Bing Badda Boom 

As you can see, this gal has an anatomical leg length discrepancy on the left side which is tibial. Can you see the other finding?

Look carefully both of her feet. Can you see the bunion on the left but not on the right? This is a common finding on the shorter leg side of a true, anatomical leg length discrepancy it. Because of the leg length discrepancy, that foot is often in supination and the head of the first ray does not make it to the ground thus the pull of the adductor hallucis muscle pulls the great toe west.

Look for bunions on the short leg side of true, anatomical leg length discrepancies.

#lld #leglengthdifference #leglengthdiscrepancy #shortleg #bunions #bunion #gaitevaluation 

Curly toes?

-We have all seen them. We like them, we hate them, we despise them, we scratch our heads.

-The question becomes why?

-it’s pretty obvious from the picture that there is dominance of the flexor muscles and not enough intrinsic strength in the extensor muscles. Look at the prominence of the extensor tendon‘s and posturing of the toes.

– Flexor dominance occurs essentially because of too much activity in the central nervous system, particularly the lower brainstem, over activating the flexors and shutting down (reciprocally inhibiting) the extensors.

-This doesn’t necessarily mean that it is a neurological problem however the nervous system is what’s driving the bus here. Extensor tone is largely regulated by the cerebellum and vestibular system with the flexor tone being regulated by the cortex as well as lower, sub cortical systems.

– The cerebellum and vestibular system get the majority of their input from joint and muscle And joint mechanoreceptors as well as the vestibular apparatus. Their output is predominantly to axial extensor muscles as well as muscles which would be directly affected, from a gravitational standpoint, from those systems as well.

– When we don’t have enough afferent information traveling in from these systems, the flexor systems have a tendency to predominate. Think about protective posture’s and DNS work.

Driving the extensors and working on posture/balance/coordination and perhaps long, sustained stretching of the flexor musculature can help to end the bane of curly toes. 

–so let’s go ahead and make those feet, lower extremity, lower kinetic chain muscles and joints and core more competent and help these folks out.

#curlytoes #flexordominance #toeproblem #toeproblems #footproblem #footproblems 

Can you say Forefoot Adductus?

-Take a look at these tootsies. Draw an imaginary lines for the center of the hill: this should normally pass up through the foot either through the second metatarsal or between the second and third. Can you see how the foot is somewhat banana shaped?

– This is also called metatarsus adductus. The deformity is at the apex of the tarsal/metatarsal joint, also known as Lisfranc joint. The fifth metatarsal base is often prominent in the foot is convex in shape with a higher arch.

-This is usually caused by intrauterine positioning and if caught early will usually spontaneously resolve. Since this gal is over 34, that’s probably not her reality. It is interesting to note that along with this congenital deformity, hip dysplasia and internal tibial torsion (which she has) are extremely common.

– Gait abnormalities seen with this include a decreased progression angle, and a propulsive gait often secondary to poor intrinsic function of the foot musculature

#forefoot #forefootadductus #adductus #foot #footproblem #gait #clinicalexam #thegaitguys 

The Glute Max does that?

-There’s lots of talks about glutes and glute function. When was the last time you thought about the gluteus maximus has an internal rotator of the hip? We did a recent podcast and talked about this during climbing. 

-As the thigh flexes to 90° or greater, the internal rotational power of both the gluteus maximus and medius increases exponentially. Think about this when prescribing your rehabilitation exercises and get creative!

For a lot more information on this as well as other fun things with the glutes join us tomorrow evening for our monthly third Wednesdays Teleseminar on onlinece.com biomechanics 328 tomorrow night, 7 central 

Come join us for an hour of talking about peoples butts and how to make them work better :-)

#gluteus #gluteusmaximus #glute #glutes #muscleaction #muscleactions #rehab #rehabilitation #exercise #gluteexercise #gluteexercises