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Overview
Describe foot and ankle joints Joint actions during running Related pathology How to prescribe running shoes
Foot function
1. Accept vertical forces during heel strike 2. Absorb and dissipate these forces across
a flexible mid- and forefoot during pronation 3. Provide propulsion as the foot becomes a rigid lever with resupination and toe-off
Articulations
Subtalar Talocalcaneonavicular Calcanealcuboid Midtarsal Tarsometatarsal Metatarsophalangeal Interphalangeal
Subtalar
Triplanar
Supination vs. Pronation
Subtalar joint
Supination
Inversion by calcaneus Abduction by talus. Dorsiflexion by talus
Subtalar joint
Pronation
Eversion by calcaneus Adduction by talus Plantarflexion by talus
Subtalar joint
Clinical significance
Mobility Shock absorption Stability
Midtarsal joint
Functional joint- includes talonavicular and
calcaneocuboid joint Triplanar supination/pronation- primarily DF/PF and abd/add Navicular- highest point of medial arch
Midtarsal joint
Assist pronation/supination of the subtalar
joint Maintain normal weight bearing forces on the forefoot Control/communication between rear foot and forefoot
Metatarsophalangeal joint
Biplanar- mostly dorsiflexion/plantarflexion
with 10 degrees of abduction/adduction Dorsiflexion- allows body to pass over foot while toes balance body weight during gait Plantarflexion- allows toes to press into ground for balance during gait
First ray
Functional joint Bones- Navicular, 1st Cuneiform, 1st
Metatarsal Plantarflexion at late stance to assist 1st MTP dorsiflexion Peroneus longus and abductor hallicus brevis muscles
Plantar fascia
Causes tension along the arch Supination facilitated as arch heightened Windlass effect
Windlass effect
Websters: machine for pulling a rope around a
drum. Pulley system to lift anchor in a boat.
Windlass effect
Tension in the
aponeurosis secondary to toe extension elevates the arch by acting as a pulley around which the aponeurosis is tightened.
Ligaments
Spring ligament
Tension wire which helps maintain arch Helps rigidity during propulsion
Function of arches
Stability
Distribution of weight
Mobility
Dampens shock of weight bearing Adaptation to changes in support surfaces Dampening of superimposed rotations
Running gait
Stance phase
40% of gait cycle 2 phases Absorption Propulsion
Swing phase
60% of gait cycle 2 phases Initial swing (ISW)75% Terminal swing (TSW)25%
Running gait
Double float Stride length Step length Cadence
Velocity=stride length
x cadence
Running gait
Kinematics vs. Kinetics
Kinematics- motion of joints independent of forces that cause the motion to occur Kinetics- study of forces that cause movement, both internally and externally Internal- muscle forces External- ground reactive forces
Ankle/foot kinematics
Ankle joint
Dorsiflexion/plantarflexion
Foot joints
Triplanar Pronation and supination
Calcaneus/talus
pronation
Parallel midtarsal joints Increased ROM Mobile adapter Mid stance
O'Connor FG, Wilder RP: Textbook of Running Medicine, McGraw Hill Companies, 2001. Page 13.
External forces
Foot strike pattern
Forefoot Midfoot Rearfoot
Rearfoot striker
80% of runners Initial contact- posterolateral foot Center of Pressure (COP)
Outer border of rear footprogresses along lateral borderthen across forefoot medially toward 1st and 2nd metatarsal head
Midfoot strikers
Most other runners Initial contact- midlateral border of foot COP
Lateral midfootprogresses posteriorly (corresponds to heel contact)rapidly moves to the medial forefoot
Training log
Weekly mileage Transition point Increase in distance or intensity Increase in mileage >10% per week Change in terrain or running surface
Shoe examination
Current running shoes
Age (days and miles) Replacement frequency New brand or model? (change biomechanics)
Shoe examination
Outsole wear
Lateral heel vs. inside heel vs. lateral sole
Midsole wear
Heel counter tilt Midsole wrinkling, tilt, or decomposition
Shoe wear
Based on foot strike pattern, initial contact,
and center of pressure Neutral gait
Wear on lateral aspect of heel Uniform wear under the toes
Shoe wear
Overpronator
Excessive wear on medial portion of heel and forefoot
Underpronator
Excessive wear on lateral heel Wear on entire lateral portion of the outersole
Arch appraisal
Standing arch
contour Wet test Static evaluation=runni ng evaluation?
Biomechanical function
Required functions of locomotion
Adaptation Shock absorption Torque conversion Stability Rigidity
Biomechanical assessment
Video gait analysis Always base on running gait, not arch
height Evaluate shoe wear
Gait analysis
Behind- location of heel strike, foot motion
during single stance, foot engaged at pushoff Side- gastroc-soleus flexibility, great toe dorsiflexion Treadmill-based analysis Force plate analysis
Neutral gait
Level Heel
Throughout Gait Cycle 90 Degree Medial Angle Throughout Gait Cycle
Intrinsic abnormalities
Pes cavus- abnormal supination Pes Planus- abnormal pronation
Supination
Normal
Late stance phase Provides rigidity, support, propulsion Facilitates lower leg external rotation
Abnormal
Minimal pronation at subtalar joint Little drop of medial longitudinal arch
Abnormal supinators
Stable and rigid foot Lacks flexibility and
adaptability
Poor gastroc-soleus
flexibility
Achilles tendonitis Plantar fasciitis
Pronation
Normal
Early in stance phase Provides flexibility, adaptability and shock absorption Facilitates lower leg internal rotation
Abnormal
Continues throughout stance phase
Overpronators
Patellofemoral pain Popliteal tendonitis Posterior tibial tendonitis Achilles tendonitis Plantar fasciitis Metatarsal stress fracture
Flat feet:
are flexible as they grip the ground and remain flexible at push off
Motion Control
Support
Midsole Outersole
Midsole
Heel counter
Tongue
Split Heel
Stabilizing Features
Support is added to the inside or medial portion of the heel to counteract the foot rolling inward (pronation)
Shoe prescription
High arch- curve-lasted,
cushion shoe Flat arch- motion control or stability shoes with firm midsoles and straight to semi-curved lasts Neutral arch- cushion or stability shoe
Orthotics
Effectiveness
Gross, et al. 90% with symptom improvement Schere. 81% with complete symptoms relief Blake and Denton. Reduced pain associated with plantar fasciitis by 80%.
Orthotics
Motion control
Control excessive pronation
Orthotics
Adjunct to rehab and training modification Return athlete to full function Prevent further injury Functional orthoses
Alter foot function Guide foot through stance phase Promote biomechanical efficiency
Orthotics
Start with soft temporary orthotic Over-the counter prefabricated devices
Most athletes report improvement
Common mistakes
Only looking at standing gait Failure to evaluate various needs of
different runners Need of different orthoses for running and everyday activity
Summary
Understand normal foot biomechanicspronation vs. supination Evaluate with functional arch and shoe wear Signs of abnormal arch Match shoes and orthotics to running alignment- correct shoes and over-thecounter inserts first
Questions??