Category Foot Progression Angle

Running Technique Video with Complications:

Here we have a good running video with a nice teaching component to it.

We found this on the web on some random site.  Nice to see others are helping to spread our good word.  Here is what the website said, and below that are our comments.

FROM:http://paraganek.blogspot.com/2011/08/stride-analysis-video.htmlNathanAugust 30, 2011 11:18 AM

Daniel,
You should send your video to The Gait Guys:
http://www.facebook.com/pages/The-Gait-Guys/169366033103080

Actually, they did a 3 part video on crossover gait recently. I looks like you’ve got a bit of crossover going on (hips are swinging side to side). Most people do some crossover. Another thing The Gait Guys always say is that what you can see in the video is usually not the problem (the right foot turning out), it is usually the compensation you are seeing…the problem is somewhere else.

@Nathan:
Thank you Nate. I will see what The Gait Guys say.

*What The Gait Guys have to say:

The most obvious thing we see is that the right foot is spun out (this is more evident on the video clips running away from the camera). This is referred to as the “foot progression angle” and here it is increased.  Depending on the source you reference, the upper limit of normal can be 25degrees. But, it is more important to do a case by case comparison.  Without the advantages of a hands on exam this case seems to indicate that the right foot progression is increased beyond the left, assuming the left is normal.  (yes, it is possible that the right is this chaps normal and that the left foot progression angle is decreased. But the usual presentation is that of increased, usually.)


What we do like is the great form his is displaying. Great natural barefoot technique. Pure barefoot technique does not allow heel strike to occur. Do not believe us? Go try it yourself, just don’t email or call us afterwards and complain !  His strike is midfoot, cadence is high, and body posture is clean and upright.  There is a minor cross over gait here. The readers were right.  Good eyes, good call !

The increased right foot progression angle will often accelerate pronation and increase its degree. This can also increase and accelerate the rate of internal spin of the tibia and limb, all the way into the hip and pelvis.  This can challenge the eccentric capabilities of the gluteals and other external hip rotator muscles and in time this can represent itself and mechanical hip joint pain or low back/Sacroiliac joint symptoms.  The increased pronation amount and rate can challenge other structures at the foot, namely the posterior tibial tendon, abductor hallucis muscle and the first ray stabilizers such as long and short hallux muscles (EHL, EHB, FHL, FHB) and thus loss of longitudinal arch capabilities and stabilizers. 

We also see, if you look closely particularly on the running away from camera views, that the left arm seems to cross the body more than the right. We always look for this in the opposite upper limb to try and help confirm or suggest which of the lower limbs is the problem.  Since the left upper arm is crossing the body, it is neurologically matched up with the right limb during swing and stance.  It can act like a ballast. This fella would most likely have some pelvic asymmetry because of this cross body deficit. 

PS: the issue can be reversed.  We have had plenty of frozen shoulder clients present with biomechanical deficits in the opposite lower limb so beware of the total body complexities and compensations.  We have also have had runners who always carry a water bottle in the same hand showing changes in the opposite lower limb. Our treatment success with one runner did not occur until we convinced this ultra trail runner to go with a camel back water supply.

Nice little case. Wish we had more information on the runner and what is bothering him.

Maybe in time we will hear from him and update him.

To get the most out of this case you should watch the 3 part cross over gait series on our youtube channel. Just type in thegaitguys and it will be right there.  You should also goto the search box in our tumblr blog and type in “arm swing” and read some of our writings on this topic.  We think it is fascinating stuff.

Shawn and Ivo……….. world wide web gait geeks……. and victims of radical hackers everywhere…… ok, just in Algeria.

External Tibial Torsion as expressed during gait.

So, last week we watched this young lad doing some static ankle and knee bends, essentially some mini squats.  Here was what we found (LINK). It is IMPERATIVE that you watch this LINK first before watching today’s video above.

Now that you have watched that link here is what you should be seeing today.

You should see that the left foot is extremely turned out. We talked about why in the linked post from last week. It is because of the degree of external tibial torsion.  When it is present the knee rides inside the foot progression line (the knee bends into the forward / sagittal plane when the ankle bends into its more lateral /coronal / frontal plane (they all mean the same thing) ie. when the foot points outwards.

Remember, the knee has only one choice of motion, to hinge forward and backward. When the knee is asked to hinge in any other direction once the foot is locked to the ground there is torque placed upon the knee joint and thus shear forces.  Menisci do not like shear forces, nor does articular joint cartilage.

So, once again we see the rule of “you cannot beat the brain” playing out. The brain took the joint with the least amount of tolerance, the knee, and gave it the easy job.  The foot was asked to entertain another plane of motion as evidenced here in this video with significant increased foot progression angle. 

When the foot progression angle is increased but the knee still must follow the forward body progression (instead of following the foot direction) the motion through the foot will be directly through the medial longitudinal foot arch.  And as seen here, over time this arch will fail and collapse. 

Essentially this lad is hinging the ankle sagittally / forward through the subtalar and midtarsal joints, instead of through the ankle mortise joint where ankle hinging normally should occur.

This is a recipe for disaster. As you can see here.  You MUST also know and see here that there is an obvious limp down onto that left limb. It appears the left limb is shorter. And with this degree of external tibial torsion and the excessive degree of foot pronation, the limb will be shorter. You need to know that internal limb spin and pronation both functionally shorten the limb length.  This fella amongst other functional things is going to need a full length sole lift. We will start with 3mm rubber infused cork to do so. And let him accomodate to that to start.

We will attempt to correct as much foot tripod (anti-pronation) control as possible to help reduce leg shortness as well as to help reduce long term damage to the foot from this excessive pronation. We will also strengthen the left gluteus medius (it was very weak) to help him engage the frontal/lateral/coronal plane better. This may bring that foot in a little. But remember, the foot cannot come in so far that it drives the knee medially. Remember who is ruling the roost here !…… the knee.  It only has one free range, the hip and foot have 3 ! 

Shawn and Ivo

The 200 yard rule for running.

The 200 yard rule for running.

This week we will focus on the basics of gait and the gait cycle in our attempt to assist in gait literacy

Gait Cycle Basics: Part 1

Steps and strides….

What does the gait cycle that have to do with therapy or rehabilitation? Well, most people walk at some point in the day, and most have walked into your office. If people can’t carry the changes you made on the table and incorporate it into walking, then what you do will have limited effectiveness. Thus, the need for understanding the gait cycle as it relates to rehabilitation or how it can give you clues to the biomechanical faults present. An example is a loss of functional hip extension and chronic LBP/ SI dysfunction. This could be due to a myriad of reasons, from weak glutes, loss of ankle dorsiflexion, or even a dysfunctional shoulder. Understanding how these seemingly unrelated body parts integrate into the kinetic chain, especially while moving upright through the gravitational plane.

 

One gait cycle consists of the events from heel strike to heel strike on one side. A step length is the distance traveled from one heel strike to the next (on the opposite side). Comparing right to left step lengths can give the evaluator insight into the symmetry of the gait.  Differences in step length, on the simplest level, should cause the individual to deviate consistently from a straight line (technically it should cause the individual to eventually walk in a large circle!).  Often, compensations occur functionally in the lower kinetic chain to compensate for the differences in step length to ensure that you walk in a straight line.  It is these longstanding complex compensations that are the generators of many of our patient’s complaints.

 

A stride length is the distance from heel strike to heel strike on the ipsilateral side (the distance covered in one gait cycle.  Step width, or base of gait, is the lateral distance between the heel centers of two consecutive foot contacts (this typically measures 6-10 cm).  Foot progression angle is the angle of deviation of the long axis of the foot from the line of progression (typically 7-10 degrees). Çhanges in the progression angle can be due to both congenital (torsions, versions) as well as developmental reasons.

Next time we will take a closer look at the gait cycle itself. Yup, we are still…The Gait Guys

special thanks to Dr. Tom Michaud, who has allowed us to use these images in our book

We came across this video on Youtube. Look at the obvious deficiency on the right limb with the amount of internal spin of the foot.  Much can be gleaned from this information. remind you that making assumptions of what is wrong or what the treatment is from what you see on a treadmill or in a person walking or running may not be their actual problem, rather it is quite often their compensation pattern. 

In this case, we see an aggressive negative foot progression angle on the right. Normal foot progression angle is anywhere from zero degress (see this persons left foot) up to 15 degrees depending on their given anatomy. 

This is likely from internal tibial torsion on the right but femoral torsion would need to be looked at. What is interesting is taking the concepts of what are seen here and projecting some other thoughts and considerations, as The Gait Guys always do.  This person is “toeing off” the lateral column of the foot (3rd-5th digits).  This will enforce a supinatory toe off, it is always nice to toe off a rigid lever but in time running in this case could eventually lead to some osseous stress reaction/response into these lesser metatarsals and could “couch” this person for a period. To gain more stability (plantar purchase of the foot on the ground) these clients frequently have over activity of their long toe flexors (FDL) and some toe hammering in the lateral digits is not uncommon.  Be sure to look for this phenomenon in your clients.

Toe off from the lateral foot is not uncommonly seen pairing up with a shortened step length on that side and same side knee hyperextension, reduction in ankle rocker (dorsiflexion through the tibial-talar joint) which can lead to anterior impingement at this interval as the ankle dorsiflexion is prematurely terminated,

We also frequently see a reduction in strength of the anterior compartment musculature; the ankle dorsiflexors (primarily the tibialis anterior) and toe extensors which further impairs any chance of normal ankle rocker range.  Additionally, these folks typically have weak lower abdominals on the affected side and tend to strategize through their quadriceps instead of the more effective glute-abdominal core stabilizing unit.In this case here, the more internal tibial torsion or internal spin a limb has, the less likely the client is able to engage the external hip rotators of which the gluteus maximus (iliac division) and gluteus medius (posterior division) are powerful proponents.

Lastly, for now, although this is likely a case of internal tibial torsion, it brings up the considerations in other cases that an internally rotated limb is typically shorter functionally and thus this can lead to an apparent leg length discrepancy.

These are all great “mental exercises” to keep your eyes and brain keen. But as we always say, what you may see may not be so.  Be sure to test your muscles and motor patterns to see if what they are displaying is their deficiency or their compensation pattern, or a bit of both. 

The Gait Guys , Shawn and Ivo

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