Wouldn’t want to walk a mile in these shoes….

Read all about it here: http://www.dailymail.co.uk/femail/article-2041188/Top-teen-model-Lindsey-Wixson-takes-tumble-Versace-shoes-blame-her.html

Have a great Friday

Ivo and Shawn

Another Gait variant: The Apropulsive gait style

Here is another important video for all you gait fanatics out there. You will see some of these components in your athletes, patients, family or even yourself if you are paying enough attention.

These animated videos are great because they exaggerate the pathology.  Here we see several things:

  1. excessive forward arm swing: this is attempting to create a forward propulsive action to help them move over the suspected primary biomechanical gait pathology.
  2. forward head “bobbing”: again, this is attempting to create a forward propulsive action to help them move over the suspected primary biomechanical gait pathology.
  3. a heavy forward lurching lean: this is attempting to create a forward propulsive action to help them move over the suspected primary biomechanical gait pathology.
  4. pronounced knee lift-hip flexion: this is attempting to create a forward propulsive action to help them move over the suspected primary biomechanical gait pathology.

So, what is driving all of these attempts to create more than normal forward propulsion ?

If you look down at the feet you see a lack of ankle rocker (dorsiflexion) as evidenced by early heel departure. This fella puts his foot on the ground and then tries to move across his ankle but he hits a restriction at the range limitation. He cannot move forward sufficiently to normalize a sound effective and efficient propulsive gait.  At the moment his ankles lock out from hinging further forward he must go into the above strategies to pull his body mass forward past his foot plant and literally pull the foot off the ground and move forward to the next dysfunctional step. Everything he is doing is to try to create forward propulsion sufficient to move across ankles that do not dorsiflex enough.

* IMPORTANT: Remember: premature heel rise typically leads to premature activation of the calf muscles, gastrocsoleus. And when this happens, the gait becomes vertical and bouncy in nature as the calf muscles are being used to lift the body more than to propulse it forward. This can lead to posterior compartment injury. Additionally, this causes a quick premature forefoot loading response which can create increased burden on the METatarsal head and fat pad but it will also create a grip response of the toes and possible hammering which can disable the lumbricals and other foot intrinsic muscles).

And if that isn’t bad enough, on the sagittal views, we see the knees hinging outside the normal forward progression line and if that isn’t bad enough, on the views from behind he clearly is dipping the contralateral hip-pelvis during stance phase (when standing on the right leg, the left pelvis drops) which is a key sign of suspect gluteus medius weakness. 

even the simple cases have nice topics for review.  Failure to have sufficient components for effortless forward motion in gait will result in compensations to get the job done.

TAKE HOME POINT: identifying and restoring ankle rocker is pretty darn important. And that does not mean simply via stretching the posterior compartment. Frequently the anterior compartment is the weakness driving the pathology, but not always.

Pixar should call us……… Shawn and Ivo

The Guys of all things Gait

John Travolta’s Pathologic Gait “Strut”.  One of the most memorable Hollywood gait patterns of all time !

First thing you must notice right away, even from the head shot as he exits the door, is the up and down head bob.  We will get back to this most important part in #2 below and keep you in suspense. 

Another thing you will see is that he has no arm swing, particularly on the right.  He also is over pronated in his upper limbs which is what gives him the “kucxkles forward” primate-type hand position but that is not his fault we would guess, men typically have little skill in higher heeled footwear, in this case a cowboy-style boot (we are trying to give him a manly excuse, the men’s higher heeled nightlife footwear of the 1970’s wasn’t exactly manly in our opinion).  Those things are hard enough walking in let alone what Travolta did in them on the dance floor.  Our point here, most men are not used to the drop down onto the forefoot that comes from the initial heel strike on a higher heeled shoes.  Men are not usually used to walking in such high heeled shoes, and so we do not realize that we have to dampen our instinct to heel strike.  In these cases men have difficulty with two things:

1). with each successive step, again stepping back up onto the heeled shoe after just descending down onto the lower forefoot from the previous step is a challenge. In this video we see some of his strategy. If you watch closely you will see that the abnormal “knuckles forward” posturing of his upper limbs allows him to most likely get his pectorals and triceps more in to the posterior propulsive swing phase action in a manner of “pulling himself up and thrusting forward with each step”.

2), this is a continuation of #1 and what we were hinting at first off …… you see a abrupt up and down movement of his head in his initial exit from the doors of the club.  This is once again a product of the higher heeled shoes-boots.  Travolta is obviously a sufferer of anterior shin splints.  After each heel strike he drops abruptly onto the forefoot with each step. This cycle is repeated and is synchronous and it is what gives the up and down head movement.  It is what also gives him his “Strut”.  He likely  suffered with terrible anterior shin splints in this movie as a result of this. This is the type of gait you will see in young ladies new to high  heeled shoes.

If one insists on choosing this footwear, this Up and Down oscillation strut can be mediated by:

1) shortening ones step

2) ensuring that the forward foot contact is met with as little difference between heel strike and forefoot load, meaning, that the wearer must move the foot forward in relative plantarflexion essentially always trying to stay on one’s forefoot, essentially trying to avoid heel strike as much as possible.  Watch any woman skilled in high heel shoes, you will see this pattern.  It is easier to stay plantarflexed and on the forefoot rather than suffer the slings and arrows of outrageous gait misfortune, that being clear heel striking and devastating your anterior compartment shin splint muscles and toe extensors.

Regardless, Travolta is still the man ……. on the dance floor or strutting down the streets of NYC in high heeled shoes or not.  Don’t believe us men ? …… then head off to yo momma’s (or wife’s) closet and give it a shot …… we dare ya !

We remain, shockingly knowledgeable about high heels shoe biomechanics……. and pleading the 5th as to how we know this stuff .

…… we are both Staying Alive and Jive Talking, and still the undisputed heavyweight champs of all things gait.  We are……

Shawn and Ivo …….. The Gait Guys

Barefoot? Minimalism? I thought barefoot WAS minimalist?

 

Barefoot fever has really caught on over the last year or so. It seemed to start with the advent of the Vibram 5 fingers several years ago (which Dr Waerlop was a biomechanics and design consultant for) and seems to have blossomed to include many different types of footwear.

In the strictest sense, barefoot means NO SHOES or UNSHOD. There are hygenic and social reasons we cover  (or need to cover) our feet, and thus the advent of the many types and styles of footwear we are seeing crop up in stores everywhere. This shoes have minimal amounts of bells and whistles (read support and rigidity) and thus promote a barefoot STYLE of walking or running. These “shoes” also have a low (or no) ramp angle. The ramp angle is how much higher the heel is in elevation than the forefoot.  Most traditional running shoes have a 2:1 ratio…..the heel is twice as high as the forefoot.  The average might be a net 10-20mm rise in the heel height over the forefoot rendering a ramp angle of approximately 15degrees.  So when we say barefoot and include these minimalistic shoes we are referring to shoes with a ramp angle of less than 2-3 degrees and less than 5 mm heel rise.

According the the last two studies published in Nature, by Dr Daniel Lieberman, barefoot or minimalistic activites appear to have many advantages: less stress on the joints, less impact forces on the body and increased proprioception (awareness of your body parts, in this case feet, in space).

 

The barefoot model is based on the simple fact that the movement of our anatomy for thousands of years has been always been that the heel and ball of our foot rest on the same plane. This is the ground work for the normal workings and biomechanics of the foot.  When we take the heel and raise it onto a level above the forefoot (as most running and dress shoes do) the body will have to make biomechanical changes to that very same anatomy that loves level ground. It is now being proven over and over again that this altered positioning and corrupted biomechanics may be what are driving much of the foot and lower limb problems we see out in the world.  Whether it is plantar fascitis, shin splints, achilles problem, toe problems, or just general foot or ankle pain, these altered biomechanics are highly suspicious culprits.

 

This is not to say that everyone can go barefoot or is ready to immediately go barefoot, despite the picture the shoe vendors and media are painting. Some folks have to gradually work their way down into lower ramp angled shoe affording the time and tissue changes that will come with adapting to different heel heights.  It can take some time for the calf muscles and achilles to restore their original length or take time to regain the strength of the foot intrinsic muscles so that the foot can no longer depend on the shoe for stability but rather it can learn to depend on the anatomy of ligaments and muscles to provide the support like our shoeless ancestors of centuries past.  This is where  minimalsitic shoes come in. They provide a transition from where you are to where you want to be. Other folks have anatomic foot types that just cannot cope well with a pure “barefoot technique” and will probably need to remain in some type of transitional shoe.

There are exercises and drills, along with types of manual therapy and muscle activation techniques that can help speed the transition from your current footwear to being a minimalist. Make sure you consult with providers with plenty of experience that are familiar with and competent with these methods.

We are still 2 foot nerds, out there making a difference…The Gait Guys

 

Hip rotation and knee pain. What we have been saying.

We have been pounding the floor on this topic on and off for the last 6 months it seems.  Lack of internal hip rotation or too much internal hip rotation ……. both abnormal hip kinematics, is a result of reduced hip-muscle performance as opposed to structural issues of the hip (anteversion, retroversion etc).

If you are not assessing for impaired hip muscle function in your knee patients, you could be missing the boat …….. and it is a big boat…… Titanic in size.

Don’t be like so many others and be tunnel visioned when you have a knee patient, expand your vision, at least to the hip and foot. 

We are……. The Gait Guys……. Shawn and Ivo

________________________________________________________________________________

Am J Sports Med. 2009 Mar;37(3):579-87. Epub 2008 Dec 19.

Predictors of hip internal rotation during running: an evaluation of hip strength and femoral structure in women with and without patellofemoral pain.

Souza RB, Powers CM.

Musculoskeletal and Quantitative Imaging Research Laboratory, Department of Radiology and Biomedical Engineering, University of California, San Francisco, California, USA.

Hip function and knee pain, again.

And once again…… another study validating the fact of weak hip stabilizing muscles in causing knee pain.  The study showed that increased activation of the gluteus maximus in individuals with patellofemoral knee pain suggests that these subjects were attempting to recruit a weakened muscle, perhaps in an effort to stabilize the hip joint.

J Orthop Sports Phys Ther. 2009 Jan;39(1):12-9.

Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain.

Souza RB, Powers CM.

Source

Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.

Hey Check it out! John Wayne has either a Left short leg or a weak left Gluteus medius and a compensatory increased arm swing on the Right ! Watch for the lean to the left on Left stance phase and the arm swing to pull him through. WE guess even the Duke needs a hand sometimes !

The “Dukes” of Gait Shawn and Ivo