Foot Strike of Women for the Olympic Time Trials:

This picture comes from Iain Hunter at BYU: We found it on Peter Larson’s Blog:

Here are some of our thoughts:

It would have been nice to see each of these in turn on video for further analysis; What this shows are a few things;

  • People who are at this level and run fast have different foot strike patterns, this type of foot strike does not always equal the fastest times (though the top 3 were mid foot strikers, something we work with our athletes to achieve)
  • 7 (and 1 DNF) were midfoot strikers
  • 4 were forefoot strikers
  • 11 were heel strikers
  • many runners has asymmetrical strikes, depending on side (4)
  • 4 of these runners seem to have a significant varus in either their fore foot or rear foot. However this is difficult to truly tell from such small single snapshot pictures.  And just because it appears to be a varus landing does not mean that it is true on examination, a foot that has reduced peroneal activity can appear to have a  varus strike, but that does not truly then comment on a true forefoot varus. Also, remember from our previous posts, if a runners is employing a notable degree of cross over gait technique the approach of the foot to the ground and at the ground can appear to be forefoot varus. * These are critical points, because what you see is not necessarily what you truly have.  There are possibly many variables playing out.
  • shoes which have green on them are more popular (7)
  • Neither Shawn nor Ivo could run a 10K and have a chance against any of these folks 

Have a great Saturday

Ivo and Shawn

Continuing on our theme of Foot Odor Friday….

Ever wonder why feet smell like Limberger cheese? How about what to do about it? Ever Wonder what the Brits think about smelly feet? We did, and this is what we found…

Have a great Friday

The Gait Guys

A Cure for Smelly Feet?

Welcome to foot odor Friday. Today’s Theme: You guessed it!

Here’s one paper we though had merit (sure, go to Pub Med and search foot odor. There were 119 entries). We think we may try this in the office…

The Gait Guys: Yes, smelly feet are something we have to deal with at the office on a daily basis. One of the pitfalls of being a Foot Geek : )

Make sure to check back later for more on malodorous extremities…                        

J Int Soc Sports Nutr. 2007 Jul 13;4:3.

A novel aromatic oil compound inhibits microbial overgrowth on feet: a case study.


West 1140 Glass Avenue Spokane, Washington, 99205, USA.




Athlete’s Foot (Tinea pedis) is a form of ringworm associated with highly contagious yeast-fungi colonies, although they look like bacteria. Foot bacteria overgrowth produces a harmless pungent odor, however, uncontrolled proliferation of yeast-fungi produces small vesicles, fissures, scaling, and maceration with eroded areas between the toes and the plantar surface of the foot, resulting in intense itching, blisters, and cracking. Painful microbial foot infection may prevent athletic participation. Keeping the feet clean and dry with the toenails trimmed reduces the incidence of skin disease of the feet. Wearing sandals in locker and shower rooms prevents intimate contact with the infecting organisms and alleviates most foot-sensitive infections. Enclosing feet in socks and shoes generates a moisture-rich environment that stimulates overgrowth of pungent both aerobic bacteria and infectious yeast-fungi. Suppression of microbial growth may be accomplished by exposing the feet to air to enhance evaporation to reduce moistures’ growth-stimulating effect and is often neglected. There is an association between yeast-fungi overgrowths and disabling foot infections. Potent agents virtually exterminate some microbial growth, but the inevitable presence of infection under the nails predicts future infection. Topical antibiotics present a potent approach with the ideal agent being one that removes moisture producing antibacterial-antifungal activity. Severe infection may require costly prescription drugs, salves, and repeated treatment.


A 63-y female volunteered to enclose feet in shoes and socks for 48 hours. Aerobic bacteria and yeast-fungi counts were determined by swab sample incubation technique (1) after 48-hours feet enclosure, (2) after washing feet, and (3) after 8-hours socks-shoes exposure to an aromatic oil powder-compound consisting of arrowroot, baking soda, basil oil, tea tree oil, sage oil, and clove oil.


Application of this novel compound to the external surfaces of feet completely inhibited both aerobic bacteria and yeast-fungi-mold proliferation for 8-hours in spite of being in an enclosed environment compatible to microbial proliferation. Whether topical application of this compound prevents microbial infections in larger populations is not known. This calls for more research collected from subjects exposed to elements that may increase the risk of microbial-induced foot diseases.

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MORE compensations for short legs…

We remember from 2 weeks ago, the week before, AND last week, there at least SIX common compensations for a short leg.

We spoke about circumducting the long leg last time. Once again, here is the list

  •  pronation of the longer side, supination of the shorter
  • leaning to he shorter leg side
  • circumduction of the longer leg around the shorter
  •  hip hike on long leg side (seen as contraction of hip abductors, obliques and quadratus  lumborum on short leg side)
  • excessive ankle plantar flexion on short side
  •  excessive knee bend on the long leg side

Lets look at “hip hiking” of the longer extremity today. Hiking the hip allows one to create enough room (hopefully) to get that long leg through without dragging on the ground. Again,  it makes no difference if the leg is functionally or structurally short, the body still needs a strategy to move around the longer leg.

This gal in the video has cerebral palsy (CP), affecting the left side. She has a short R leg and hikes the L pelvis pelvis up to get it to clear (she has L g med weakness due to the CP)

Watch the above video a few times to see what we are talking about. You can really see it when she is walking toward you.

Remember here is that what you are seeing is the compensation, not necessarily the problem. When one leg is shorter, something must be done to get the longer leg through swing phase.

Hip Hiking. Not quite the “Walk in the Woods” Bill Bryson was talking about, but yet another compensation for a short leg.

Ivo and Shawn. …bald, good looking, geeky…… The Gait Guys

Neuromechanics Weekly: How does appropriate movement diminish pain?

We talk about proper (or should we say appropriate) movement (including gait) inhibiting or diminishing pain. So, how does that happen?

Above on the left is a great diagram that we will work through.

You are looking at a cross section of a spinal cord (We can hear the groans already!) We remember that the dorsal horn (posterior part) is sensory and the ventral horn (front) is motor. In between them (the lateral horn) is autonomic (this runs automatized body functions such as your heart, lung, guts, etc).

Small nerve fibers subserve pain. These are the A delta and C nerve fibers. “Small” refers to fiber diameter of the nerve. These nerves are where pain stimuli enters the spinal cord; they enter the sensory dorsal horn and synapse/connect there with the next neuron in line that takes the sensory message up the spinal cord to the brain to tell you about the pain including its intensity, location etc. Pain can result from tissue damage or injury (which can be due to, or the result of, poor biomechanics).

Large diameter nerve fibers subserve sensations like touch, pressure, vibration, muscle spindles (muscle length) and golgi tendon organs (muscle tension/load). These fibers also enter the sensory dorsal horn, but they do not synapse immediately, unlike pain fibers. They ultimately travel up to the top of the brainstem or cerebellum to coordinate information with other data your brain is processing. They send a branch (or collateral) to an inhibitory neuron, which excites the inhibitory neuron. Thus, if you excite an inhibitory neuron, it does it’s job and inhibits the propagation of an impulse. In this case, it inhibits the pain impulse from traveling to the cortex. So pain is inhibited. Appropriate biomechanics excite the largest population of receptors and provide the most effective response. 

Now look at the diagram on the right. It is a simplified schematic of the one on the left, with detail of the connections. Note that the LARGE FIBERS (from joint mechanoreceptors, spindles, muscles, etc) EXCITE the inhibitory interneuron (which would inhibit it). Also note that the SMALL FIBERS INHIBIT the inhibitory internuron (which would excite it!)

There you have it. Clear as mud? Go through some of our old posts on receptors and FEEL THE PAIN (parts 1, 2, 3+4) and come back to this and read it again. You know you want to be a geek, so go ahead!

The Gait Guys: Geeks on many levels. helping you to presynaptically inhibit pain on a daily basis, through better movement.

Case of the Week: Rib Pain while Running: Part 2

Welcome back. Glad you picked choice d (or maybe you had a pint anyway)

Assessment: This patient has a significant difference in the length of her legs; her left leg being short, right leg being longer. The right ilia is rotated posteriorly (thus the tissue fold) in an attempt to shorten the extremity and the left ilia is rotated anteriorly, in an attempt to lengthen the leg. This is putting the abdominal external obliques in a  lengthened and shortened position, respectively. The right is short weak and the left is long (stretch).  The obliques attach to the lower ribs 5-12 (for external) and ribs 10-12 (for the internals).

The psoas muscle takes its origin form the lumbar vertebral bodies and inserts on the lesser trochanter of the femur. Due to the poterior rotation of the right ilia, it has been lengthened over time (thus the difference in hip extension) and is stretch weak on the right.

So why only on the right and during running?

due to the anatomical leg length difference, the right oblique has shortened over time. Running (forced inspiration and expiration) causes us to use some of our accessory muscles of respiration (obliques, intercostals, serratus posterior superior and inferior, sternocleidomastoid, scalenes. Remember that for quiet respiration, only the diaphragm is used for inspiration; passive tension in muscles for expiration).

Also, the stride length will be increased on the longer leg side (ie when the L leg is in swing and R in stance); this put additional stretch on the R iliopsoas and R abdominal obliques.


Treatment Plan: We placed a 3 mm lift in her left shoe. We treated with manipulative therapy of the lumbar spine.  She was given the nontripod, side bridge, cross/crawl quadruped and hip flexor stretch with side bending exercises to perform on a daily basis.  She felt better post treatment.

Case of the Week: Rib Pain While Running: Part 1

Case of the Week: Rib Pain while Running: Part 1

This 39 year old woman presents with with rib pain, pointing to right ribs. First time it “went out” 1 ½ year ago, second time a year ago and recently two weeks ago. It is usually related to running with pain the day of and day after it is acute; it hurts to lie on her back or roll onto that side or breathe deep. She seems to do best when she is semiflexed on her knees.  Stretching can take the edge off.  When she has an acute episode, it usually lasts about a day.

She is very physically active and works out almost everyday. She runs triathlons and Ironman’s (or Ironwoman’s in this case), and generally is in good shape.

Above is what you see physically (hover mouse over each picture) and here are her exam findings:

She is 5’ and weighs approx. 105 pounds.BP 100/72 left, pulse ox 94, pulse 52. Lungs auscultate clearly, normal heart sounds, abdomen non tender and normal to percussion and auscultation.

Viewed from posterior in a standing position, she had increased tibial varum bi-lat., right greater than left, right hip had posterior rotation, less space between iliac crest and rib margin right hand side. No tenderness noted over the obliques or lower ribs left hand side. She had a loss of lateral bending to the left L2 through L4 negative theta-z stress.

She has a L  left short leg (tibial) 5 mm, bi-lat. external tibial torsion left greater than right. There is weakness of the abdominal internal and external obliques bi-lat. as well as iliopsoas, R > L. There was point tenderness at the R lesser trochanter; active and passive hip extensoin was 10 degrees right, 15 degrees left.

Question: What is your assessment and what are you going to do?

a. do not know, go have a beer

b. do not know, go have 2 beers

c. do not know, do not drink beer, have a double latte after reading Fridays post and try not to spill it

d. reply to this post,  think about it and check back later to see what The Gait Guys have to say

We Seek to Make a Difference

A small boy was walking along a beach at low tide, where countless thousands of small sea creatures, having been washed up, were stranded and doomed to perish. A man watched as the boy picked up individual creatures and took them back into the water.

“I can see you’re being very kind,” said the watching man, “But there must be a million of them; it can’t possibly make any difference.”

Returning from the water’s edge, the boy said, “It will for that one.”

We seek to make a difference, no matter how small.

The Gait Guys

Injury and Repair

Injury and Repair?

It appears injury and repair are the yin and yang of healing. Injury may be necessary for nerve regeneration to occur, at least in mice. Talk about neural learning! So injuries (from a neurological perspective) may be a good thing!  Perhaps this is why acupuncture, dry needling and intramuscular therapy work so well for these conditions. ( Watch for a Live Gait Guys course in dry needling and intramuscular stimulation this fall in Chicago and Denver!)    
A protein abbreviated DLK (which stands for dual leucine zipper kinase) apparently is necessary to activate nerve regeneration after an injury.    
“DLK is a key molecule linking an injury to the nerve’s response to that injury, allowing the nerve to regenerate,” says Aaron DiAntonio, MD, PhD, professor of developmental biology. “How does an injured nerve know that it is injured? How does it take that information and turn on a regenerative program and regrow connections? And why does only the peripheral nervous system respond this way, while the central nervous system does not? We think DLK is part of the answer.”    
Most injuries have a neurological component, whether it be the inflammatory process, a change in muscle tone or activity, the perception of pain or proprioceptive abnormality. If this mechanism is not triggered, the nervous system may not heal. This may provide clues as to why nerve injuries heal so slowly or are less responsive. Learning more about this protein may provide clues and answers to this commonly encountered dilemma.    
The original paper was published in Neuron and a nice summary can be found here.    
The Gait Guys: sorting out the literature and giving you the latest information so you can make more informed clinical decisions.