The Toe Waving Exercise: Part 1

Welcome to Friday, Folks. A little exercise here for you today that we use all the time.

There are at least 3 muscles important in forming and maintaining the foot tripod. The short flexors of the lesser digits (Flexor Digitorum Brevis or FDB) are one of the important component sfor creating and maintaining the foot tripod (the tripod between the head of the 1st metatarsal, head of 5th metatarsal and center of calcaneus).

It arises by a narrow tendon from the medial process of the calcaneal tuberosity the plantar aponeurosis, and from the connective tissue between it and the adjacent muscles. As it passes forward, and divides into four tendons, one for each of the four lesser toes which divide into 2 slips ( to allow the long flexor tendons to pass through), unite and divides a second time, inserting into the sides of the second phalanx.

Because the axes of the tendons passe anterior to the metatarsal phaalngeal joint (MTP), they also provide an upward (or dorsal) movement of the MTP joint complex, moving it posterior (or dorsal) with respect to the 1st metatarsal heal (thus functionally moving the 1st met head “down”). This is a boon for people with a forefoot varus, as it can help create more mobility of the 1st ray, as well as help descend the head of 1st ray to form the medial tripod (and assist the peroneus longus in anchoring the base of the big toe). It also helps the lumbricals to promote flexion of the toes at the MTP, rather than the distal interphalangeal joint.

In this brief video, Dr Ivo explains the exercise to a patient (Thank you N, for allowing us to use this footage).

The Toe Wave: try it. Use it with your patients. Spread the tripod. We know you want to….

Ivo and Shawn


all material copyright 2012: The Homunculus Group/The Gait Guys

EHB: Extensor Hallucis Brevis

Did you know that the EHB (extensor hallucis brevis) the topic of today’s video tutorial, originates off of the forepart of the medial aspect of calcaneus & lateral talocalcaneal ligament. It is just above the bulk origin of the EDB (extensor digitorum brevis). It is frequently torn/strained in ankle inversion sprains and frequently goes undiagnosed. It can be torn/avulsed from the bone if the inversion sprain is focused below the lateral ankle joint. This occurs mostly when the foot is more plantarflexed before the inversion event. A foot cannot afford to have an impaired big toe ! Don’t miss this one !

The Gait Guys Podcast #7: S1E7

This one will get you to the show player of all of our podcasts.
http://directory.libsyn.com/shows/view/id/thegaitguys

And this link will get you a nicely laid out “show notes”.
http://thegaitguys.libsyn.com/webpage/2012/08

Show Notes: The Gait Guys Podcast, Season 1, Episode 6

1- CPR:  neurscience story

http://www.bbc.co.uk/news/health-15552957

 
Correctly performed CPR  triples survival rates. The UK Resuscitation Council recommends that the chest should be compressed by 5-6 cm and at a rate of 100-120 compressions per minute. A study published in 2009 showed that using a familiar song as an AID did increase the number of people getting the right rate. But there was a drop in those hitting the correct depth.
 
2. – more lectures available  on www.onlineCE.com 13 hours of courses there !  Go there and look up our lectures

3. – EMAIL CASE:

off our FB page, from Lisa

I’m so hoping you can help me out with a patient. He is a military runner (Army) who hope to compete his first full Tri this year. In a nutshell: He has been plagued with peroneus Longus pain on his slightly longer side with running. This now occurs only with running in the combat boots and he uses a Nike Free Boot. I have checked all shoes for manufacturer defects.
Barefoot running, ankle rocker exercises, Glu. med strengthening for cross-over gait have helped his out of boot running experience, but he is frustrated by calf pain in the boots and so am I. I do have a video gait barefoot that I can send you. We have discussed the problem of trying to be a midfoot striker in a boot.
He does the waddle gait w/ theraband, squats with toes up, shuffle gait and moonwalk backwards. As far as i know, the military has banned VFFs for training and maybe all minimalist shoes. Scratching head…

4. Have you ever wondered why people who walk together quickly synchronize their gaits ?

What is thought to happen is that one partner dominates the lead in the gait, just as in dancing, one person is the leader and the other is the follower. The lead partner’s lower limbs determine the movement of their arms, which in turn when holding hands, sets the arm movement pattern in the partner then determining the leg swing and stance phases. Thus, synchrony is achieved. 

References used:
J Neuroengineering Rehabil. 2007; 4: 28. The sensory feedback mechanisms enabling couples to walk synchronously. An initial investigation.  Ari Z Zivotofsky and Jeffrey M Hausdorff  Published online 2007 August 8. doi:  10.1186/1743-0003-4-28

Hum Mov Sci. 2012 Jun 22. [Epub ahead of print] Modality-specific communication enabling gait synchronization during over-ground side-by-side walking. Zivotofsky AZ, Gruendlinger L, Hausdorff JM.Gonda Brain Research Center, Bar-Ilan University, Ramat-Gan 52900, Israel.

5 – Payloadz.com
-pedographs on FB and blog
LEMINGS new shoe line www.lemingfootwear.com

6.-EMAIL CASE
The gait guys,
My name is Nathaniel and i am e-mailing from the UK having found you through my endless googling of my injury. I  was hoping you might be able to give me a helping hand.
  • So a bit of background, i am a 28 year old very keen amateur (2.23 marathon) who has a 5 year history of heavy run training (80-120 miles per week) having been a triathlete prior to that and a swimmer from the age of 8. I had no injury history prior to this except, perhaps crucially, in 2006 i twisted my right ankle into supination, several times over the course of 2-4 months, I never had to stop running for more than a day or two at this time but it was very swollen and for at least 6 months was very unstable, but i ran through it.
  • so current injury is a 2.5 years of vague right posterolateral gluteal pain which is constantly there but progresses with running to a spasm, over the area i believe to be the glute medius and some mild adductor pain on the same right hand . . i can usually get through easy mileage but the pain is always there and speed work/racing is a no no. I had bilateral sports hernia surgery on the 3rd january in the belief that it would cure the problem , it helped and certainly reduced the abdominal/adductor aspect but i still cant race and I know think the sports hernias were a product of the problem and not the problems route cause.
  • I have no problems on the left. my right foot are some callouses on the right on the medial aspect of the arch.just proximal to the 1st MTP
  • the navicular is much more prominent on the right.
    the foot wear pattern on the right shoe is different, there appears to be a far heavier heel strike on the right lateral side, greater wear under where the right 1st MTP joint would be.
  • on the left there is far more “toe off” wear on the shoe after periods of inactivity it feels as though the foot needs to warm up before it will pronate sufficiently to allow toe off. like im walking on the outside of the foot.
  • the right hip has more internal rotation and less external rotation than the left,
  • flexion and extension at the hip are stiff but within i believe normal limits.
  • the hallux tests i have found online dont appear to show any restricton although i was initially cheating on the right with foot pronation.
  •  the podiatrist said I had bilateral forefoot varus with it being worse on the right. he noted my prominent naviculars, he initially thought I had accesory bones but confirmed that i did not. he said that on the right (my bad leg) had a restriction/fixed at the midtarsal joint so the increased required pronation to get the first ray down had to come from sub-talar pronation.
  • onto the walking pressure pad analysis,
-on the right (bad leg) i had alot of lateral edge mid foot loading, the right foot was much more externally rotated than the left.
-on my left leg the peak force/pressure was very unusally right under the tip if the hallux 
-on the right the forces were much less throught the heel strike, stance, and push off phase

onto the video analysis.
when you slow down my gait the left (my good, pain free leg) looks incredibly odd.
on the “swing through” phase (so when my right was on the floor) my left knee points laterally and appears to circumduct through rather than progress straight in the saggital (?) plane. as the left foot approached foot strike is looks much more supinated than the right.
 -this is in contrast to my right (painful leg) which swung though perfectly in the saggital plane,
-no movement laterally in the frontal plane, no cicumduction, approached foot strike with much less supination and just looked mor normal.
The podiatrist thinks all my problems are coming from my left foot, despite that being my good leg. so he gave me a knocked up orthotic to use in my left shoe which basically pushes me more into supination at the arch and calcaneus, nothing in the forefoot. he thought there was nothing to do in the right foot.he told me to try it for 6 weeks and if it worked he would prepare a more robust permanent version.
 
This is where my questions came from the things I have learnt from the gaitguys, Basically i questioned why if I have a forefoot varus is there nothing in the forefoot to bring the ground up to the first ray. and help attenuate the subtalar pronation on the right and mid tarsal/subtalar joint on the left. he said through years of experience, which is fair enough of an answer as I dont have any experience or qualifications of my own!
 
I enjoyed the assessment and I thought it was enlightening but cant help but feel he mar be very good at detecting/ diagnosing but im not convinced that his remedy is the way forward.
Despite the abberent movements of the left leg Im still convinced the right is the problem and what i see in the left in swing though is a product of poor mechanics of the right foot when its on the floor.
 
Thanks again. Nathaniel , United Kingdom

The Gait Guys www.onlineCE.com courses.

https://chirocredit.com/courses/index.php?catid=124&pid=1

Biomechanics

Biomechanics 208 Case Studies in Gait Analysis: Challenges to the Knee during Gait
Credit Hour(s): 1.0

Educational Objectives:

Review the pertinent anatomy of the knee

  • Review the kinematics and kinetics of knee function during the gait cycle
  • View and discuss case studies involving knee function
  • Predict pathomechanics that will arise from the gait abnormalities presented
  • Propose remedies for the gait abnormalities seen

Format(s):Adobe PDF Download Android Compatible

Ipad/Iphone compatible using Puffin Browser
Slides with audio

Price:$20.00 USD

Biomechanics 207  A case study in gait analysis: focus on torsions and versions

Credit Hour(s):1.0

Educational Objectives:

  • Assess actions of the lower kinetic chain during gait
  • Predict pathomechanics that will arise from gait abnormalities presented
  • Propose remedies for the gait abnormalities seen
  • Review the gait cycle and gait cycle biomechanics
  • View and discuss case studies of gait

Format(s):

Adobe PDF Download
Android Compatible
Ipad/Iphone compatible using Puffin Browser
Slides with audio

Price:$20.00 USD

Biomechanics 206  A Case Study in Gait Analysis

Credit Hour(s): 1.0

Educational Objectives:

  • Review the gait cycle and gait cycle biomechanics
  • View and discuss case studies of gait
  • Assess actions of the lower kinetic chain during gait
  • Predict pathomechanics that will arise from gait abnormalities presented
  • Propose remedies for the gait abnormalities seen

Format(s):

Adobe PDF Download
Android Compatible
Ipad/Iphone compatible using Puffin Browser
Slides with audio

Price:$20.00 USD

Biomechanics 205: Barefoot Running and Gait: What you need to know

Credit Hour(s):1.0

Educational Objectives:

  • Explore barefoot running from a position of biomechanical efficiency
  • Contrast the differences in shod vs unshod running
  • Predict problems that can arise from shod and barefoot running
  • Apply visual analysis skills to barefoot running technique
  • Describe how to introduce barefoot running to your patient population

Format(s):

Adobe PDF Download
Android Compatible
Ipad/Iphone compatible using Puffin Browser
Slides with audio

Price:$20.00 USD

Biomechanics 204: Shoe selection and the effect and impact on gait

Credit Hour(s):1.0

Educational Objectives:

  • Describe and identify how the parts of a running shoe affect running biomechanics
  • Compare and contrast different shoe constructions to the biomechanical needs of an individual
  • Determine the appropriate last shape for different foot types
  • Discuss the biomechanical consequences of improper vs. proper selection of last types
  • Predict which features in a shoe are necessary to correct faulty gait patterns

Format(s):

Adobe PDF Download
Android Compatible
Ipad/Iphone compatible using Puffin Browser
Video Presentation

Price:$20.00 USD

Biomechanics 203:Gait Analysis: Normal and Abnormal Gait and factors affecting them

Credit Hour(s):3.0
Educational Objectives:

  • Discuss the normal walking gait cycle
  • Apply the biomechanics of the pelvis and lower kinetic chain during walking to clinical practice
  • Predict and discuss problems and clinical strategies that can arise from altered lower extremity biomechanics
  • Apply visual analysis skills
  • Evaluate case studies in gait analysis
  • Clinically apply solutions for gait abnormalities

Format(s):Adobe PDF Download

Android Compatible
Ipad/Iphone compatible using Puffin Browser
Video Presentation

Price:$60.00 USD

Biomechanics 202:Foot Function and the Effects on the Core and Body Dynamics

Credit Hour(s):1.0
Educational Objectives:

  • Describe how the motor and sensory homunculus relate to the foot and are integral to training and rehabilitation
  • Discuss the 3 rockers of the foot
  • Give examples of problems that result from a loss of the 3 rockers of the foot
  • Explain the concept of pelvis neutrality and its effect on training
  • Describe and examine the tripod of the foot
  • Breakdown most movement into 2 basic rules or tenets
  • Give examples of the problems which can arise if the 2 basic rules or tenets of movement are not followed
  • Discuss the clinical consequences of loss of the medial and lateral tripods of the foot

Format(s):

Android Compatible
Ipad/Iphone compatible using Puffin Browser
Video Presentation

Price:$20.00 USD

Biomechanics 201: Introduction to Gait: Pedographs and Gait Analysis

Credit Hour(s):4.0
Educational Objectives:

  • Explain the phases of human walking gait
  • Discuss the biomechanical events associated with stance phase of gait
  • Discuss the biomechanical events associated with swing phase of gait
  • Explain biomechanically what is happening during each phase of gait in the foot, ankle, knee and hip
  • Discuss the 3 rockers of the foot and how they apply to the gait cycle
  • Understand the calcaneocuboid locking mechanism and defend it’s importance in the stance phase of gait
  • Summarize the ranges of motion of the foot, ankle, knee and hip and their importance in normal gait
  • Explain how stance phase abnormalities would impact the gait cycle
  • Demonstrate competency in obtaining a reproducible Pedograph print
  • Interpret rearfoot, midfoot and forefoot mechanics as seen on a pedograph print
  • Identify and interpret problem areas in a pedograph print
  • Identify stance phase abnormalities on a Pedograph print
  • Extrapolate pathomechanics which would occur rostrally in the kinetic chain during pathomechanics occurring in the gait cycle
  • Evaluate the impact of gait abnormalities on human locomotion

Format(s):

Android Compatible
Iphone/Ipad Compatible

Price:$80.00 USD

The Gait Guys www.onlineCE.com courses.

https://chirocredit.com/courses/index.php?catid=124&pid=1

Biomechanics

Biomechanics 208 Case Studies in Gait Analysis: Challenges to the Knee during Gait
Credit Hour(s): 1.0

Educational Objectives:

Review the pertinent anatomy of the knee

  • Review the kinematics and kinetics of knee function during the gait cycle
  • View and discuss case studies involving knee function
  • Predict pathomechanics that will arise from the gait abnormalities presented
  • Propose remedies for the gait abnormalities seen

Format(s):Adobe PDF Download Android Compatible

Ipad/Iphone compatible using Puffin Browser
Slides with audio

Price:$20.00 USD

Biomechanics 207  A case study in gait analysis: focus on torsions and versions

Credit Hour(s):1.0

Educational Objectives:

  • Assess actions of the lower kinetic chain during gait
  • Predict pathomechanics that will arise from gait abnormalities presented
  • Propose remedies for the gait abnormalities seen
  • Review the gait cycle and gait cycle biomechanics
  • View and discuss case studies of gait

Format(s):

Adobe PDF Download
Android Compatible
Ipad/Iphone compatible using Puffin Browser
Slides with audio

Price:$20.00 USD

Biomechanics 206  A Case Study in Gait Analysis

Credit Hour(s): 1.0

Educational Objectives:

  • Review the gait cycle and gait cycle biomechanics
  • View and discuss case studies of gait
  • Assess actions of the lower kinetic chain during gait
  • Predict pathomechanics that will arise from gait abnormalities presented
  • Propose remedies for the gait abnormalities seen

Format(s):

Adobe PDF Download
Android Compatible
Ipad/Iphone compatible using Puffin Browser
Slides with audio

Price:$20.00 USD

Biomechanics 205: Barefoot Running and Gait: What you need to know

Credit Hour(s):1.0

Educational Objectives:

  • Explore barefoot running from a position of biomechanical efficiency
  • Contrast the differences in shod vs unshod running
  • Predict problems that can arise from shod and barefoot running
  • Apply visual analysis skills to barefoot running technique
  • Describe how to introduce barefoot running to your patient population

Format(s):

Adobe PDF Download
Android Compatible
Ipad/Iphone compatible using Puffin Browser
Slides with audio

Price:$20.00 USD

Biomechanics 204: Shoe selection and the effect and impact on gait

Credit Hour(s):1.0

Educational Objectives:

  • Describe and identify how the parts of a running shoe affect running biomechanics
  • Compare and contrast different shoe constructions to the biomechanical needs of an individual
  • Determine the appropriate last shape for different foot types
  • Discuss the biomechanical consequences of improper vs. proper selection of last types
  • Predict which features in a shoe are necessary to correct faulty gait patterns

Format(s):

Adobe PDF Download
Android Compatible
Ipad/Iphone compatible using Puffin Browser
Video Presentation

Price:$20.00 USD

Biomechanics 203:Gait Analysis: Normal and Abnormal Gait and factors affecting them

Credit Hour(s):3.0
Educational Objectives:

  • Discuss the normal walking gait cycle
  • Apply the biomechanics of the pelvis and lower kinetic chain during walking to clinical practice
  • Predict and discuss problems and clinical strategies that can arise from altered lower extremity biomechanics
  • Apply visual analysis skills
  • Evaluate case studies in gait analysis
  • Clinically apply solutions for gait abnormalities

Format(s):Adobe PDF Download

Android Compatible
Ipad/Iphone compatible using Puffin Browser
Video Presentation

Price:$60.00 USD

Biomechanics 202:Foot Function and the Effects on the Core and Body Dynamics

Credit Hour(s):1.0
Educational Objectives:

  • Describe how the motor and sensory homunculus relate to the foot and are integral to training and rehabilitation
  • Discuss the 3 rockers of the foot
  • Give examples of problems that result from a loss of the 3 rockers of the foot
  • Explain the concept of pelvis neutrality and its effect on training
  • Describe and examine the tripod of the foot
  • Breakdown most movement into 2 basic rules or tenets
  • Give examples of the problems which can arise if the 2 basic rules or tenets of movement are not followed
  • Discuss the clinical consequences of loss of the medial and lateral tripods of the foot

Format(s):

Android Compatible
Ipad/Iphone compatible using Puffin Browser
Video Presentation

Price:$20.00 USD

Biomechanics 201: Introduction to Gait: Pedographs and Gait Analysis

Credit Hour(s):4.0
Educational Objectives:

  • Explain the phases of human walking gait
  • Discuss the biomechanical events associated with stance phase of gait
  • Discuss the biomechanical events associated with swing phase of gait
  • Explain biomechanically what is happening during each phase of gait in the foot, ankle, knee and hip
  • Discuss the 3 rockers of the foot and how they apply to the gait cycle
  • Understand the calcaneocuboid locking mechanism and defend it’s importance in the stance phase of gait
  • Summarize the ranges of motion of the foot, ankle, knee and hip and their importance in normal gait
  • Explain how stance phase abnormalities would impact the gait cycle
  • Demonstrate competency in obtaining a reproducible Pedograph print
  • Interpret rearfoot, midfoot and forefoot mechanics as seen on a pedograph print
  • Identify and interpret problem areas in a pedograph print
  • Identify stance phase abnormalities on a Pedograph print
  • Extrapolate pathomechanics which would occur rostrally in the kinetic chain during pathomechanics occurring in the gait cycle
  • Evaluate the impact of gait abnormalities on human locomotion

Format(s):

Android Compatible
Iphone/Ipad Compatible

Price:$80.00 USD

Runners . . . On Your Mark, Ready, Set…..Swim.

For many of the years of my youth I watched just about every NBA basketball game I could get my eyes on.  When I wasn’t dreaming of playing ball in the big time I was at the local YMCA in my small town shooting jump shots, working on my fading jumper (because i was a small guard with no vertical, the worst of combinations), and working on my ball handling techniques. I was not a great player, not by any means, but I could play in pretty competitive pick up games and at least be somewhat respectable (note that ‘somewhat’ is highlighted).  But I still dreamed big about the NBA until I became old enough to realize that I was just too short and not blessed with the natural talent for the game that others obviously had been blessed. No matter how much I dreamed, being 5 foot 8 inches wasn’t going to ever get me to the big dance.  Body type, form, physiology and your anatomy have a big part in what sport you will be good at. There just are not too many 5’8" NBA guards, there never were minus Mugsy and Spud. They were an exception, obvious outliers. 

Are you a runner with runner’s anatomy ?  Do you have bowed legs ? Forefoot varus flat feet ? Anteverted hips ? Excessive tibial torsion ?  These are not great traits for runners. They tend to lead to many biomechanical issues that provoke injury at a much higher incidence than someone like my friend Charlie Kern , the USA masters mile champion.  Charlie is like Tiger Woods. Charlie has straight lower limb bones, no bony versions or torsions, great feet, he is slender, excellent muscle structure, and has tons of natural ability.  If you have ever seen him run it is like watching water flow. Charlie is as a runner just like Tiger is as a golfing Ferrari. They both happened to pick a sport that their body’s were perfectly suited for, then they had the passion for that sport, were lucky to have found it at a young age, and they worked harder than anyone else at their sport.  Anatomy, a bit of luck in sport choice early on, a physiology that paired well with the anatomy, and a work ethic to trump anyone. Being the best is a combination of things. You can have all the desire in the world as a runner or athlete but if you do not have the magic mixture of all things necessary you might just be average instead of extraordinary. 

Do you get injured all the time when you run ? How are your feet, are they competent or are they flat ? Do your tibias bow like a weathered piece of lumber ?  Are your knees kinked inwards (genu valgum) ? Are you tall and thin or are you build like a line backer ?  In other words, are you suited to be a distance runner or marathoner ? Or should you be happy with three to four 5k runs a week and be happy you can run those smaller distances rather than spend every 2 weeks in the therapists office getting a foot fixed, an orthotic tweaked, kinesiotape on a knee, more rehab. Do you spend more time icing your injuries and doing pre-run theapeutic exercises and foam rolling than you do running ? 

If this is you. God bless your dedicated heart. But maybe you should put on your Speedo and go for a swim.  I put my NBA dreams on hold long ago after realizing that at 5’8" it just wasnt going to happen. I picked up golf and did much better at that game in a shorter period of time than all the work on my hoop dreams.  I would fathom to say I should have picked up ping-pong long ago as a child. Perhaps I would be world champ by this time.

Run, bike, swim, hoops, golf…..whatever your passion. There is nothing wrong with having heart and grinding it out daily to be a runner or do whatever your sport happens to be.  Just never lose sight of the obvious. Maybe you need to look past your heart and look in the mirror and your mounting therapy bills and make some adjustments to your running dreams. Some of my best Triathletes were awesome runners at one time … .  when we could get them healthy to a start line line.  The problem was that they had more unused race bibs than completed races. They were in my office regularly pleading me to fix them up so they could get their training in so they could get to race day. However, after much psychoanalysis and reality talking we finally got through to some of the best athletes. Once we switched them to triathlons where they could moderate the runs and hit some alternative sports that did not play up their challenged race anatomy, they rose to the top and rarely had to hand off a race bib to a friend who was healthy.  And they are happier.  I see them far less in my office and far more at the finish lines with a huge smile.

Do some honest inventory of your body.  Sometimes a Speedo just makes sense, well, sort of. If you catch our drift.

Dr. Shawn Allen, The Gait Guys