Is Your Foot Tripod Stable Enough to Walk or Run without Injury or Problem ?

The all to common case of the Wobbling Tripod.

Note the music we have chosen today. We tried to match the rate of the dancing tibialis anterior tendon to the tempo of the song, just for fun of course. Well, actually, for neurological reasons as well, as with a steady tempo or beat, your nervous system can learn better. Why do you think we teach kids songs to learn (or you can’t get the theme from the “Jetsons” out of your head).

This is a great video. This client has an obvious problem stabilizing the foot tripod during single leg stance as seen here.  There is also evidence of long term tripod problems by the degree of redness and size (although difficult to see on this plane of view) of the medial metatarsophalangeal (MTP) joint (the MPJ or big knuckle joint) just proximal to the big toe.  This is the area of the METatarsal head, the medial aspect of the foot tripod.

As this client moves slowly from stance into a mild single leg squat knee bend the challenges to the foot’s stability, the tripod, become obvious.  Stability is under duress. There is much frontal plane “Checking” or shifting and the tibial and body mass is rocking back and forth on a microscopic level as evidenced by the dancing tibialis tendon at the ankle level.  The medial foot tripod is loading and unloading multiple times a second. 

Is it any shock to you that this person has chronic foot problems which are exacerbated by running ?  Every time this foot hits the ground the foot is trying to find stability. The medial tripod fails and the big knuckle joint (the 1st MPJ or big toe joint) is enlarging from inflammation and early cartilage wear and decay, not to mention the knee falling medially as well!  Hallux limitus (turf toe) is subclinical at this time, but it is on the menu for a later date. A dorsal crown of osteophytes (the turf toe ridge on the top of the foot) is developing steadily, soon to block out the range necessary for adequate toe off in this client.  And that means a limitation in  hip extension sometime down the road (and premature heel rise……. did you read Wednesday’s blog post on that topic ?).

*addendum:

Take the time to develop the skill. We ask our clients to work on standing with the toes up to find a clean tripod and do some shallow squats working on holding the tripod quietly. Be sure your glutes are in charge. Then, again using the toes pressed flat but be sure the tripod is still valid, esp the medial tripod. No toe curling/hammering. Keep that glute on. Move the swing leg forward during a squat, and then behind you during a squat (mimicing early and late midstance phases of gait/running). This will help your brain realize when it needs this stability and it will also act to press you off balance and will make the foot check and challenge. Do this until you feel the foot fatigue on the bottom. Then Stop. Repeat later. If the medial tripod collapses, the knee will drop inwards and excess pronation is inevitable. We modified this with our prescription of the “100 ups”…..combine the two !

Shawn and Ivo … .  comfortably numb.

Once you have been to the Dark Side of the Moon  (and hopefully you didn’t have any Brain Damage) you will know it well and know what to expect when you return again.  Meaning, when you have seen these issues over and over again, hopefully in your daily work if not regularly here at The Gait Guys, you will quickly know what things to assess and look for in your athletes.  And you might just turn into a Pink Floyd fan at the same time, or at least crave some Figgy Pudding (but you have to eat yer’ meat! How can you have any pudding if you don’t eat  yer’ meat?).

Podcast #10: In the Running.

Podcast #10 is Live !

*Call to action ! If you like this podcast, think of some friends and colleagues who might enjoy it…… and consider sending it their way !

This link will get you a nicely laid out “show notes” and pod player.

http://thegaitguys.libsyn.com/webpage/podcast-10-in-the-running

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

Here are the show liner notes:

Payloadz link for our DVD’s and efile downloads: http://store.payloadz.com/results/results.asp?m=80204

1- NEUROSCIENCE PIECE: In the Running. Much thanks to our friends Nadia, Jennifer, Jad and Robert over at www.radiolab.org and “Radiolab: The Podcast” over on iTunes for giving us written permission to reproduce this awesome podcast named “Shorts: in the Running” from April 2011. Please visit their website. It is awesome !

2- Email from a Facebook Follower:

Hi there – I did a google search for “turned out foot” and came across your youtube video:  http://www.youtube.com/watch?v=-DE5VPxJOMU  I have this issue but I don’t think it is from a weak glut (although possibly could be, not sure). In the text, it mentions “looking at another case” as well as more info about this on your blog but I’m having trouble finding it. could you refer me to the right page? Also, where are you located?
thanks for the informative blog!!- Kim

3- DISCLAIMER:
We are not your doctors so anything you hear here should not be taken as medical advice. For that you need to visit YOUR doctors and ask them the questions. We have not examined you, we do not know you, we know very little about your medical status. So, do not hold us responsible for taking our advice when we have just told you not to !  Again, we are NOT your doctors !

4-  Updates and Sponsor talk:
A-  more lectures available  on www.onlineCE.com   Go there and look up our lectures
 
B- In January we will be taking on sponsors for our podcast.  We have had some interest already but we wanted to work out the quality control issues first. Early in means savings. 
Contact us if you would like to be a sponsor……If we believe your product has value to this listener community we will give you a professional and personalized company or product plug and advertisment.  From our lips to our listeners ears ! 
We will basically expose your product to our international fan base.
 The sponsors will help make our mission possible, defray costs and time to put out this podcast and blog. These things take is away from our practices a little.  Each week we will have 2 center-Stage sponsors . Your sponsorship can run as long as you want.

5-  Mail from an International Follower of our Blog:
Hi there,
I was hoping you might settle a debate I had with a physiotherapist about the efficiency of movement.

I argued that a running gait is a more efficient way of moving over distance because of less vertical ground reactive forces acting on the body during a running gait. I concluded that our natural environment requires us to run rather than walk as predation of non-sebatious hominids gives us the advantage of stamina rather than explosive speed.
The counter argument was that walking generates less metabolic demand therefore increases efficiency of movement. But I don’t think this is true in terms of calories/mile.
Any help would be appreciated.
Thanks! -Jesse, Luxumborg

http://www.runningplanet.com/training/running-versus-walking.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1283673/

running on feet: http://www.sciencedaily.com/releases/2010/02/100212092304.htm

6- EMAIL FROM A COACH: 
Do all the running form clinics have value ? It seems that you can teach someone what they believe is better form, but what if they do not have the anatomy to embrace that form you have taught ? What if they are weak in that form, might they build a compensation in that new form ?  It seems to me that merely adopting an apparently better running form does not necessarily mean one will be less injury prone.
-Thx Anonymous

TGG: midfoot strike, avoid heel strike.
Our beef is that No, not one, running form clinic we have seen talks about your anatomy such as”

– know your foot type
-know if you have tib torsion or torsional issues that will challenge patellar tracking and glute use (versions)
– know what your ankle rocker is like
– can you adopt forefoot strike ? midfoot strike?
– can you go into minimalism ? Ankle rocker ?  (patient with fusion)

vimeo: http://vimeo.com/40442384
by NakedRunnersTV Plus 5 months ago. An insight into the thoughts & experiences related to running & running barefoot, by Kenyan-based running coach, Rob Higley. Taken from the evening seminar held in Newcastle’s E10 (Hamilton Baptist) Church in Feb, 2012.

7- READER EMAIL:
    My name is Robert and am retired from the Navy.  I have chronic dorsal foot pain on my left foot and am tired of dealing with Podiatrists and Orthopedic doctors who just want to put you in orthotics.  I no longer wear orthotics just the Prokinetic 6mm inserts.  I have become extremely interested in your posts and would like to seek further help.  I live in the upstate SC and my question is could you direct me to a doctor that utilizes your techniques and would be in close proximity to my location.  I have some pretty interesting feet that I’ve ignored for far too long and am now paying the price.  Just from watching your video’s I have multiple issues that I need to address, I just don’t know how. (Collapsed arch and Mallet Toe on left foot,  Hammer Toes, Crossover Toe (No Bunion yet), Splayed 4th & 5th Meta on the right foot). I have Morton Foot Anatomy with 1st MPJ being about ½ inch shorter than 2nd meta.  All this together with low back pain, neck pain, forward head posture, and I waddle when I walk.  I’m really looking for someone to help me put it all together so I can figure out how to fix myself.  Getting a lot harder to run around with my 10 year old boy.  Any referrals or help would be greatly appreciated.

8- Blog post we liked recently:

The Pedograph

09- Our dvd’s and efile downloads
Are all on payloadz. Link is in the show notes.
Link: http://store.payloadz.com/results/results.asp?m=80204
 

10 – Email from a Field Doctor
Hi guys,
Do you have any clever exercises for getting someone to initiate swing phase with abs instead of psoas?
I wanted to check and see if you had any suggestions.
Hope you’re well!
We withheld the name

OUR RESPONSE:

1- first trick is to make sure they can supinate the stance foot and initiate external rotation from lower in the stance leg
2- make sure all external rotators are available……otherwise the hip-pelvis and abdominals will not get the clean signal to prepare
3- look for any functional or anatomical limitations to #1 and #2……such as forefoot varus, valgus, sustained pronation issues, genu valgus etc……
4- seated marches……..  sit in neutral spine/neutral pelvis…..ie. neutral lordosis……sit on two points of ischeal tuberosities……..hands in front like frankenstein…….. press one foot into the ground while the other thigh is lifted…….this must be done on an exhale to help drop the ribcage…….be sure the lift leg thigh does not rock back the pelvis on that side or lose the lordosis.  Doctor finger on the lordosis will queue them not to change spine angle……..if they do it right they will feel the lower abdominal fire first…….if they lose the pelvis or lordosis (ie. let them drop into lumbar kyphosis slump) they will only feel the hip flexor and quad lifting the leg which for most is easier but wrong
5- add challenge………put hands over head and repeat…..
6- pray  🙂