Holy Hand Grenades! What kind of shoe do I put these feet in?
Take a look at these feet. (* click on each of the photos to see the full photo, they get cropped in the viewer) Pretty bad, eh? How about a motion control shoe to help things along? NOT! OK. but WHY NOT? Let’s take a look and talk about it.
To orient you:
- top photo: full internal rotation of the Left leg
- 2nd photo: full internal rotation of the Right leg
- 3rd photo: full external rotation of the Left leg
- last photo: full external rotation of the Right leg
Yes, this gal has internal tibial torsion (yikes! what’s that? click here for a review).
Yes, it is worse on the Left side
Yes, she has a moderate genu valgus, bilaterally.
If someone has internal tibial torsion, the foot points inward when the knee is in the saggital plane (it is like a hinge). The brain will not allow us to walk this way, as we would trip, so we rotate the feet out. This moves the knee out of the saggital plane (ie. now it points outward).
What happens when we place a motion control shoe (with a generous arch and midfoot and rearfoot control) under the foot? It lifts the arch (ie it creates supination and it PREVENTS pronation). This creates EXTERNAL rotation of the leg and thigh, moving the knee EVEN FURTHER outside the saggital plane. No bueno for walking forward and bad news for the menisci.
Another point worth mentioning is the genu valgus. What happens when you pick up the arch? It forces the knee laterally, correct? It does this by externally rotating the leg. This places more pressure/compression on the medial aspect of the knee joint (particularly the medial condyle of the femur). Not a good idea if there is any degeneration present, as it will increase pain. And this is no way to let younger clients start out their life either.
So, what type of shoe would be best?
- a shoe with little to no torsional rigidity (the shoe needs to have some “give”)
- a shoe with no motion control features
- a shoe with less of a ramp delta (ie; less drop, because more drop = more supination of the foot (supination is plantarflexion, inversion and adduction)
- a shoe that matches her sox, so as not to interfere with the harmonic radiation of the colors (OK, maybe not so much…)
Sometimes giving the foot what it appears to need can wreak havoc elsewhere. One needs to understand the whole system and understand what interventions will do to each part. Sometimes one has to compromise to a partial remedy in one area so as not to create a problem elsewhere. (Kind of like your eye-glass doctor. Rarely do they give you the full prescription you need, because the full prescription might be too much for the brain all at once. Better to see decent and not fall over, than to see perfectly while face down in the dirt.)
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We are the Gait Guys, and yes, we like her sox : )