Ankle Plantarflexors as Gait compensators ?

We are always talking about compensations. We have worn out our statement “what you see in someone’s gait is not their problem, ti is their compensation stratetgy(s).”
Here is a study with an interesting thought.
Just remember, try to fix the underlying problems. But, realizing sometimes you cannot, especially in the elderly population, sometimes you have to give a strategy to help them even though it is not the solution you want. And remember also that driving the anterior compartment with appropriate exercises as our “shuffle walk” might stop any loss of ankle dorsiflexion that might be met with the extra calf work that this article seems to suggest.

From the study: “ Of particular importance were the compensatory mechanisms provided by the plantar flexors, which were shown to be able to compensate for many musculoskeletal deficits, including diminished muscle strength in the hip and knee flexors and extensors and increased hip joint stiffness. This importance was further highlighted when a normal walking pattern could not be achieved through compensatory action of other muscle groups when the uniarticular and biarticular plantar flexor strength was decreased as a group. Thus, rehabilitation or preventative exercise programs may consider focusing on increasing or maintaining plantar flexor strength, which appears critical to maintaining normal walking mechanics.”

Gait Posture. 2007 Mar;25(3):360-7. Epub 2006 May 23.
Compensatory strategies during normal walking in response to muscle weakness and increased hip joint stiffness.
Goldberg EJ1, Neptune RR.

Achilles Tendonitis

The motion needs to occur somewhere…Make sure you look at the whole picture

Since the knee was bent, perhaps we should be looking at the soleus? And the talo crural articulation?

“A more limited ankle Dorsi Flexion Range Of Motion as measured in Non Weight Bearing with the knee bent increases the risk of developing Achilles Tendonitis among military recruits taking part in intensive physical training.”

J Foot Ankle Res. 2014 Nov 18;7(1):48. doi: 10.1186/s13047-014-0048-3. eCollection 2014.
Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study.
Rabin A1, Kozol Z1, Finestone AS2.


Want to strengthen that gluteus medius we were talking about Monday? Have you considered walking lunges with dumbbells? These seem to activate the side contralateral to a better extent than split squats.

We wonder if you get the same effect with a medicine ball. Anyone out there have some data or experience with that?

Stastny P1, Lehnert M, Zaatar Zaki AM, Svoboda Z, Xaverova Z. DOES THE DUMBBELL CARRYING POSITION CHANGE THE MUSCLE ACTIVITY DURING SPLIT SQUATS AND WALKING LUNGES? J Strength Cond Res. 2015 May 8. [Epub ahead of print]

Foot orthoses and patellofemoral pain: frontal plane effects during running | Lower Extremity Review Magazine

We all see people with patellofemoral pain. Some of those cases may have responded to orthotic therapy. Some studies show that the effects on frontal plane kinematics are minimal (1 degree); this doesn’t mean it didn’t work, or this amount is not clinically significant. So why do they help? Perhaps it is a “timing” issue and the knee abduction moment.

“Our results are consistent with a 2003 study by Mundermann et al that compared the effects of custom orthoses (with posting, molding, or a combination of both) to flat inserts. For each orthotic condition, these authors reported a significant delay in the timing of the peak knee abduction moment. This finding may be related to the aforementioned clinical effects, as delaying the peak knee abduction moment would effectively decrease the rate of loading at the knee joint. The rate of loading has been previously implicated as a possible contributing factor in running-related overuse injuries, as runners with a history of injury have demonstrated a higher rate of loading of the vertical ground reaction force than runners with no history of running-related injury.”

This is an interesting take. If you have a few moments, give it a read:

Foot orthoses and patellofemoral pain: frontal plane effects during running | Lower Extremity Review Magazine

Lumbar link? Ankle, spinal pathologies coexist in cadavers | Lower Extremity Review Magazine

It makes sense…but which came 1st?

Just make sure you ask your foot patients about their back, and your back patients about their feet

The Gait Guys

Lumbar link? Ankle, spinal pathologies coexist in cadavers | Lower Extremity Review Magazine

Forefoot Varus or Forefoot Supinatus?

Forefoot varus is a fixed, frontal plane deformity where the forefoot is inverted with respect to the rearfoot. Forefoot varus is normal in early childhood, but should not persist past 6 years of age (i.e. when developmental valgus rotation of forefoot on rearfoot is complete, and plantar aspects of fore- and rearfoot become parallel to, and on same plane as, one another (1)

Forefoot supinatus is the supination of the forefoot that develops with adult acquired flatfoot deformity. This is an acquired soft tissue adaptation in which the forefoot is inverted on the rearfoot. Forefoot supinatus is a reducible deformity. Forefoot supinatus can mimic, and often be mistaken for, a forefoot varus. (2)

A forefoot varus differs from forefoot supinatus in that a forefoot varus is a congenital osseous where a forefoot supinatus is acquired and develops because of subtalar joint pronation.

“Interestingly, only internal rotation of the hip was increased in subjects with FV – no differences were present in hip adduction and knee abduction between subjects with and without FV. The authors nevertheless conclude that FV causes significant changes in mechanics of proximal segments in the lower extremity and speculate that during high-speed weight-bearing tasks such as running, the effects of FV on proximal segments in the kinetic chain might be more pronounced.”

We wonder if the folks in this study had a true forefoot varus, or actually a forefoot supinatus (3).

The Gait Guys

1. Illustrated Dictionary of Podiatry and Foot Science by Jean Mooney © 2009 Elsevier Limited.

2. Evans EL1, Catanzariti AR2. Forefoot supinatus.
Clin Podiatr Med Surg. 2014 Jul;31(3):405-13. doi: 10.1016/j.cpm.2014.03.009.

3. Scattone Silva R1, Maciel CD2, Serrão FV3. The effects of forefoot varus on hip and knee kinematics during single-leg squat. Man Ther. 2015 Feb;20(1):79-83. doi: 10.1016/j.math.2014.07.001. Epub 2014 Jul 12.

Just because it looks good, doesn’t mean that it is.

We have all had patients with seemingly negative knee x rays and pain, only to develop arthritic changes at a later date. Find and treat the cause!

“Our analysis found that incident radiographic knee osteoarthritis is preceded by prodromal symptoms lasting at least 2-3 years. This has potential implications for understanding phasic development and progression of osteoarthritis and for early recognition and management.”

Case R, Thomas E, Clarke E, Peat G. Prodromal symptoms in knee osteoarthritis: a nested case-control study using data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2015 Apr 2. [Epub ahead of print]

picture from:…/chronic-pain-understanding-the-roots…/

Foam rolling, a literature review – Anatomy & Physiotherapy

What does the literature say about foam rolling?

The folks here bring up a good point: “ Despite these findings, without clearly defined parameters and more importantly, mechanisms of action, to what extent should we incorporate SMR and foam rolling into our programming?”

Foam rolling, a literature review – Anatomy & Physiotherapy

#92: Your Brain on running. Ankle tightness, Femur rotation and more.

Plus a little on Oliver Sacks and homeostasis.

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A General Feeling of Disorder: Oliver Sacks

How Running Keeps Your Brain Humming

Hey Gait Guys,
I’ve been reading your blog and listening to your pod-casts (now on 71 but have listened to some new ones too so maybe 10 more to go). I’ve become so much more aware of the body’s biomechanics. Maybe this has been discussed by you guys before but I haven’t come across it yet. I was in Walmart and saw the Dr. Scholl’s foot map system and arch supports. I don’t know if you’ve seen the machine or have tested it out but they are everywhere. I found it interesting that for EVERY foot type they are recommending a ‘specialized’ heel lift. It involves statically standing on the machine on one leg. Interestingly there are handles which one can hold to help support the body on this single leg stance. After listening to so many podcasts and applying my new found knowledge, it immediately raises red flags in my brain. Thought you might be interested.

Overtightening of the ankle syndesmosis: is it really possible?
Tornetta P 3rd1, Spoo JE, Reynolds FA, Lee C.
J Bone Joint Surg Am. 2001 Apr;83-A(4):489-92.

Femur rotation

Hi there Dr Ivo and Dr Allen
I thought this article may interest you.
This last paragraph/quote in particular caught my eye.
I was wondering what your opinion of this would be and wether you agree with it entirely?
Wenger et al (1989) suggest that, since flexible flat foot is generally a benign condition, it rarely requires treatment.

wreck method, squats ?

High performance high heels ?

oy. At $925 a pair, maybe she is the smart one (but we don’t think so). There is always an opportunist it seems.

“If I was to continue to [wear heels] in the same level as I did in my 20s, I would literally end up with super deformed, damaged feet,” said Singh, 36.
Traditionally, the structure of a high heel relies on a single metal shank running along the sole of the shoe providing a very stiff — and uncomfortable — platform that puts 75 percent of the pressure on the ball of the foot.
Singh and her team are trying to adjust the distribution of load so that the ball of the foot carries 50 percent of the weight and the heel carries the other 50 percent such that the impact — and with it, the pain — is lessened.