The Great toe’s effect on external hip rotation.

We have a simple video for you today. 

When we assess our clients for gait and locomotion we do a quick screen of all the big player joints, from the toes at least up into the thoracic spine to start. Loss of mobility/range of motion means probable functional impairment. 

In this video we display the effects of the Windlass Mechanism of the great toe. A windlass mechanism according to Wikipedia is:

a type of winch used especially on ships to hoist anchors and haul on mooring lines and, especially formerly, to lower buckets into and hoist them up from wells.

In this case, dorsiflexing the big toe spools the plantarfascia and flexor hallucis longus and brevis around the metatarsophalangeal joint (1st. MTPJ), thus pulling the heel towards the forefoot thus raising the arch. When the arch raises, the talus moves cephalad (upwards) and because of the supinatory movement orientation, it spins the tibial externally which in turn spins the femur externally. This is what you see in this video, note the blue dots being carried laterally with the limb external rotation.

The point here today, if you have loss of external hip rotation, it could be crying for you to evaluate the range of motion of the 1st MTP joint , it could be crying for you to evaluate the skill of toe extension, strength or endurance or all of the above. Impairment of the 1st MTP has great inroads into ineffective locomotion. You must have decent range of motion to effectively supinate, to effectively toe off, to externally rotate the limb, to effectively acquire hip extension to maximize gluteal use.  Thus, one could easily say that impaired hallux/great toe extension (skill, ability, endurance, strength) can impair hip extension (and clean hip extension patterning) and result in possible terminal propulsive gait extension occurring through the lumbar spine instead of through the hip joint proper.

Think of the effects of two asymmetrical great toe extensions, comparing the great toe left to right. Asymmetry in the limbs, pelvis, hip extension and perhaps worse, the lumbar spine, is a virtual guarantee.  Compare hallux extension side to side, if you can achieve symmetry through skill, endurance and strength retraining, you must do it. If you have a hallux limitus, a bunion or anything that impairs the symmetry of great toe extension side to side, you have some interesting work to do. 

You have to know what you have in your client, and know what it means to their locomotion.  Seeing or recognizing what you have must translate into understanding and action. 

Play mental games with clinical entities.  In this case, if at terminal toe off you did not have full hallux extension like in this client, and thus you did not get that last little final external rotation spin in the limb at the hip … . . what could that do to your gait ? Go tape your toe and limit terminal extension (terminal dorsiflexion) and walk around, to feel it in yourself is to get first hand experience. 

Shawn Allen, one of the gait guys

Big Toe Woes: One way to learn to load the head of the 1st metatarsal

On Thursday morning, while sprinting up a hill on the latter part of a run, I had the fortuosity of catching my big toe on what I beleive was an exposed root and fell sudddenly. Instinctively I rolled to protect my back (as you often do if you have had any history of back injuries). After a few expletives and a bruised ego, I took inventory of my body: back was fine, an abrasion and contusion on my left elbow and a really sore big toe. I got up and decided to run home as I was less than a mile from there.

I immediately noticed that my gait would need to be altered if I was going to make it home. I had injured the distal interphalangeal joint and distal phalanyx from the best I could tell; loading them in any way brought excruciating pain, so I was forced into one of my mantra’s: “Keep your toes up”*. I did this for the rest of my run and noticed, probably more than ever, how much this simple technique shifts the weight to the head of the 1st metatarsal and sesamoids. It also made me make my gait more “circular” (rather than pendular, another thing we teach in gait retraining).

I made it home and promptly iced. After getting to the office, an X ray confirmed my suspicion of a fracture in the proximal portion of the distal phalanyx. A day later and from my distal to my 1st metatarsal phalangeal joint is sausage like and a beautiful violet color. I am grateful I did not seem to injure the MTP…Oh well, I will either have to run carefully or switch to mountain biking for the next few weeks. Some ipriflavone (to assist in calcium absorption), cucumin and essentail oils (for inflammation) and I was good to go. Yes it throbs a bit, but it is a reminder that I need to push off through the head of the 1st : )

Try “toes up”with your peeps and let us know how it goes.

TGG

* “Toes up” technique involves conciously firing the anterior compartment muscles, particularly the extensor digitorum longus. It fires more into the extensor pool and assists in firing ALL your extensors through spacial and temporal summation and also heps to shut down flexor tone through reciprocal inhibition. It will also help you to rocker through your stance phase and get more into your hip extensors.

Steppage gait ? Or just a runway model ?  Take the thinking farther.
Today we have a short blog post for you. You may take the topic simply on the surface or cogitate over it and find some deeper epiphanies from the well of knowledge we have tried to present here on our blog for the past 4+ years.  
It is clear that in this video that the model has a consciously driven steppage gait. Meaning, she is lifting her limb/foot via exaggerated hip flexion and knee flexion to clear the foot.  This is often seen unilaterally in a foot drop case where the client has a neurologic lesion that for one reason or another has impaired the client’s ability to extend the toes or dorsiflex the ankle sufficiently to clear the foot (so they do not drag toes and trip/fall).  
But, why is she doing this steppage gait ? It is highly unlikely that she has bilateral lesions.  Sure, she was asked to walk this way by her mentor but again, take it further.  Is there a factor making this gait necessary regardless of the coaching ? 
Obviously the answer is yes or we wouldn’t be doing a blog post on this topic.  She is wearing ridiculously high heels. This is forcing her into an extreme plantarflexed foot and ankle posture. IF she were to swing her leg normally during the swing phase she would drive the foot and ankle into dorsiflexion (a normal gait event) and the long pointed heel would be made more prominent as it was driven forward and downward. This would surely catch on the ground, immediately driving the foot into sudden violent forefoot loading and pitch her into a forward fall.  Yes, you have seen this on the run way videos on youtube, and yes we know you laughed too ! You see, when wearing heels this high, one must deploy a certain degree of steppage gait to clear the heel because ankle plantarflexion is fraught with the risk we just discussed above, the heel is too prominent and will catch. How much steppage (knee flexion and hip flexion to clear the foot) is necessary ? Well, to a large degree it depends on how much of a heel is present.  If you are wearing a small heeled shoe, lets say 1 inch, then a small steppage is necessary.
None the less, there is a bigger problem lurking and brewing underneath when heels are a regular occurrence. Slowly and gradually the disuse of the anterior compartment muscles (Extensor dig., Ext. hallucis, peroneus tertius, tibialis anterior) will weaken and the posterior compartment will shorten respectively. IF left too long, it will result in tightness (yes, there is a difference between tightness and shortness, one is a neurlogical protective mechanism, the other is a more permanent change.) We have said this many times here and in our videos, much of posterior compartment problems (ie achilles tendonitis, Sever’s, Hagglunds etc) are related to a degree of anterior compartment weakness, skill deficits or endurance challenges.  Wearing high heels often will often, but not always, increase this risk. 
If you are an athlete, but someone who wears high heels often, you may have to do extra work to keep your anterior compartment competent on several levels.  Eccentric strength is just as important as concentric in this region. Remember, many gait problems come on slowly, a slow simmering smoldering fire. And remember this last point about heeled shoes, your forefoot is always being loaded initially in ankle plantarflexion, this is not normal and in time this will have a cost in many people.  
One last thing. We are not necessarily talking about dress shoes, although they are a greater culprit.  Many running shoes still have accentuated rear foot stack heights where the heel will be many millimeters above the plane of the forefoot.  Do not discount these shoes as a possible contributor of your problem, remember, physiological adaptation takes time to express into a biomechanical symptom creating problem, and it may take quite some time to resolve your compensations and adaptations.
PS: drive that “cross over gait” lady.  Fools.
Shawn and Ivo
the gait guys

In this great little slow mo video we see some things. Do you ? … The Perfect Runner.

1. First clips….. awesome toe extension through the entire swing phase all the way into early contact phase.  You have read here before on our blog entries how critical toe extension is for stable and optimal arch contruction prior to foot loading. Suboptimal arch height can mean that pronation loading occurs in a suboptimal foot tripod posturing and can mean difficulties controlling the normal end point where pronation should stop and convert back into supination to ensure rigid toe off.  (It is kind of like two runners in a 100m sprint. One starts at the line off the blocks and the other gets to start 1 second earlier 10 meters back from the line and gain speed towards the line before the gun goes off.  This is what it is like to start pronation prematurely, or with a suboptimal arch, the starting line where things are fair to all parts has been moved. The foot (the other guy in the race) doesnt have a chance.  Maybe a bad example but you catch the drift we’re surfin’ here.)  Back to our point, Niobe has great running form and great technicals.  Great midfoot strike, yes a little forefoot here but that is what happens when you are barefoot naked on hard surfaces. You have to get good form before you can clean up the technicals.  We spend alot of time on the technicals of running once form is clean. It is what makes the difference between 2nd place and a winner. And it is these little things that mushroom into nagging injuries over time.  We cannot express enough how important toe extension range and strength is for proper foot function and a strong neutral foot tripod.  We rarely have to address long toe flexor strength, short flexor strength yes, but not long.  Toe curls, towel scrunches, picking up stuff is not on our list of homework.

2. Second clip. He is skirting the issue of cross over without going too far. He could do a bit better but all in all pretty decent.

3. Emmanual Pairs, big dude ! No cross over. Awesome form.

4. Krysha Bailey. Long jumper. As with all sprinters, no cross over, beautiful form.

Just some easy topics and viewing for a Saturday blog post.

Have a good day brethren !

Shawn and Ivo

The Importance of the foot function and posturing at terminal swing in a great and talented runner. Part 2 of the Toe Extensor Dialogue.

* This is a follow up from yesterday’s video blog post. Lets review once again and then dive in, layering some deeper principles onto yesterday’s dialogue.

Stand up. Both feet on the floor. Close your eyes and raise your toes up off the floor, just the toes, and then let them fall. Pay great attention to what happens to your arch height as you raise and lower the toes. Yes, do this now. Then come sit down again and read some more. Go !

Ok, now you are back.

Do you think that toe extension ability (range, skill, endurance AND STRENGTH) will play a significant part in achieving adequate successful arch height and thus treating plantar foot pain syndromes (plantar fascitis to name the most obvious and simple nemesis)? You better believe it, we showed it in yesterday’s blog post ! * For a great little video sample of a young boy with flat feet using our queue’s to restore tripod positioning and arch height along with a more normal foot progression angle, see yesterday’s blog post or click here.

So, if toe extension is critical for arch height, both in preparation for foot strike/contact and in arch height and control should you ever try to consciously limit this natural phenomenon ?

In the video above the author and runner (Jordan McGowan) at 1:07 discusses his concern that the left foot is coming across in too much toe extension (ie. ankle dorsiflexion as well) in preparation for contact phase and that his right foot is coming across less extended/dorsiflexed, something we sometimes call shallow dorsiflexion. He indicates that he likes the appearance of the right foot pre-contact approach but he feels that he wants to relax the toe up/dorsiflexion exaggeration on the left. We do not necessarily agree based on the principles discussed above and yesterday because arch height preparation will be reduced (again, see yesterday’s blog post and video). However, Jordan is not wrong either. Read on !

Now, although Jordan himself does not discuss any deeper concerns we could imagine that some less skilled runners in this scenario might worry that if the toe extension is too excessive that it will pre-position the foot for a heel strike phenomenon. This does seem very reasonable thinking, but it is not necessarily so. Heel strike is a conscious choice. If this is your concern, it can easily be overcome; you will just have to do one of two things to avoid heel strike (ie. get to mid foot strike, which Jordan does very well on both sides, even the left, despite its increased toe extension/ankle dorsiflexion).

To overcome the concerns of heel striking with high toe extension pre-contact:

1. One will have to lean forward more to offset the possible early heel strike. Leaning forward more (as is done in natural/chi running form) will make it harder to heel strike because the foot will land even further under the body. Whenever the foot reaches out in front, the opportunity for heel strike increases. Make no mistake however, there is a difference between heel strike and heel contact. A skilled walker or runner can heel contact and quickly transition to midfoot load and get the same effect as a more pure midfoot strike. The difference is whether you LOAD the heel contact or quickly transition to the midfoot. Any skilled runner can do this and feel this. When done skillfully, a mere kissing of the heel, a mere light brushing with the ground, before the midfoot loading occurs is completely fine just do not load the heel otherwise a deceleration event is going to occur and that is a definite “no no”. This is a problem with amateur gait analysts and runners, and proves once again that what you see is not always what you get. We demo this illusion all the time with our runners and without a skilled eye they cannot see the difference, but they can feel the difference when asked to focus on the skill difference. To reiterate, for MOST runners there should be little if any rearfoot loading response, it is a mere zone of transition. This topic is absolutely no comment here on Jordan, he has superb midfoot contact.

2. Back to overcoming heel loading……. one will also have to better eccentrically control the descent of the forefoot to the ground. This is a normal biomechanical event. Yes, you can reduce this need if you bring the foot through shallowly as Jordan explained regarding his right foot, but at the possible consequences of entering the pronation phase with a partially unprepared arch and subtalar joint configuration (if the subtalar joint is starting its loading at the mid or anterior facet joint pronatory unlocking of the midfoot will occur too soon). A runner with a highly competent and strong foot can get away with cheating this mechanical event, and it is quite (very) possible that Jordan has such a foot with all his running experience. On the other hand, a more amateur runner could be loading a bullet into the pronation gun. Now, back to the eccentric loading of the anterior compartment muscles. Too slow an ankle dorsiflexion posture release and the heel will strike first, too fast and the forefoot could slap on the ground. One will thus need to get the proverbial porridge just right (not too hot, not too cold…..rather just right). Most skilled runners will be able to get this skill down within just one workout and then master it over the next 12 weeks (the time we find necessary to engrain a new motor pattern in the cerebellum and parabrachial nucleus, the primary pattern generators). And with more skill and foot strength a more risky shallow posturing can be taken with success. And, this may very well be the case with Jordan. He may be there and be correct in his evaluation. We just wanted to share both sides.

Understanding the end-phase swing foot and toe function is important. Understanding what your foot is doing is paramount. We wanted to share both sides of the coin because we would hate for amateur runners to see this and try to reduce their proper and necessary toe extension/ankle dorsiflexion and mimic a shallow late swing phase foot posture. This is where running moves from science to an art. Guys like Jordan can play with this stuff safely, but not everyone else can or should. For many, better preparation of the foot for the contact phase in a solid tripod will reduce excessive and possibly deformative pronatory forces. Presenting the foot to the ground with a less than optimal arch, via a conscious reduction in toe extension, will increase risk for the deformative pronatory forces to have a better chance of creating tissue pathology (ie. plantar fascitis etc).

Here is one of the reasons we recommend even our elite runners from time to time to exaggerate the toe extension-ankle dorsiflexion range off and on during runs. If you never use the FULL range Tib Anterior and extensor digitorum longus muscles (as in the shallow end swing foot posturing), you will begin to lose their strength at the end ranges. We often lose end range strength first. And in time that can trickle down those weaknesses into the ranges where more of the strength is truly needed. This is the “gosh, my pain just started out of the blue phenomenon !” Truth is, it did not, you just finally found yourself without that necessary extra little bit necessary to adequately protect a joint for the load at hand. And perhaps this is the take home point here. We all need to be sure that we still have what is necessary for optimal joint complex protection from time to time. It is why many athletes come to see us a few weeks before big events, for assessment to be sure that they are not trickling down into that risk zone as they peak their training and then taper.

In another post, we will discuss Jordan’s frontal view issues. He wisely has detected his foot pronation issues and we couldn’t agree more about his mention of the gluteal control and an important factor. So we will once again review our Cross over gait pathologic movement pattern which is somewhat evident here and part of the foot posturing, but we will also discuss the abductory twist phenomenon of his left foot, which is truly what is going on at the foot level (don’t get us wrong, the glute is part of the deal, but it is not the entire deal).

From the start our mission has never been to strike at the moral fiber of someones good intent. Rather, our mission has always been to dispel the myths and state the facts. This was a great assessment by Jordan, we just wanted to point out a few possible misconceptions and explain some of the differences between a skilled runner and what they are working on and what an amateur runner should be aware of mainly so that the masses of runners who will see this great video will get the honest facts and not start to, or too early, consciously change normal behaviors and start to generate compensations.

We spoke to Jordan about this blog post before we ran it and he was a champion about it. It opened some productive dialogue on both ends, that’s the way it should always work. Jordan was all for stating the truth and facts from all angles.

We are Jordan and Newton fans. We thank Jordan for his input, his feedback and for sharing his nearly flawless running form in his Newton’s. This is a form everyone should take note of and try to strive for.

The Gait Guys

Shawn and Ivo