Loss of medial tripod

It is Rewind Friday.
Today, we are reaching back to a brief 2009 lecture I did for the local NSCA chapter on the patterns of kinetic chain compensation that match with loss of medial and lateral foot tripod. (video starts at 49 seconds, for some reason)

Loss of medial tripod

We came across this video on Youtube. Look at the obvious deficiency on the right limb with the amount of internal spin of the foot.  Much can be gleaned from this information. remind you that making assumptions of what is wrong or what the treatment is from what you see on a treadmill or in a person walking or running may not be their actual problem, rather it is quite often their compensation pattern. 

In this case, we see an aggressive negative foot progression angle on the right. Normal foot progression angle is anywhere from zero degress (see this persons left foot) up to 15 degrees depending on their given anatomy. 

This is likely from internal tibial torsion on the right but femoral torsion would need to be looked at. What is interesting is taking the concepts of what are seen here and projecting some other thoughts and considerations, as The Gait Guys always do.  This person is “toeing off” the lateral column of the foot (3rd-5th digits).  This will enforce a supinatory toe off, it is always nice to toe off a rigid lever but in time running in this case could eventually lead to some osseous stress reaction/response into these lesser metatarsals and could “couch” this person for a period. To gain more stability (plantar purchase of the foot on the ground) these clients frequently have over activity of their long toe flexors (FDL) and some toe hammering in the lateral digits is not uncommon.  Be sure to look for this phenomenon in your clients.

Toe off from the lateral foot is not uncommonly seen pairing up with a shortened step length on that side and same side knee hyperextension, reduction in ankle rocker (dorsiflexion through the tibial-talar joint) which can lead to anterior impingement at this interval as the ankle dorsiflexion is prematurely terminated,

We also frequently see a reduction in strength of the anterior compartment musculature; the ankle dorsiflexors (primarily the tibialis anterior) and toe extensors which further impairs any chance of normal ankle rocker range.  Additionally, these folks typically have weak lower abdominals on the affected side and tend to strategize through their quadriceps instead of the more effective glute-abdominal core stabilizing unit.In this case here, the more internal tibial torsion or internal spin a limb has, the less likely the client is able to engage the external hip rotators of which the gluteus maximus (iliac division) and gluteus medius (posterior division) are powerful proponents.

Lastly, for now, although this is likely a case of internal tibial torsion, it brings up the considerations in other cases that an internally rotated limb is typically shorter functionally and thus this can lead to an apparent leg length discrepancy.

These are all great “mental exercises” to keep your eyes and brain keen. But as we always say, what you may see may not be so.  Be sure to test your muscles and motor patterns to see if what they are displaying is their deficiency or their compensation pattern, or a bit of both. 

The Gait Guys , Shawn and Ivo