#forefoot

11. Nigam PK, Nigam A. Botulinum toxin. Indian J Dermatol. 2010;55(1):8–14. doi:10.4103/0019-5154.60343

http://thegaitguys.libsyn.com/podcast-123-the-rear-foot-understanding-your-rearfoot-type Show sponsors: www.newbalancechicago.com www.thegaitguys.com That is our website, and it is all you need to remember. Everything you want, need and wish for is right there on the site. Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).   Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.   Show Notes: https://www.ncbi.nlm.nih.gov/pubmed/27134364 https://www.ncbi.nlm.nih.gov/pubmed/25364132 RearFoot positions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588658/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990938/ Powers CM, Maffucci R, Hampton S. Rearfoot posture in subjects with patellofemoral pain. J Orthop Sports Phys Ther. 1995 Oct;22(4):155-60. Power V, Clifford AM. The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic Individuals with a Pronated Foot Type. J Hum Kinet. 2012 Mar;31:5-15. doi: 10.2478/v10078-012-0001-0. Epub 2012 Apr 3. Shultz SP, Song J, Kraszewski AP, Hafer JF, Rao S, Backus , Mootanah R, Hillstrom HJ. An Investigation of Structure, Flexibility and Function Variables that Discriminate Asymptomatic Foot Types. J Appl Biomech. 2016 Dec 19:1-25. [Epub ahead of print]

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If you are a sprinter, how you load the forefoot bipod might be a variable for speed or injury. Tendons can change their cross sectional area, if you load them, but they don't change, if you don't. Of course this article is not exclusive for sprinters, it pertains to any running sport, even endurance. Maximum isometric force had increased by 49% and tendon CSA by 17% ! Tendons can change their cross sectional area, if you load them. Here I show lateral forefoot loading in a heel raise, and a medial forefoot loading in heel raise. This has to be part of the discovery process outlined below. Forefoot types will play into the loading choice, and unequal strength of the medial or lateral calf compartment will also play into the loading choice made. Where do you need to put your strength ? And is the forefoot competent to take that loading challenge ? Meaning, do they have a forefoot valgus? A forefoot supinatus ? These things matter. If you are a sprinter, how you load the forefoot bipod might be a variable of foot type, asymmetrical posterior compartment strength, or foot strike pattern in the frontal plane (search our blog for cross over gait and glute medius targeting strategies for step width) ,or a combination of several or all of the above. These things matter, and why and where you put your strength matters, if you are even aware of where and how you are putting the loads, and why of course. Of course, then there are people like the recent Outside online article that says how you foot strike doesn’t matter, but it does matter. But of course, if you do not know the things we have just mentioned, it is easy to write such an article. Isometrics are useful, they have their place. In a recent podcast we discussed the place and time to use isometrics, isotonics, eccentrics and concentrics. One of the goals in a tendinopathy is to restore the tendon stiffness. Isometrics are a safe way to load the muscle tendon complex without engaging a movement that might have to go through a painful arc of movement. With isometrics here is neurologic overspill into the painful arc without having to actually go there. The key seems to be load. More load seems to get most people further along. Remember, the tendon is often problematic because it is inflammed and cannot provide a stiffness across its expanse. Heavy isometric loading seems to be a huge key for most cases. But, we have to say it here, not everyone fits this mold. Some tendons, in some people, will respond better to eccentrics, and strangely enough, some cases like stretching (perhaps because this is a subset of an eccentric it seems or because there is a range of motion issue in the joint that is a subset of the problem). Now the literature suggests that stretching is foolish, but each case is unique all in its own way, and finding what works for a client is their medicine, regardless of what the literature and research says. Finding the right load for a given tendon and a right frequency of loading and duraction of loading is also case by case specific. Part of finding the right loading position is a discovery process as well, as noted in the photos above. Finding the fascicles you want to load, and the ones you do not want to load (painful) can be a challenging discovery process for you and your client. Finding the right slice of the pie to load, and the ones not to load takes experimentation. When it is the achilles complex, finding the safe However, if one is looking for a rough template to build from, brief, often, heavy painfree loads is a good template recipe to start with. Here, in this Geremia et al article, "ultrasound was used to determine Achilles tendon cross-sectional area (CSA), length and elongation as a function of plantar flexion torque during voluntary plantar flexion." They discovered that, "At the end of the training program, maximum isometric force had increased by 49% and tendon CSA by 17%, but tendon length, maximal tendon elongation and maximal strain were unchanged. Hence, tendon stiffness had increased by 82%, and so had Young’s modulus, by 86%. Effects of high loading by eccentric triceps surae training on Achilles tendon properties in humans. Jeam Marcel Geremia, Bruno Manfredini Baroni, Maarten Frank Bobbert, Rodrigo Rico Bini, Fabio Juner Lanferdini, Marco Aurélio Vaz European Journal of Applied Physiology August 2018, Volume 118, Issue 8, pp 1725–1736

So, you see at foot that looks like this and what do you think? What are some of the biomechanical characteristics of people with the foot that when, you bisect the calcaneus, the line passing forward passes lateral to the second metatarsal or a line between the second and third? This condition can be congenital, in conditions like forefoot adductus or compensatory. The first thing that springs to mind when we see deformities like this is “things usually occur in threes“. So we would expect to see other anatomical and/or genetic abnormalities. An adducted forefoot, like you see here, often occurs as the result of lack of internal rotation of the hip on that side so therefore will often be present with conditions like internal tibial torsion and femoral retrotorsion, which we often, but not always, see together. Because of the increased gait and foot progression angle in these individuals, the forefoot compensates and adducts to bring the center of gravity more to midline. Feet like this are often, but not always, cavus and rigid. If it remains in relative supination (plantarflexion, abduction and inversion) it is an excellent level but poor shock absorber. Forefoot adduction can also be a compensation pattern if an individual is unable to get the head of their first ray completely down to the ground. It could be a true forefoot varus or more commonly, a forefoot supinatus; either results in an inability to get the first ray down. This often causes the foot to adduct in compensation, and, due to the tarsal articulations, often raises the base of the first metatarsal increasing the inclination angle of the first ray. This frequently leads to limited dorsiflexion of the first metatarsophalangeal articulation. So what is a clinician to do? Ensure that the mechanics of the foot are clean through manipulation and mobilization Make sure there are appropriate flexors/extensor ratios of skill, endurance, and strength of the foot musculature both intrinsically and extrinsically. This means making sure that the long flexors and extensors are in some degree of balance. Work on balance and coordination of the lower extremity. This can be impeded if they’re unable to get ahead of the first right down to the ground. Exercises for the peroneus longus, extensor hallucis brevis and short flexors of the foot will often help with this. “Banana foot”. Coming to your clinic, or a clinic near you. Maybe today… Dr. Ivo Waerlop, one of The Gait Guys. #forefootadductus #bananafoot #supination #thegaitguys

Take a good look at these pictures of this gentleman‘s feet. Can you see any differences from side to side? If you look closely, you will notice that his right foot is in an adducted position (forefoot adductus) and the left one relatively normal. If you bisect the heel, it should pass through the second or between the second and third metatarsal in his clearly falls laterally. So what you say? Well, putting a foot in relative supination with respect to the other causes certain biomechanical sequela. This forefoot adductus often leads to a forefoot supinatus, so he’s unable to get the head of his first ray down to the ground. Think that might make a difference in his gait cycle? Think about all the extra internal rotation that will have to occur in that lower extremity during a normal gait cycle. Now combine that with something like external tibial torsion or a leg length discrepancy and things can really stack up and make a big difference. Lastly, think about the asymmetrical mechanoreceptor input from the joint mechanoreceptors and muscle spindles traveling up the neuraxis. Do you think over time that that may cause some cortical remodeling and ultimately change the way he activates muscles? Look for asymmetries, they really do matter Dr Ivo Waerlop, one of The Gait Guys #asymmetriesmatter #gaitanalysis #thegaitguys #forefootadductus