Foot “Roll Out” at Toe Off : Do you do this ? And if so, why do YOU do it ?
As we always say, “what you see in someone’s gait is often not the problem, rather a compensatory strategy around the problem”.
What do you see in this case ? We would like to draw your attention at this time to the transition from midfoot stance to toe off on the right foot. You should watch both feet and note that the right foot tips outward (inverts) as toe off progresses.
What could cause this ? It is certainly not normal. Remember, it is highly likely it is not the problem, that something is driving it there or something is not working correctly to drive this client to normal big toe propulsive toe off. Now, there are many other issues in this case, some of which you can see and many of which you cannot, but do not get distracted here, our point is to talk about that aberrant Right toe off into inversion which prevents the optimal hallux (big toe) toe off.
A clinical exam will give many answers to joint ranges and what muscles are strong and which are weak and inhibited. Without the clinical exam and this information about the entire kinetic linkage there is no way to know what is wrong. This thinking should awaken shoe stores when prescribing shoes off of watching clients run or walk on a treadmill. There is so much to it beyond what one sees.
So what could be causing this foot to continue its supinatory events from heel strike all the way through lateral toe off ?
The foot could be:
- a rigid high arched cavus foot
- perhaps pronation through the midfoot and forefoot is painful (metatarsal stress pain, painful sesamoiditis, plantar fascitis) so it is an avoidance strategy possibly
- a common one with this gait presentation is perhaps there is a hallux limitus/rigidus (turf toe), painful or non-painful
- weak peronei and/or lateral gastrocsoleus thus failing to drive the foot medially to the big toe during the midstance-to-forefoot loading transition
- contractured medial gastrocsoleus complex (maybe an old achilles tear or reconstruction ?)
-rigid rearfoot deformity not allowing the calcaneus to perform its natural evertion during early stance phases thus maintaining lateral foot pressures the entire time
- presence of a rigid forefoot valgus
- avoidance of the detrimental medial pressures from a forefoot varus
These and many other issues could be the reason for the aberrant toe off pattern. This is not an exhaustive list but it should get your brain humming and asking some harder questions, such as (sorry, we have to say it again), “is what you see the problem, or a compensatory strategy to get around the problem ?”
We know you have busy days but we appreciate your time watching our videos and embracing something we are both passionate about.
We are The Gait Guys
Dr. Shawn Allen & Dr. Ivo Waerlop
