Podcast 123: The Rear foot: Understanding your RearFoot type

Key tag words:
foot types, rearfoot, forefoot, pronation, supination, shoe fit, forefoot varus, forefoot supinatus, rearfoot inversion, ankle rocker, injuries, rehab, corrective exercises

Rearfoot varus and Rearfoot valgus. Knowing the anatomy of your rear foot and its anatomic and functional posturing can lead to many problems in anyone. If you do not know the rearfoot type and posturing, you will not understand the rest of the foot mechanics. Without this knowledge, you will not know the reason for midfoot or forefoot problems, not understand what shoe you are in, or even why the shoe, footbed, orthotic you have chosen is either not fixing your problems, or causing them.  Join us on a journey down the rearfoot rabbit hole over the next hour.  Plus a few funny stories to lighten the biomechanics-heavy dialogue.
 

Show links:
http://traffic.libsyn.com/thegaitguys/pod_123final_cut.mp3

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]

You better keep that Hallux Dorsiflexion

Geee....Looks like forefoot rocker really IS IMPORTANT, eh?

...and what have we been saying about being able to dorsiflex your big toe? Watch how well you or your client can descend the 1st ray (remember that if the head of the 1st does not go down and anchor, its axis of rotation moves dorsally and posterior, limiting dorsiflexion of the joint)

This article should make you look at the "toe break" in a shoe...

"They found that increasing bending stiffness assisted with propulsion during running, reducing the metabolic cost of running by about 1%. However, at a certain level, the increased elasticity began to interfere with the natural flexion of the first MTP joint, reducing the contribution of ankle joint torque to push-off and counteracting the metabolic benefits. Within the study population, the threshold of bending stiffness for optimal energetics varied significantly from one runner to the next, suggesting running shoe design may need to be tuned to an individual runner’s needs." 

http://lermagazine.com/news/in-the-moment-sports-medicine/stiffer-shoes-improve-running-energetics-as-long-as-first-mtp-flexion-is-preserved

Metatarsus Adductus: The Basics

Metatarsus Adductus: The Basics

A few points to remember:

• Metatarsus adductus deformity is a forefoot which is adducted in the transverse plane with the apex of the deformity at LisFranc’s (tarso-metatarsal) joint. The fifth metatarsal base will be prominent and the lateral border of the foot which is convex in shape . The medial foot border is concave with a deep vertical skin crease located at the first metatarso cuneiform joint level. The hallux (great toe) may be widely separated from the second digit and the lesser digits will usually be adducted at their bases (se below). ln some cases the abductor hallucis tendon may be palpably taut just proximal to its insertion into the inferomedial aspect of the proximal phalanx (1)
• To measure the deviation of the metatarsals, the midline of the foot correspondingto bisecting the heel is used as a reference. This is the line that divides the heel pad into equal parts and, when extended, runs through the second toe or the second web space. In mild deformities, the midline of the foot runs through the third toe. In moderate adductus deformities, it falls between the third and fourth toes. In severe deformities the line is lateral to the third web space.(2)
• If detected early, stretching is a common and effective treatment for mild and some moderate cases. The heel is steadied with one hand while the forefoot is abducted in relation to the hind foot. This is done for 5 reps, 5-7 times per day. (2)
• 85% will resolve spontaneously, is caused by intrauterine position, is flexible & resolves spontaneously in more than 90 % of children. (3)
• Though often used interchangeably, the term "metatarsus adductus" is usually reserved for milder cases, where the forefoot is adducted on the hindfoot at the tarso-metatarsal articulation. Metatarsus varus is often reserved for conditions where the matatrsals are actually curved AND the forefoot is adducted on the hindfoot. (4) The term "Metatarsus primus varus" is reserved for feet which have the same neutral or valgus hindfoot and varus forefoot but, in addition, increased divergence of the first and second metatarsals. (5)
• It is interesting to note that along with forefoot adductus, hip dysplasia and internal tibial torsion are common (6) and this patient has the latter
• Gait abnormalities seen with this deformity include a decreased progression angle, in toed gait, excessive supination of the feet with low gear push off from the lesser metatarsals. 

1.  Bleck E: Metatarsus adductus: classification and relationship to outcomes of treatment. J Pediatric Orthop 3:2-9,1983.

2. Bohne W. Metatarsus adductus. Bulletin of the New York Academy of Medicine. 1987;63(9):835-838.  link to FREE full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1629274/

3. http://www.wheelessonline.com/ortho/metatarsus_adductus

4. Peabody, C.W. and Muro, F.: Congenital metatarsus varus. J. Bone Joint Surg. 15:171-89, 1933.

5. Truslow, W.: Metatarsus primus varus or hallux valgus? J. Bone Joint Surg.23:98-108, 1925.

6. Jacobs J: Metatarsus varus and hip dysplasia. C/inO rth o p 16:203-212, 1960

additional references:

Kane R. Metatarsus varus. Bulletin of the New York Academy of Medicine. 1987;63(9):828-834. link to FREE full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1629282/

Wynne-Davies R, Littlejohn A, Gormley J. Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis). Journal of Medical Genetics. 1982;19(5):321-328. link to FREE full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1048914/

Cuvy Feet, anyone?

What is going on with this gal? Hmmmmm.... Watch on...

Take the minute to tie your shoes properly.

Plantar thermal stress response (TSR) leads to skin shear forces.

"Fifteen eligible subjects were enrolled. The left foot was used as a reference and fitted to a self-adjusted and habitual lace-tightening method by each subject. The right foot was used as a test closure and fitted into three lace closure conditions: loose, tight, and preset optimal closure (reel clutch, BOA technology). Thermal images were taken after 5 minutes of acclimatization (pre-trial) and immediately after 200 walking steps in each shoe closure condition (post-trial)."

Their conclusions:
"The results from this study suggest that shoelace closure technique can have a profound effect on TSR. It therefore stands to reason that optimal lace closure may have an impact in reducing risk of plantar ulcers in people with Diabetic peripheral neuropathy (DPN). Interestingly, results revealed that even a self-adjusted lace closure may not be necessarily optimal and a preset closure setting like reel clutch might ultimately be recommended to minimize risk."


Lace Up for Healthy Feet: The Impact of Shoe Closure on Plantar Stress Response

Hadi Rahemi, PhD, David G. Armstrong, DPM, MD, PhD, Ana Enriquez, BSc, Joshua Owl,BSc, Talal K. Talal, DPM, Bijan Najafi, PhD, MSc
First Published April 18, 2017

http://journals.sagepub.com/doi/abs/10.1177/1932296817703669?platform=hootsuite&journalCode=dsta

Wool socks ?

Blisters, wet feet, smell, skin maceration, who needs that. 
Here at The Gait Guys, we swear by wool socks. We wear them everyday, every season, and even in our running and hiking or athletic shoes. Cotton and synthetics are not in our life, and this is a personal choice. Ivo likes the Darn Tough brand, so do I, but I also love the REI thinner black dress socks for every day wear. I could wear a single pair all week if i wanted, and admittedly often do, without any smell. Yes, you read that right, no odor.  That is the genius of wool. But, there are other benefits as well.
Wool is also king for moving moisture, the fatty acids in the wool fibers eat up the bacteria and microbes that can possibly cause infection. 

Darn Tough ran a test where they soaked their socks in a bacteria that hikers might encounter on the trail; within an hour, 50 to 80 percent of the bacteria ws gone. 

Wool is also great in all temperatures. They insulate when its cold and assist in evaporation when warm. Plus, these things are durable, it is why we love them, and hence the name, Darn Tough Socks. The will get you through a 1000 mile hike, as long as you have shoes on over them :)

https://www.outsideonline.com/2173601/do-i-really-need-25-merino-hiking-socks

https://darntough.com/

The "Bad Guys" are watching your gait, too.

It is cold coffee and stale donut Thursday here on The Gait Guys, poorly palatable stuff, but stuff we need to eat anyways.  This is gait related. Read on.

"The cues used by prisoners were: gait, body posture (body movements not related to gait), age, gender, attractiveness, build, clothing, attention, fitness, environment (e.g., lack of lighting), and whether target was alone."

Yes, "Bad Guys" are looking at your gait.
___________

"Bad guys" are relentless and patient, opportunistic and flexible — and they pay attention, to us. And so, what does this mean to us ? And to our gait, how we move about our communities ?

It is in the MSM everyday, so we might as well pay attention to it. It is happening all around us, all the time. Opportunists. You should up your awareness game when you are out an about. We are not talking about becoming paranoid, but we should all be more aware. And, this article proves it.  

Are you a soft target ? "Bad Guys" like easy soft targets. So, read this and don't be a softie.  

"In a classic study conducted by a prison psychologist where dozens of convicted felons were interviewed, the psychologist played videos or presented several snapshots of random crowds of people in shopping malls, subway stations, and busy city streets and asked each of the inmates to point out for him the softest target in the pictures–that is the individual that they would most likely attack if given the opportunity. All responses were recorded. The study concluded that nearly every inmate selected the same people in each segment for similar reasons—these reasons form the baseline definition of Soft Target Indicators."
"Examples that help describe a Soft Target Indicator come from snippets of those recorded study responses, and include “looks sheepish,” “eyes were looking down,” ”obviously lost,” “an easy mark,” “looks out of place,” “not paying attention,” “distracted,”  and the most common—“unaware of their surroundings.”

These are all gait related. We have talked about dual tasking and many other gait and locomotion distractors that can make us vulnerable to falling and stepping off of cliffs and into ponds at the local mall. But now we should all be aware that there are other people watching our gait for reasons other than capturing the next viral video for YouTube. They are opportunists. 

The top vulnerable cues for these opportunists were: 

- Walk/gait – walking with confidence versus walking like a soft target. 

- Gender – females appear as softer targets than males. 

- Body type – In good physical shape versus heavy set or slow - - - - Apparent Fitness level – 

- Attention to surroundings versus Not paying attention; Appears to be cautious versus appears to be clueless.

So, our advice, especially if you are in a new environment or travelling?  Plan ahead, so you can pay attention. Keep your head up and look around, walk with confidence and be observant. If your head is down in your phone and you are dual tasking, this articles suggests that the "Bad Guys" are looking for you. 


http://www.recoilweb.com/adversarial-attraction-predators-optic-90271.html

Podcast 122: Achilles problems, glutes, & feet.

Key tag words:
neuroscience, elon musk, achilles, tendonitis, tendonopathy, eccentric loading, tendon loading, gluteus maximus, gmax, glutes, abductor hallucis, foot pain, hip biomechanics, navicular drop, BEAR, ACL tear, ACL reconstruction, plantar fascitis
 

Show links:

http://traffic.libsyn.com/thegaitguys/pod_122f.mp3

http://thegaitguys.libsyn.com/podcast-122-achilles-problems-glutes-the-feet
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:

Stanford Develops Computer That Literally Plugs Into People's Brains

https://www.entrepreneur.com/article/289645


Elon Musk says humans must become cyborgs to stay relevant. 

https://www.theguardian.com/technology/2017/feb/15/elon-musk-cyborgs-robots-artificial-intelligence-is-he-right

1. achilles tendonopathy:

http://www.jospt.org/doi/abs/10.2519/jospt.2016.6462?platform=hootsuite&code=jospt-site

2. achilles tendinitis and tendonosis.

Ohberg L, Lorentzon R, Alfredson H, Maffulli N. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. British Journal of Sports Medicine. 2004;38(1):8-11. doi:10.1136/bjsm.2001.000284.

link to abstract: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724744/

3. Is Achilles tendon blood flow related to foot pronation?
 E. Wezenbeek,T. M. Willems,N. Mahieu,I. Van Caekenberghe,E. Witvrouw,D. De Clercq

http://onlinelibrary.wiley.com/doi/10.1111/sms.12834/full

4.  The effects of gluteus maximus and abductor hallucis strengthening exercises for four weeks on navicular drop and lower extremity muscle activity during gait with flatfoot

Young-Mi Goo, MS, PT,1 Tae-Ho Kim, PhD, PT,1,* and Jin-Yong Lim, MS, PT1  J Phys Ther Sci. 2016 Mar; 28(3): 911–915.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842464/

5. BEAR
https://www.youtube.com/watch?v=k3g-CagCrZM

Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) procedure uses stitches and a bridging scaffold (a sponge injected with the patient’s blood) to stimulate healing of the torn ACL eliminating the need tendon graft.

References:
Murray, M., Flutie, B., Kalish, L., Ecklund, K., Fleming, B., Proffen, B. and Micheli, L. (2016). The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure: An Early Feasibility Cohort Study. Orthopaedic Journal of Sports Medicine, 4(11).

L. Proffen, B., S. Perrone, G., Roberts, G. and M. Murray, M. (2015). Bridge-Enhanced ACL Repair: A Review of the Science and the Pathway Through FDA Investigational Device Approval. Annals of Biomedical Engineering, 43(3), pp.805-818.

Distracted Kids Walk Slower

Do Gait rehab on Kids?

Distracted kids walk slower and spend more time in double leg stance.

We know it can effect adults, usually resulting a mild decomposition of gait, by decreasing step length in many and slowing of gait in older folks (becoming more primitive).

Watch where you do your gait rehab in the younger set; keep them focused and engaged for better outcomes.

"Significant main effects of walking experience groupand visual distraction condition were found. Visual environmental distraction significantly affected gait performance in children regardless of walking experience. Velocity decreased from 110.04 to 97.73 cm/sec (p = 0.003) while double limb stance % of gait cycle increased from 18.29% to 20.39% (p = 0.025)."

Phys Occup Ther Pediatr. 2017 Apr 10:1-10. doi: 10.1080/01942638.2017.1297987. [Epub ahead of print]
The Effect of Visual Environmental Distraction on Gait Performance in Children.
Bizama F, Medley A, Trudelle-Jackson E, Csiza L.

J Neuroeng Rehabil. 2014 Apr 28;11:74. doi: 10.1186/1743-0003-11-74.
Effect of explicit visual feedback distortion on human gait.
Kim SJ, Mugisha D.

Curr Gerontol Geriatr Res. 2011;2011:651718. doi: 10.1155/2011/651718. Epub 2011 Jun 16.
Effects of a Visual Distracter Task on the Gait of Elderly versus Young Persons.
Bock O, Beurskens R.

You can only take so many whacks to the head before it starts to show...

In addition to vision and the vestibular system, proprioceptive information is gathered by primarily 2 sources: The peripheral joint mechanoreceptors left (type 1, type 2, type 3, and type 4 ), as well as the muscle mechanoreceptors: Muscle spindles and golgi tendon organs. This information is transmitted to the cortex via the dorsal column and spinocerebellar pathways. The information is then integrated in the parietal lobe (for information in the dorsal columns) and cerebellum. The information is then relayed to the motor cortex, basal ganglia, and vestibular system. The interplay of these 3 systems, vision, the vestibular system, and the joint/muscle mechanoreceptors is what allows us to keep our bodies up right and functioning in the gravitational field. When integration is compromised, at either a peripheral or cortical level, proprioception suffers.

" Measures of cumulative subconcussive head impacts during a men’s lacrosse season are associated with decreases in balance scores from pre- to postseason, according to findings from Sacred Heart University in Fairfield, CT, that could have implications for lower extremity injury risk. The findings suggest that, even in the absence of a concussion, repetitive subconcussive impacts can negatively affect an athlete’s balance, which in turn can increase the risk of lower extremity injury"

http://lermagazine.com/news/in-the-moment-sports-medicine/subconcussive-subtleties-lacrosse-study-links-balance-impacts

Miyashita TL, Diakogeorgiou E, Marrie K. Correlation of head impacts to change in balance error scoring system scores in Division I Men’s lacrosse players. Sports Health 2017 Jan 1. [Epub ahead of print]

Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther 2006;36(12):911-919.

Podcast 121: Carrying things, Overtraining Syndrome, Ankle Rocker and more.

Key tag words:  OTS, overtraining, carries, carrying babies, ankle rocker, foot types, forefoot supinatus, forefoot varus, ankle sprains, nervous system, mitochondria, motor patterns, fatigue

Show links:  http://traffic.libsyn.com/thegaitguys/pod_121final.mp3

http://thegaitguys.libsyn.com/podcast-121-carrying-things-overtraining-syndrome-ankle-rocker-and-more

Show sponsors:  newbalancechicago.com

www.thegaitguys.comis 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:

Neuroscience:
1. Why women carry babies on their left side
- perhaps a transition talk into arm swing symmetry, and built in asymmetries in peoples gait

http://www.dailytelegraph.com.au/lifestyle/parenting/why-most-women-carry-babies-on-their-left-side/news-story/f5489a944a37487ce7e6b6ccd10a79e1?utm_content=SocialFlow&utm_campaign=EditorialSF&utm_source=DailyTelegraph&utm_medium=Facebook

2. OTS: Overtraining syndrome
this post got many hits
- CNS sympathetic-parasympathetic talk again, homeostasis
https://www.thegaitguys.com/thedailyblog/2017/1/14/ots-it-is-taking-down-the-best-athletes-one-by-one

3. Chris Beardsley   Strength and Conditioning Research
From posts: December 24, 2016 , Nov 24, 2016

4. The ankles have it:
http://www.theglobeandmail.com/life/health-and-fitness/how-weak-ankles-slow-us-down-with-age/article33458151/

https://www.thegaitguys.com/thedailyblog/2017/1/4/ankle-function-be-a-chef-be-a-scientist-not-a-juice-bar-junkie

5. Foot types and knee arthritis:
The Association of Forefoot Varus Deformity with Patellofemoral Cartilage Damage in Older Adult Cadavers. Lufler, Stefanik, Niu, Sawyer, Hoagland, Gross
http://onlinelibrary.wiley.com/doi/10.1002/ar.23524/full

http://www.itsafootcaptain.com/is-forefoot-varus-related-to-patellofemoral-osteoarthritis/

6. Fatigue and motor patterns:
https://www.ncbi.nlm.nih.gov/pubmed/27846435

7. Forefoot loading:
https://www.thegaitguys.com/thedailyblog/2016/12/27/abnormal-forefoot-loading-creates-fatigue-