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Short Foot
Short Foot
1.
To neutralize the excessive inversion you will want to address both the foot
and the hips. Start with mobilization via Self Myofascial Release (SMR) of
the STJ invertors:
Tibialis anterior
Posterior tibialis
Soleus
Abductor hallucis / plantar fascia
Next, move up to the hip and mobilize (via SMR) the hip external rotators:
Gluteus medius
Piriformis
Compensation: Increased STJ Eversion
If STJ inversion means rigid and locked, then STJ eversion is going to mean
unstable and unlocked. If you notice your client striking the ground on an
unstable foot that is already unlocked, proper dissipation of ground reaction
forces is going to be compromised. Remember when we discussed how the
foot and lower extremity absorbs impact forces? It was the STJ inversion to
eversion that drove the body spirals and efficiently loaded impact forces.
If this step is compromised then efficient movement is also compromised.
Your goal is to get the client or athlete foot back into a position in which they
can strike the ground in an inverted STJ position.
To neutralize the excessive eversion you will want to address both the feet and
hips. For correcting excessive STJ eversion your program will include both
mobilization and activation or strengthening.
Start with mobilization of the STJ evertors:
Peroneus brevis / longus
Gastrocnemius
Next, move up to the hip and mobilize the hip internal rotators:
Adductors
TFL
Rectus femoris
After mobilization, focus on activating / strengthening the STJ invertors:
Abductor hallucis
Tibialis anterior
Posterior tibialis
Soleus
As well as to activate and strengthen the hip external rotators:
Deep lateral rotators
Gluteus medius
Common Compensations Seen During Midstance
Compensation: Knee Valgus
The presence of knee valgus during midstance means that there is a lack of
control of the body spiral. Since midstance marks the point of peak
deceleration, knee valgus typically denotes poor eccentric control of either the
glutes and/or the foot invertors (namely the posterior tibialis).
There are two types of knee valgus which can be observed:
with STJ eversion
without STJ eversion
Compensation: Knee Valgus with STJ Eversion
Knee valgus with STJ eversion can be characterized as both a proximal and
distal spiral issue. The STJ eversion is often a compensation for weak
eccentric deceleration by the foot invertors (namely posterior tibialis). The
STJ eversion drives the knee into valgus requiring increased deceleration by
the posterior gluteus medius.
Every time the foot abducts there is an activation of the hip external rotators,
namely piriformis.
FitnessRx for Abductory Twist:
To correct for the abductory twist the focus should be on restoring proper
ankle joint dorsiflexion. Focus on mobilization of both the soleus and
gastrocnemius.
Compensation: Early Heel Lift
Altered push-off can be the result of limited ankle mobility, poor deceleration
of the body spiral, STJ eversion at heel strike or STJ eversion on relaxed
stance. This common push-off position compromises the activation of the
plantar fascia, the efficiency of gait and elastic recoil at push-off.
Without correcting push-off, gait can never fully be optimal.
FitnessRx for Low Gear Push-Off:
To correct for a low gear push-off we need to go back to what is driving this
compensation pattern in the first place. Is there limited ankle mobility? Is
there tibial:femoral external rotation?
The answer to these questions will determine how to address your corrective
exercise programming. See the above compensations for the
appropriate FitnessRx programming.
The 1st
Metatarsophalangeal Joint (MPJ)
Formed by the head of the first metatarsal and base of
the proximal phalanx this ginglymoarthrodial
or hinge joint allows sagittal plane progression
during walking, running, jumping etc.
With the movements of plantarflexion and
dorsiflexion, optimal push-off during the gait cycle
requires at least 30 degrees of dorsiflexion but having
closer to 65 75 degrees dorsiflexion is ideal.
Limited hallux dorsiflexion during push-off can be
associated with a low-gear push off position, early heel
rise, overactive adductors and under active gluteus
maximus.
Complexity of Hallux Dorsiflexion
At first glance 1st MPJ dorsiflexion seems quite
straight forward and based on the increasing emphasis
on the great toe in many fitness and performance
lectures I think it is imperative that professionals
So here we go.
In closed chain movements such as walking, the
propulsive phase of gait is the phase in which
maximum great toe dorsiflexion is required. As the
foot prepares for the large amount of power output
during propulsion, the flexor hallucis longus (FHL)
engages thereby anchoring the distal aspect of the
hallux to the ground.
This fixed hallux provides a stable base or lever for
propulsion thus allowing the metatarsal head to move
relative to the base of the proximal phalynx. See
picture to the right.
Sliding, Gliding and Jamming
If you look at the picture on the right you will see that
as I am dorsiflexing th
e hallux the 1st
metatarsal head plantar flexes greatly. This degree of
plantar flexion is not possible when standing on the
ground as it would be blocked by the ground when we
walk. This means that Step 2 assessment doesnt
really translate to closed chain dorsiflexion.
To get a more accurate representation of closed chain
mobility you want to load the 1st metatarsal head like I
am doing in the picture to the left. This mimics the
ground when closed chain. Now dorsiflex the hallux
and determine your mobility.
toe test.
Have the client stand with the feet in a relaxed
calcaneal position. In the case of our above client you
can see that she is mildly pronating or in an unlocked
position. Remember that we ideally want to
assess STJ position from behind not anteriorly
like in the picture to the right.
please clickHERE)
In this client our goal is to improve STJ positning
through posterior tibialis strengthening, short foot
activation and glute strengthening. One of my favorite
the format
through corrective exercises.
Please know why you are doing what you are doing.
I am seeing too much of cluffy wedge for everyone!
and l dont think everyone fully understands who and
when this is the most appropriate.
Remember sometimes its best to refer out.
When in doubt get a copy of your clients X-rays