more than you ever wanted to know about the footcastingworkshop.com/images/dl_foot_injury.pdf ·...
TRANSCRIPT
![Page 1: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/1.jpg)
More than you ever wanted to know about the foot
MAJ Joel L. Shaw, US ArmySports Medicine
![Page 2: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/2.jpg)
Overview
• Describe foot and ankle joints• Joint actions during running• Related pathology• How to prescribe running shoes
![Page 3: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/3.jpg)
Foot function
• 1. Accept vertical forces during heel strike• 2. Absorb and dissipate these forces across
a flexible mid- and forefoot during pronation
• 3. Provide propulsion as the foot becomes a rigid lever with resupination and toe-off
![Page 4: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/4.jpg)
Articulations
• Subtalar• Talocalcaneonavicular• Calcanealcuboid• Midtarsal• Tarsometatarsal• Metatarsophalangeal• Interphalangeal
![Page 5: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/5.jpg)
Subtalar
• Triplanar – Supination vs. Pronation
• Bones: inferior talus, superior calcaneus• Alternating concave-convex facets limit
mobility• Ligaments- talocalcaneal, interosseous
talocalcaneal, cervical
![Page 6: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/6.jpg)
Subtalar joint
• Supination– Inversion by calcaneus– Abduction by talus. – Dorsiflexion by talus
• Talar abduction causes external rotation of the tibia
• Position of most stability
![Page 7: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/7.jpg)
Subtalar joint
• Pronation– Eversion by calcaneus– Adduction by talus– Plantarflexion by talus
• Talar adduction causes internal rotation of the tibia– May increase Q angle
• Increased flexibility and shock absorption
![Page 8: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/8.jpg)
Subtalar joint
• Clinical significance– Mobility– Shock absorption– Stability
![Page 9: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/9.jpg)
Midtarsal joint
• Functional joint- includes talonavicular and calcaneocuboid joint
• Triplanar supination/pronation- primarily DF/PF and abd/add
• Navicular- highest point of medial arch
![Page 10: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/10.jpg)
Midtarsal joint
• Assist pronation/supination of the subtalar joint
• Maintain normal weight bearing forces on the forefoot
• Control/communication between rear foot and forefoot
![Page 11: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/11.jpg)
Tarsometatarsal joint
• Connection from cuneiforms/cuboid to metatarsals
• Continue function of midtarsal joint• Positional regulation of metatarsals/
phalanges to the weight-bearing surface• Distributes body weight laterally• Pronate/supinate to keep forefoot on ground
![Page 12: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/12.jpg)
Metatarsophalangeal joint
• Biplanar- mostly dorsiflexion/plantarflexion with 10 degrees of abduction/adduction
• Dorsiflexion- allows body to pass over foot while toes balance body weight during gait
• Plantarflexion- allows toes to press into ground for balance during gait
![Page 13: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/13.jpg)
Metatarsophalangeal joint
• Metatarsal break– Oblique axis for flexion/extension passing
through 2nd to 5th metatarsal heads– Where foot hinges as the heel raises– Rigid lever during plantarflexion– Supination causes rearfoot/midfoot locking– Shifts body weight from medial to lateral
![Page 14: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/14.jpg)
First ray
• Functional joint• Bones- Navicular, 1st Cuneiform, 1st
Metatarsal• Plantarflexion at late stance to assist 1st
MTP dorsiflexion• Peroneus longus and abductor hallicus
brevis muscles
![Page 15: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/15.jpg)
Supporting soft tissues
• Plantar aponeurosis• Plantar arches• Ligaments
![Page 16: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/16.jpg)
Plantar fascia
• Causes tension along the arch• Supination facilitated as arch heightened• Windlass effect
![Page 17: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/17.jpg)
Windlass effect
• Webster’s: machine for pulling a rope around a drum. Pulley system to lift anchor in a boat.
![Page 18: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/18.jpg)
Windlass effect
• Tension in the aponeurosis secondary to toe extension elevates the arch by acting as a pulley around which the aponeurosis is tightened.
![Page 19: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/19.jpg)
Plantar arches
• Longitudinal arch– Shock absorption– Continuous medially and laterally– Bears most weight medially
• Transverse arch– Mobility– Extends from anterior tarsals to base of
metatarsals
![Page 20: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/20.jpg)
Ligaments
• Spring ligament– Tension wire which helps maintain arch– Helps rigidity during propulsion
• Long plantar ligament• Plantar aponeurosis• Short plantar ligament
![Page 21: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/21.jpg)
Function of arches
• Stability– Distribution of weight
• Mobility– Dampens shock of weight bearing– Adaptation to changes in support surfaces– Dampening of superimposed rotations
![Page 22: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/22.jpg)
Running gait
• Stance phase– 40% of gait cycle– 2 phases
• Absorption• Propulsion
• Swing phase– 60% of gait cycle– 2 phases
• Initial swing (ISW)-75%
• Terminal swing (TSW)-25%
![Page 23: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/23.jpg)
Running gait
• Double float• Stride length• Step length• Cadence
• Velocity=stride length x cadence
![Page 24: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/24.jpg)
Running gait
• Kinematics vs. Kinetics– Kinematics- motion of joints independent of
forces that cause the motion to occur– Kinetics- study of forces that cause movement,
both internally and externally• Internal- muscle forces• External- ground reactive forces
![Page 25: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/25.jpg)
Ankle/foot kinematics
• Ankle joint– Dorsiflexion/plantarflexion
• Foot joints– Triplanar– Pronation and supination
![Page 26: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/26.jpg)
Running gait- ankle kinematics
• Absorption and midstance– Rapid dorsiflexion (response to increased hip
and knee flexion)– Decreased plantarflexion in runningà
decreased supinationàcause of increased running injuries??
![Page 27: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/27.jpg)
Running gait- foot kinematics
• Subtalar motion determined by muscular activity and ground reactive forces
• Midtarsal motion determined by subtalar position
![Page 28: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/28.jpg)
Running gait- midtarsal joint• Calcaneus/talus
supination– Increase midtarsal
obliquity– Lock joint– “Rigid lever”– During propulsion and
ISW
• Calcaneus/talus pronation– Parallel midtarsal
joints– Increased ROM– “Mobile adapter”– Mid stance
![Page 29: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/29.jpg)
O'Connor FG, Wilder RP: Textbook of Running Medicine, McGraw Hill
Companies, 2001. Page 13.
Axis of transverse tarsal joint
![Page 30: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/30.jpg)
Running gait- foot kinematics
• Absorption– Pelvis, femur, tibia internally rotate– Eversion and unlocking of subtalar joint– Pronation of midtarsal joints
• Allows mobility and shock absorption.• Able to adapt to ground surface.
– Plantar fascia- relax medial arch
![Page 31: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/31.jpg)
Running gait- foot kinetics
• External forces- ground reactive forces– Vertical- 3-4 times body weight– Fore-aft- 30% of body weight– Medial-lateral- 10% of body weight– Newton’s third law
• Internal forces- muscle forces
![Page 32: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/32.jpg)
External forces
• Foot strike pattern– Forefoot Midfoot Rearfoot
![Page 33: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/33.jpg)
Rearfoot striker• 80% of runners• Initial contact- posterolateral foot• Center of Pressure (COP)
– Outer border of rear footàprogresses along lateral borderàthen across forefoot mediallyàtoward 1st and 2nd metatarsal head
![Page 34: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/34.jpg)
Midfoot strikers
• Most other runners• Initial contact- midlateral border of foot• COP
– Lateral midfootàprogresses posteriorly (corresponds to heel contact)àrapidly moves to the medial forefoot
![Page 35: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/35.jpg)
O'Connor FG, WilderRP: Textbook of Running Medicine, McGraw-Hill
Companies, 2001. Page 17
Center of Pressure
![Page 36: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/36.jpg)
Evaluation of running injuries
• Training log• Shoe examination• Arch appraisal• Gait analysis• Running shoe
prescription
![Page 37: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/37.jpg)
Training log
• Weekly mileage• Transition point• Increase in distance or intensity• Increase in mileage >10% per week• Change in terrain or running surface
![Page 38: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/38.jpg)
Shoe examination
• Current running shoes– Age (days and miles)– Replacement frequency– New brand or model? (change biomechanics)
![Page 39: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/39.jpg)
Shoe examination
• Outsole wear– Lateral heel vs. inside heel vs. lateral sole
• Midsole wear– Heel counter tilt– Midsole wrinkling, tilt, or decomposition
![Page 40: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/40.jpg)
To help protect your privacy, PowerPoint prevented this external picture from being automatically downloaded. To download and display this picture, click Options in the Message Bar, and then click Enable external content.
Shoe wear
• Based on foot strike pattern, initial contact, and center of pressure
• Neutral gait– Wear on lateral aspect of heel– Uniform wear under the toes
![Page 41: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/41.jpg)
Shoe wear
• Overpronator– Excessive wear on medial portion of heel and
forefoot• Underpronator
– Excessive wear on lateral heel– Wear on entire lateral portion of the outersole
![Page 42: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/42.jpg)
Arch appraisal
• Standing arch contour
• “Wet test”• Static
evaluation=running evaluation?
![Page 43: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/43.jpg)
Biomechanical function
• Required functions of locomotion– Adaptation– Shock absorption– Torque conversion– Stability– Rigidity
![Page 44: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/44.jpg)
Biomechanical assessment
• Video gait analysis• Always base on running gait, not arch
height• Evaluate shoe wear
![Page 45: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/45.jpg)
Gait analysis
• Behind- location of heel strike, foot motion during single stance, foot engaged at push-off
• Side- gastroc-soleus flexibility, great toe dorsiflexion
• Treadmill-based analysis• Force plate analysis
![Page 46: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/46.jpg)
Neutral gait
• Level Heel Throughout Gait Cycle
• 90 Degree Medial Angle Throughout Gait Cycle
![Page 47: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/47.jpg)
Intrinsic abnormalities
• Pes cavus- abnormal supination• Pes Planus- abnormal pronation
![Page 48: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/48.jpg)
Supination
• Normal– Late stance phase– Provides rigidity,
support, propulsion– Facilitates lower leg
external rotation
• Abnormal– Minimal pronation at
subtalar joint– Little drop of medial
longitudinal arch
![Page 49: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/49.jpg)
Abnormal supination- signs
• Lateral Leaning Foot Surface Placement
• Inflexible Foot• Callus- 1st and 5th
metatarsal heads• Clawing of 4th and 5th
digits
![Page 50: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/50.jpg)
Abnormal supinators
• Stable and rigid foot• Lacks flexibility and
adaptability
• Poor gastroc-soleus flexibility– Achilles tendonitis– Plantar fasciitis
• Poor shock absorption– Tibial and femoral
stress fractures
![Page 51: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/51.jpg)
Pronation
• Normal– Early in stance phase– Provides flexibility,
adaptability and shock absorption
– Facilitates lower leg internal rotation
• Abnormal– Continues throughout
stance phase
![Page 52: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/52.jpg)
Mild Overpronation- signs
• Slightly Greater than 90 Degree Angle Throughout Gait Cycle
• Medial Leaning Foot Surface Placement
• Some Ankle Instability/ unstable position
![Page 53: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/53.jpg)
Severe overpronation- signs
• Significant Medial Leaning of Surface Foot
• Great Instability• Excessive internal
tibial rotation• Increased medial
stress
![Page 54: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/54.jpg)
Overpronators
• Patellofemoral pain• Popliteal tendonitis• Posterior tibial tendonitis• Achilles tendonitis• Plantar fasciitis• Metatarsal stress fracture
•
![Page 55: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/55.jpg)
Arch Height Will Produce Different Levels of Flexibility
• Normal feet:– are flexible as they grip the ground and become stiff at
push off
• Flat feet:– are flexible as they grip the ground and remain flexible
at push off
• High arched feet– are inflexible and do not adjust to terrain well, but
provide a good base for push off.
![Page 56: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/56.jpg)
Running Shoe Design• In an attempt to minimize injuries, running
shoes need to provide:– Cushioning
– Motion Control
– Support
![Page 57: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/57.jpg)
Anatomyof the Running Shoe
Outersole
Uppers
Midsole
Midsole
![Page 58: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/58.jpg)
Anatomy of the Running Shoe
Tongue
ToeboxLacing system
Heel notch
Heel counter
![Page 59: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/59.jpg)
Anatomy of the Running Shoe
Flex GroovesFlex Grooves
Split HeelSplit Heel
![Page 60: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/60.jpg)
Anatomy of the Running Shoe Last (Curvature)
Straight, Semi-curved and Curved
![Page 61: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/61.jpg)
Anatomy of the Running Shoe
• Lasts (Shoe Template) – Board – Slip– Combination
• If you cannot remove insole, remove shoe…it is of poor quality
![Page 62: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/62.jpg)
Shoe DesignMotion Control, Stability, Cushion
• Motion Control– Mod-Severe
overpronator • Stability
– majority of the population, slight overpronation
• Cushioned– Neutral/underpronator
runner
![Page 63: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/63.jpg)
Stabilizing FeaturesSupport is added to
the inside or medial portion of the heel to counteract the foot rolling inward (pronation)
![Page 64: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/64.jpg)
Running Shoe Selection
• The three basic types of running gait based on ankle biomechanics are: over-pronation, neutral and underpronation
• Shoes should be bought to accommodate your running gait, not your arch height!
![Page 65: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/65.jpg)
Shoe prescription
• High arch- curve-lasted, cushion shoe
• Flat arch- motion control or stability shoes with firm midsoles and straight to semi-curved lasts
• Neutral arch- cushion or stability shoe
![Page 66: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/66.jpg)
Orthotics
• Effectiveness– Gross, et al. 90% with symptom improvement– Schere. 81% with complete symptoms relief– Blake and Denton. Reduced pain associated
with plantar fasciitis by 80%.
![Page 67: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/67.jpg)
Orthotics
• Motion control– Control excessive pronation
• Shock absorption• Pressure relief in specific area
– Plantar heel or great toe metatarsophalangeal• Redistribution of forces away from area
– Metatarsal pad for metatarsalgia/Morton’s neuroma
![Page 68: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/68.jpg)
Orthotics
• Adjunct to rehab and training modification• Return athlete to full function• Prevent further injury• Functional orthoses
– Alter foot function– Guide foot through stance phase– Promote biomechanical efficiency
![Page 69: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/69.jpg)
Orthotics
• Start with soft temporary orthotic• Over-the counter prefabricated devices
– Most athletes report improvement• Incomplete improvementàcustom orthotic
![Page 70: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/70.jpg)
Pronated foot orthotic
• Flat medial arch• Unstable rearfoot and excessive motion of
plantar calcaneal fat pad• Weak plantarflexion of first metatarsal head
and weak “windlass” effect
![Page 71: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/71.jpg)
Common mistakes
• Only looking at standing gait• Failure to evaluate various needs of
different runners• Need of different orthoses for running and
everyday activity
![Page 72: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/72.jpg)
Summary
• Understand normal foot biomechanics-pronation vs. supination
• Evaluate with functional arch and shoe wear• Signs of abnormal arch• Match shoes and orthotics to running
alignment- correct shoes and over-the-counter inserts first
![Page 73: More than you ever wanted to know about the footcastingworkshop.com/images/DL_Foot_Injury.pdf · neutral and underpronation • Shoes should be bought to accommodate your running](https://reader033.vdocuments.mx/reader033/viewer/2022042918/5f5d6ce5de16a57c4e56c93c/html5/thumbnails/73.jpg)
Questions??
•