2016

Foot Evaluations and Interventions

Greg Robidoux PT, Spaulding Rehabilitation Cycling Medicine Director of Education SICI

& Happy Freedman, Bike Fit Specialist Hospital for Special Surgery

2016

Disclosures:Greg Robidoux PT: Director of Education/Consultant/Instructor for the

Serotta International Cycling Institute

Happy Freedman: None

2016

Summary/Goals

•Understand Anatomy and Kinematics of the Foot •Evaluation Skills/Screening Tests •Understanding Abnormal Foot Pathology •Foot/Shoe/Pedal Interventions •Off-the-bike considerations •On-the-bike considerations

2016

Anatomy and Kinematics of the Foot in Cycling

2016

2016Three Arches

Medial Longitudinal Arch

2016Three Arches

Lateral Longitudinal Arch

2016Three Arches

Transverse Arch

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Talocrural Joint

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Subtalar Joint

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Evaluation of the Foot

2016

Sizing the foot using the Brannock device:

Measures arch lengthMeasures overall foot length

Measures foot widthRight Heel

2016

Sizing the foot using the Brannock device:

Shoe size: •Critical to evaluate both total length and arch length.-Overall length and arch length may not match-Go with the larger measurement

•Width will be determined within a range using the larger of the length measurements.

2016Foot Shape:

Over-pronated to pronated foot •Largest segment of the population (87%)•Hyper-mobile foot•Will usually see expansion of the foot with weight bearing•Often requires support to control motion

Supinated Foot •Very small portion of the population•Rigid foot•May require foot support for comfort

2016 Navicular Drop

2016 Navicular Drop

2016 Navicular Drop

Measure Navicular Drop • In sitting/non-weightbearing find talo-navicular neutral • Measure the height of the navicular in neutral • Allow patient/client to stand without support and

measure again • The difference is navicular drop

>7mm = arch support >15mm may also need to consider forefoot support

2016 Talo-Navicular Neutral

2016 Navicular Drop

2016

Craig’s Test

1. Patient is prone with the knee flexed to 90º 2. The examiner palpates the posterior aspect of

the greater trochanter of the femur, then the hip is passively rotated until the most prominent portion of the greater trochanter reaches the horizontal plane

3. The degree of antiversion or retroversion is determined by measuring the tibia in relation to the vertical plane

4. < 5º is retroversion, 5-15º is normal, and >15º is antiversion

Tests for “versions” of the femoral neck

2016

Anti & Retro-Version of the Hip

2016

• Bridge 2 times. • Scoop under medial maleolus.

Leg Length Discrepancy

2016

Leg Length Discrepancy

The foot on the longer side will bear a greater percentage of the body weight usually resulting in increased pronation of the foot on the LONG side.

2016

Functional Single Leg Squat

1. Good functional strength test2. In the frontal plane client should be able

to maintain good hip-knee-ankle alignment.

3. Goal hip and knee angle should be at least 70 deg (no need to go beyond 90 deg).

4. Assesses ankle mobility.5. Assesses quad vs glute dominance. 6. Assesses foot mechanics (reassess with

orthotics and forefoot wedges.

A. good test B. weak trunk stabilizersC. weak hip stabilizersD. weak hip and ankle stabilizers, femoral antiversion

2016

Hands-on Section 1

1. Measure weighted and unweighted foot size with Brannock 2. Determine shape of the foot 3. Find Talo-navicular neutral 4. Measure navicular drop 5. Craigs test 6. LLD 7. Functional single leg squat

2016

Happy Freedman

Foot Pathology: “What You Don’t Know Can Hurt You…”

2016Pes Plantus

2016Pes Cavus

2016

Morton’s Neuroma

2016

Morton’s Neuroma

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Morton’s Neuroma

2016

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Assess Calf Texture

2016Plantar Fasciitis

2016

Interventions at the Foot

2016Hierarchy of Foot Intervention

Shoe Specific Interventions: Shoe Size (foot length/arch length)

Shoe Shape/Width Full length in shoe support (footbed)

Internal Wedging External Wedging and Shimming

Other Interventions: Pedal choice

cleat placement crank arm length

2016

• Foot Size – Confirm in proper

shoe • Arch Length

– Shoe size based on longer of arch or foot

• Arch height • Forefoot alignment • Internal/External

rotation

2016The Correct Shoe for Foot Type

Consider: heel offset

forefoot width closure type(velcro, ratchet, Boa)

2016

Proper Foot Support

Specialized BG

G8 performanceFull Custom

Semi-custom options: Off the shelf

Full custom options:

2016

Possible Fixes for Specific Pathologies

2016

Metatarsalgia/Morton’s Neuroma/Sesmoiditis

• Corrective Foot bed (OTC, semi-custom, custom) • Transverse arch support (metatarsal pad/bar) • Cut out • Correct placement and attachment of cleats

2016

Hallux Valgus (Bunion)

• Shoe with wide toe box (custom?) • Correct shoe closure • Modify existing shoe

2016Pes Plantus

• Corrective foot bed (OTC, semi-custom, custom) • Forefoot support (internal forefoot wedge)

2016

Pes Cavus

• High Volume Shoe • Corrective foot bed (OTC, semi-custom, custom)

2016

Achilles Tendonitis

• Appropriate shoe (specifically the heel cup) • Move Cleat backward toward heel

(more common in multisport/triathlete population)

2016

Plantar Fasciitis

• Corrective foot bed (OTC, semi-custom, custom) • Move Cleat backward toward heel

(more common in multisport/triathlete population)

2016

Leg Length Discrepancy

• Corrective foot bed (OTC, semi-custom, custom) • Internal Forefoot wedging • External Shim (fit to long leg and adjust the short)

2016

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References