rebuilding the foot...big toe to get firmly down to the ground for com progression and torsional...

1

Rebuilding

the Footan algorithm for

building a runnerrsquos

contact point

Jay Dicharry MPT SCSREP Biomechanics Lab Director

Bend OR

Solve

the

problem

Running demands that the body(including the foot) functions

appropriately during gait

bull Dicharry J Kinematics and kinetics of gait from lab to clinic Clin Sports Med 2010 Jul29(3)347-64

bull De Wit et al Biomechanical analysis of the stance phase during barefoot and shod running Journal of Biomechanics 2000 33 269-278

bull Lieberman et al Foot strike patterns and collision forces in habitually barefoot versus shod runners Nature 2010 463 (7280) 531-535

bull Dicharry J Clinical Gait Analysis Textbook of Running Medicine 2nd Ed Healthy Learning 2014

bull Neal BS et al Foot posture as a risk factor for lower limb overuse injury a systematic review and meta-analysis J Foot Ankle Research 2014

Running Demands That All Feet Work

1 Allow forward progression of COM

2 Torsional displacement and support through stance phase

3 Proprioceptive contact on the ground Sensory input = output

Letrsquos not get bogged down with foot types

Feet move more similar than differently

Hypomobile0-3mm

Hypermobile7-10mm

Neutral4-6mm

No difference in walk and run

79mm82

No difference bet walk and

run83mm86mm

Some Difference

87mm99mm

Dicharry et al JOSPT 2009

Δ = 00

plusmn 44ordm

Δ = 14

plusmn 37ordm

Δ = 25

plusmn 50ordm

No single foot type works best

GoalEnable THEIR foot to

work best

Optimize the foot type they have

bull You arenrsquot treating a research average you are treating an individual foot

bull We seendash high stiff arches

ndash high mobile arches

ndash low stiff arches

ndash low mobile arches

ndash And everything in between

bull All feet need to work You can improve the function of any foot in front of you

2

1 Allow forward progression of COMtranslation can you move enough

Talocrual mobility

ndash 30 deg

ndash O cm on wall test for runners

ndash 4-6cm if doing squat lifts

ndash Limitersbull tibfib mechanics and talar glide

bull Gastroc-soleus complex

bull Soft tissue tension restriction

bull Altered proprioception

MTP mobilitybull 30 deg with flexed knee and ankle at 10 deg

of DF

bull Limiters

MTP arthrokinematics

PF tissue length


How is COP path affected bybull Rearfoot mobility

bull Lateral column hypomobility

bull Medial column hypomobility

bull Soft tissue adaptations

bull Poor stabilization (wait for it)

bull Hint callus patterns have stories to tell


bull Does your foot even work

bull blocks in sensory input compromise OUTPUT

bull Restore COORDINATION for CONTROL


Balance is altered in people with ankle sprainsbull Herb CC et al Shank-rearfoot coupling with ankle instability Journal of Applied Biomechanics Accepted December 2013bull Chinn L etal Ankle kinematics of individuals with chronic ankle instability while walking and jogging on a treadmill with shoes

Physical Therapy in Sport 201314(4)232-239bull Chinn L et al Gait kinematics after taping in subjects with chronic ankle instability J of Athletic Training accepted April 2013

Fatigued feet move more and fail to stabilize the same capacity to function normallybull Headlee et al Fatigue of the plantar intrinsic foot muscles increases navicular drop Journal of Electromyography and

Kinesiology 2008 18 (3) 420-425bull Kelly L A etal Recruitment of the plantar intrinsic foot muscles with increasing postural demand Clinical Biomechanics 2012

27 (1) 46-51bull Kelly A etal Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch J R Soc Interface 11

(2014) p 93

Attempts to strengthen the feet ARE successful and more importantly that improving foot strength results in an INCREASE in performancebull Goldmann JP et al The potential of toe flexor muscles to enhance performance J Sports Sci 201331(4)424-33 bull Bruumlggemann et Al Effect of increased mechanical stimuli on foot muscles functional capacity ISB XXth Congress - ASB 29th

Annual Meeting 2005bull Suloska et al The Influence of Plantar Short Foot Muscle Exercises on the Lower Extremity Muscle Strength and Power in

Proximal Segments of the Kinematic Chain in Long-Distance Runners BioMed Research Int 2019 Article ID 6947273

When does max pronation DEFORMATION occur

Dicharry et al JOSPT

Architecture Demands Control

bull Remember joints donrsquot ldquodordquo anything Their architecture biases axis of movement not create motion

bull Joints are passive and move when forced to by external load or internal control If your exercise goals + sport demand high loads on your body then you better show up READY for it

bull More stability within the foot = less stress in the foot and up the chain

3

Train the foot to work as a systemneuromuscular

What if the system breaks

X

X


X

X

So then balance training right

BALANCE ne PROPRIOCEPTION

To up-regulate NM system

Which environment is best

Flat ground

Orthoticsfootwear research + changing vocabulary

Holding rigid object in place ne Using an adaptive lever

Rigid

Lock

Hold

Stabilize

evolve

Adapt

Conform

Match

Support

4

Orthotics What do I doMostly Influenced by thousands of individual lab gait analysis

put the foot in the best environment to work

bull Standing STJN forefoot adaptation test

Assessment

Good Foot Function

1 Identify and improve blocks that restrict the big toe to get firmly down to the ground for COM progression and torsional stability within the foot

2 Build a solid NM program

to control available mobility

Good Foot Functionthe big toe is responsible for 80-85 of the stability in the foot

HELP IT WORK

1 Look for blocks that restrict big toe from getting to ground


HELP IT WORK


Manual Exam

1 Wall test2 Talocrual mobility3 Tib-fib mobility4 MTP DF ROM5 Calc eversion inversion6 Forefoot planar torsion test7 Segmental Lateral column assessment8 Segmental Medial column assessment

Intervention unblocking blocks

PROBLEM FIX

Restriction in front arthrokinematics

Restriction in back Post chain soft tissue length

Can hit but stiff Soft tissue mobility work

No hardware block but compensating movement

Software issue ndash train stab


PROBLEM FIX

MTP block Arthrokinematics of MTP sesmoids PF

rearfoot adaptation Calc glide medial retinaculum

Torsion Test Lateral column mobility Joint glides ST mob

Torsion Test Medial column mobility Joint glides ST mob

Torsion Test soft tissue forefoot varus Soft tissue mobility

Foot Segmental Asymmetry stiffness arthrokinematics

5


homework


HELP IT WORK

2 Build AP + torsional control through available ROM

Functional Exam

1 Squat2 Unilateral Stance COP question3 Uni-lateral squat4 Closed chain torsion5 Functional Plantar flexion test6 Tib Post break test7 TOGA

Intervention Build ControlGOAL Corrective

Interdigit coordination TOGA bilateral

Digit coordination + balance TOGA unilateral

Post tib endurance Foot sweep

INTRINSIC Torsional control Closed chain prosup

Torsional integration of limb Foam Roller Drill

First ray isolation Foot Band Twist

AP foot postural awareness Overhead press

Torsional control Long bar (Water Jug) Pass

Torsional control of limb Tippy Twist

Dynamic Control work Rocker training

Impulse Control Impulse training

Integrate kinetic chain Rocker SLD

Torsional rearfoot on forefoot Foot Screws

Load Tolerance for Sport Plyo Loading

Intervention Build Control

TOGA

Donrsquot smear the arch

Progress from bilateral unilateral support


FOOT SWEEP

Reed Ferber says postural muscles respond well to High Volume


CLOSED CHAIN PROSUP

Use INTRINSICS not the HIP

6


FOAM ROLLER DRILL

INTRINSICS drive motion HIP follows

Or

Hip drives motion foot follows


FOOT BAND TWIST

Isolate and integrate first ray


OVERHEAD PRESS

AP Postural awareness


LONGBAR (water jug) PASS

Intrinsic Torsional Control


TIPPY TWIST

Torsional Control of Limb


ROCKER Band Pulls

OTIS

7


ROCKER TRAINING

OTIS


ROCKER SLD

Integrate hip ER with foot

Intervention Control Propulsion

FOOT SCREWS

Torsional Control of rearfoot on forefoot


PLYO LOADING

Load Tolerance for Sport

THANKS

2

1 Allow forward progression of COMtranslation can you move enough

Talocrual mobility

ndash 30 deg

ndash O cm on wall test for runners

ndash 4-6cm if doing squat lifts

ndash Limitersbull tibfib mechanics and talar glide

bull Gastroc-soleus complex

bull Soft tissue tension restriction

bull Altered proprioception

MTP mobilitybull 30 deg with flexed knee and ankle at 10 deg

of DF

bull Limiters

MTP arthrokinematics

PF tissue length


How is COP path affected bybull Rearfoot mobility

bull Lateral column hypomobility

bull Medial column hypomobility

bull Soft tissue adaptations

bull Poor stabilization (wait for it)

bull Hint callus patterns have stories to tell


bull Does your foot even work

bull blocks in sensory input compromise OUTPUT

bull Restore COORDINATION for CONTROL


Balance is altered in people with ankle sprainsbull Herb CC et al Shank-rearfoot coupling with ankle instability Journal of Applied Biomechanics Accepted December 2013bull Chinn L etal Ankle kinematics of individuals with chronic ankle instability while walking and jogging on a treadmill with shoes

Physical Therapy in Sport 201314(4)232-239bull Chinn L et al Gait kinematics after taping in subjects with chronic ankle instability J of Athletic Training accepted April 2013

Fatigued feet move more and fail to stabilize the same capacity to function normallybull Headlee et al Fatigue of the plantar intrinsic foot muscles increases navicular drop Journal of Electromyography and

Kinesiology 2008 18 (3) 420-425bull Kelly L A etal Recruitment of the plantar intrinsic foot muscles with increasing postural demand Clinical Biomechanics 2012

27 (1) 46-51bull Kelly A etal Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch J R Soc Interface 11

(2014) p 93

Attempts to strengthen the feet ARE successful and more importantly that improving foot strength results in an INCREASE in performancebull Goldmann JP et al The potential of toe flexor muscles to enhance performance J Sports Sci 201331(4)424-33 bull Bruumlggemann et Al Effect of increased mechanical stimuli on foot muscles functional capacity ISB XXth Congress - ASB 29th

Annual Meeting 2005bull Suloska et al The Influence of Plantar Short Foot Muscle Exercises on the Lower Extremity Muscle Strength and Power in

Proximal Segments of the Kinematic Chain in Long-Distance Runners BioMed Research Int 2019 Article ID 6947273

When does max pronation DEFORMATION occur

Dicharry et al JOSPT

Architecture Demands Control

bull Remember joints donrsquot ldquodordquo anything Their architecture biases axis of movement not create motion

bull Joints are passive and move when forced to by external load or internal control If your exercise goals + sport demand high loads on your body then you better show up READY for it

bull More stability within the foot = less stress in the foot and up the chain

3



X

X


X

X





Flat ground



Rigid

Lock

Hold

Stabilize

evolve

Adapt

Conform

Match

Support

4




Assessment

Good Foot Function





HELP IT WORK



HELP IT WORK


Manual Exam



PROBLEM FIX







PROBLEM FIX







5


homework


HELP IT WORK


Functional Exam


















TOGA




FOOT SWEEP



CLOSED CHAIN PROSUP


6


FOAM ROLLER DRILL


Or



FOOT BAND TWIST



OVERHEAD PRESS






TIPPY TWIST



ROCKER Band Pulls

OTIS

7


ROCKER TRAINING

OTIS


ROCKER SLD



FOOT SCREWS



PLYO LOADING


THANKS

3



X

X


X

X





Flat ground



Rigid

Lock

Hold

Stabilize

evolve

Adapt

Conform

Match

Support

4




Assessment

Good Foot Function





HELP IT WORK



HELP IT WORK


Manual Exam



PROBLEM FIX







PROBLEM FIX







5


homework


HELP IT WORK


Functional Exam


















TOGA




FOOT SWEEP



CLOSED CHAIN PROSUP


6


FOAM ROLLER DRILL


Or



FOOT BAND TWIST



OVERHEAD PRESS






TIPPY TWIST



ROCKER Band Pulls

OTIS

7


ROCKER TRAINING

OTIS


ROCKER SLD



FOOT SCREWS



PLYO LOADING


THANKS

4




Assessment

Good Foot Function





HELP IT WORK



HELP IT WORK


Manual Exam



PROBLEM FIX







PROBLEM FIX







5


homework


HELP IT WORK


Functional Exam


















TOGA




FOOT SWEEP



CLOSED CHAIN PROSUP


6


FOAM ROLLER DRILL


Or



FOOT BAND TWIST



OVERHEAD PRESS






TIPPY TWIST



ROCKER Band Pulls

OTIS

7


ROCKER TRAINING

OTIS


ROCKER SLD



FOOT SCREWS



PLYO LOADING


THANKS

5


homework


HELP IT WORK


Functional Exam


















TOGA




FOOT SWEEP



CLOSED CHAIN PROSUP


6


FOAM ROLLER DRILL


Or



FOOT BAND TWIST



OVERHEAD PRESS






TIPPY TWIST



ROCKER Band Pulls

OTIS

7


ROCKER TRAINING

OTIS


ROCKER SLD



FOOT SCREWS



PLYO LOADING


THANKS

6


FOAM ROLLER DRILL


Or



FOOT BAND TWIST



OVERHEAD PRESS






TIPPY TWIST



ROCKER Band Pulls

OTIS

7


ROCKER TRAINING

OTIS


ROCKER SLD



FOOT SCREWS



PLYO LOADING


THANKS

7


ROCKER TRAINING

OTIS


ROCKER SLD



FOOT SCREWS



PLYO LOADING


THANKS

rebuilding the foot...big toe to get firmly down to the ground for com progression and torsional...

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