| Lisa Knox

Foot Notes: September 18th, 2019

From the desk of Kevin B. Rosenbloom 
Here's a dose of what I'm pondering and enjoying this week ...

Students demonstrate gait types
Some students put together a short video demonstrating 6 abnormal gait types and explain the paralysis causing each type of pathological gait. It's a very concise nugget of a video that gets right to the point and clarifies the pathological mechanics causing abnormal gait. Watch here

Unilateral vs. bilateral squat training for strength, sprints, and agility in academy rugby players
by Speirs, Bennett, Finn & Turner
In this paper by Speirs et al. they demonstrate the efficacy of unilateral squat training for athletic rugby players. This is important because when I recommend exercises to patients who are capable of it, I usually put emphasis on unilateral exercises when appropriate, since most of my patients may not be capable of stable bilateral movements. In this study, however, unilateral squats were shown to be a good exercise for building lower body strength and should not be ignored. Read here 
Ian Reilly Discusses Podiatric Surgery in the UK
Tyson Franklin in this 48 min. podcast speaks with consultant podiatric surgeon, Ian Reilly. They discuss clinicians using social media to build clinician relations and the education patients can gain from it. He also elaborates about the obstacles he faced during his career among other topics. Definitely a more mellow listen compared to the previous weeks! Listen here

Question: I have a Military patient that has hallux limitus. No pain at home in civilian shoes with zero drop or negative drop, however, when wearing service boots the positive heel to toe drop presents a lot of pain under the 1st MTJ. What orthotic recommendations do you have to help eliminate the pain that's being caused by the boot's heel to toe drop?

Kevin's Answer: There are a lot of biomechanical factors I'd like to know before answering this question from a biomechanical assessment profile. The foot morphology, foot flexibility and geometric alignment, for example. Short of the Biomechanical Intelligence (BIQ) profile, it would be hard to determine the root cause of the sub1st MTJ pain. However, with moderate confidence, I can suggest a full-contact frame in an equilibrium alignment distributing orthotic reaction force along the plantar surface of the foot. Also, a Morton's Extension to toes to elevate the hallux relative to the lesser toes to help reduce the mechanical dorsiflexion moment on the 1st MTJ that's typically present in positive heel-to-met head drop shoe gear. Another consideration is to offload the 1st MTP with a 1st ray cut out and balance pad or reverse morton's extension to transfer force away from the 1st MTJ. A biomechanical intelligence (BIQ) profile would help to make a decision for this patient. See our BIQ form here.

Hope this helps with you and your patient's preference!


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