As the interface between the body and the ground the foot is subject to enormous stresses and loads during normal walking and running. With the hard unyielding ground and the rotations of the leg and trunk acting on it this complex structure it’s not surprising that occasionally we have problems. Sports men and women are more prone to problems as they demand more from their feet and legs.
When, we walk the first part of the foot to hit the ground is the outside of our heel (this is why we wear this part of our shoe first); as the rest of the foot comes in contact with the ground we start to move our body weight over the foot. At this point the foot starts to pronate (the rolling and flattening of the arch) this is a normal part of the gait cycle and allows the foot to adapt to uneven surfaces and absorb shock. As the body continues to move over the foot the foot starts to supernate, the arch starts to rise and the foot becomes more of a rigid lever enabling us to pivot over the foot (or push off) so we can take our next step, and so the cycle continues. We take an average of 2500 steps a day which means we walk about 3000 miles a year. It is not difficult to imagine that small changes in the gait cycle could have a significant impact on the whole system. If for example there is excessive pronation or flattening of the arch during the gait cycle, then we may be trying to pivot (push off) a foot that is a mobile adaptor rather than a rigid lever. Not only would this be less effective at moving us forward and therefore require more effort, but it may also have an impact on the structure doing the moving, i.e. the feet and legs. Excessive pronation can lead to many foot and leg conditions including, plantar fasciitis, tendonitis, shin splints, patello femoral problems and capsulitus to name a few. There may well be more remote symptoms including back pain and even tempro mandibular joint problems (jaw pain). Equally if there is excessive supernation and the foot is a rigid lever when it should be a mobile adaptor then the feet will be poor shock absorbers and this may also lead to problems like ankle sprains, Morton’s neuroma, stress fractures and knee problems, once again to name a few. Even callous and corns can often be traced back to underlying biomechanical problems causing increased pressure and or friction on a certain part of the foot.
Part of the role of a podiatrist is to assess the patient’s biomechanical problems when appropriate. This usually takes the form of a biomechanical assessment. The patient is examined to see how everything lines up, feet, legs, knees, and the rest of the body, lines may be drawn on the legs and feet and ranges of joint motion measured. Weakness or tightness of associated muscles will be noted. The gait may be observed and foot ware examined. From this the podiatrist can then make a diagnosis and prescribe the appropriate care often in the form of a custom made orthotic which fits in the shoe, this reduces excessive pronation or supernation and helps to align the legs and feet. Muscle stretching or strengthening may also be required. Often direct treatment to the injury or problem could be needed in the form of manipulation, strapping or laser treatment to the area. This type of treatment can not only resolve the presenting problem but also improve the way an individual walks or runs helping them to go faster or longer and preventing further injuries. Over the years I have treated many sports men and women from ramblers and power walkers, junior tri athletes, to professional footballers and marathon runners.
