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Thursday, June 28, 2018

Clinical Biomechanics for Podiatry (Post #5): Think about Pain Syndromes and Mechanical Causes

     Certain mechanics produce certain pain patterns or syndromes. The 4 common types of mechanical faults which can produce predictable pain patterns are:
  1. Over Pronation
  2. Over Supination
  3. Poor Shock Absorption
  4. Limb Length Discrepancies
     Every bio mechanical oriented practitioner looks at these 4 areas when initially evaluating an injury for cause. Could it be from Over Pronation? Could it be from Over Supination (also called Under Pronation)? Could it be Poor Shock Absorption? Could it be tied into one leg being longer than the other?

     It is important to note here that there can be more than one issue going on at once causing symptoms, or confusing the treatment plan? Since 80% of patients have one leg longer (either structurally, functionally, or both), and 99% of patients are have dominant right or left sides (right handed vs left handed), and 10% or so of patients I see have a past injury which affects mechanics (ie. old knee injury), the complexity can be intense, but treatment can logically work through the issues.

     The treatment of these 4 common areas can also be complete or partial for many reasons. Some injuries need 100% correction of the mechanical fault to get better, another injury requiring 20% or so. I tend to personally shoot to correct a problem close to 100% if I think it is the cause or major contributor to the pain syndrome. I can give you hundreds of examples when treatment  near the 100% level was extremely important, but also hundreds of examples when 20 to 30% correction of the mechanics was all that was needed. An easy example of this is low back pain and short legs. If a patient has an 1 inch short right leg with lower back pain, they normally present to my office with 1/4 inch heel lifts. Patients tend to say it was helpful, but they still have back pain. Why are they left with this 25% correction? Because it is much more difficult going to the next level of lift therapy when some or all is placed in the mid sole or on to the outer sole of the shoe.  This same problem is seen in the treatment of over pronation, over supination, and poor shock absorption.

With the onset of very unprotected shoes, we may see a new category arise of Poor Foot Protection, or over protected shoes that weaken our feet!! . I have 3 patients now injured in these less protective shoes that I am unsure if the cause was poor protection, over pronation, or poor shock absorption. Perhaps each factor played a role in the injuries and they all had to be present for the injury to occur. And perhaps it was poor training techniques, the jury is out at this time.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.