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Saturday, November 6, 2010

Top 100 Biomechanical Guidelines #15: Know the Gait Patterns for Mechanical Problems

     I have been talking about the 5 most common mechanical problems health care providers who deal with foot and leg biomechanics normally treat. My last post showed over pronation in a walker on video, and the health care provider must attempt to control the forces on this abnormal motion with all the weapons in their arsenal: orthotic devices, shoe selection, shoe modifications, power lacing, strengthening exercises, gait changes, etc. By the end of these 100 Guidelines, you will understand these issues rather completely.

To summarize the 5 mechanical problems are:
  1. Over Pronation (also called Excessive Pronation)
  2. Over Supination (also called Under Pronation or Lateral Instability)
  3. Limb Length Discrepancy (also called Leg Differences or Short Leg Syndrome)
  4. Forefoot Abnormalities (also called Forefoot Varus or Valgus, or Collapsed or Elevated Metatarsals)
  5. Poor Shock Absorption (also called Inadequate Shock Absorption, Pounding Heel Gait, or Stress Fracture Gait Pattern)

But, the patterns are very different from patient to patient, and combinations of patterns can exist in the same patient either same side of the body, or a different pattern of the right side to the left side. Let us first look at a video on Over Pronation demonstrated for the purpose of recommending stability or motion control shoes.

Image if this patient had one of the many foot and leg problems related to pronation. The health care provider must decide how much support is necessary to help this patient. I like the patient before I go to a custom made device to purchase a motion control shoe, learn to power lace,  and be fitted for one of the soft athletic Sole inserts that I can modify. In this way, I can see how much force I will need to correct their pronation if symptom wise I need to fully (100%) correct to get them pain free.

I thank Kristina (whomever you are) for this slow motion video of over pronation. The inward collapse of the foot, ankle, arch is very well demonstrated following heel strike. If this patient had a severe problem caused or aggravated by pronation, varus shoe wedging would be necessary into the midsole along with the above anti-pronation measures. I see alot of patients with this gait that have unsuccessful surgery since their original orthotics just did not control the motion, but after surgery, they tried to get back to activity in those same orthotic devices.

This last video is another typical patient I see in practice whom may not aspire to be a great runner, but does want to walk better and have less or no pain. This patient may require multiple orthotics devices to gradually build up the arch over time, since they would reject a fully corrective orthotic device if all the support was given to them at once.

I have used 3 videos on over pronation to demonstrate that there is alot to understanding the patterns of these gait abnormalities. To summarize some of the key points:
  • Over Pronation--when does it occur, how fast is it, and what is the end point?
  • Over Supination--when does it occur, how fast is it, and what is the end point?
  • Limb Length Discrepancies--is there dominance and is there asymmetries from right to left?
  • Forefoot Abnormalities--is the gait apropulsive, is there digital clawing, is it a part of the pronatory or supinatory gait pattern?
  • Poor Shock Absorption--is there jarring or heel pounding, is the knee too stiff?

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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.