Saturday, June 19, 2010

Inverted Heel

I am putting up a few posts basically for myself as I try to figure out things I am learning about my feet. In this way I can check back and see what works and doesn't work and keep track of my thinking. Please skip over if you are not interested, but sometimes people find my stuff on the web and offer really good suggestions or are also looking for similar answers to biomechanical issues.

Last night I posted what I am learning from the Active Release doctor who I am currently working with. My left foot is a problem foot and he gave words to the strange things that my foot does that affects my stride, hip, and back.

Basically he said the left foot has an inverted heel, which causes the foot to suppinate and then I have something called functional hallux limitus which means the forefoot goes into a severe pronation because the bog toe and metatarsal do not work and contact the ground correctly. Thus I have problems.

Here is what I have found on inverted heels (besides some crazy dance step). It comes from Carson Boddicker, whose blog I have been reading for the past few months (see "My Blog List" to the left). He gives some exercises and drills (some using a wedge that I have not tried as I am relying on the therapy I am undergoing now).

Following ankle injury, a positional fault is often observed in subtalar joint position, which is locked into inversion known as rear foot or subtalar vars Rear foot vars is when the position of the foot is inverted relative to the ground in subtalar neutral.

Given the body’s remarkable ability to adapt, it can attempt to shift the position of the talus to compensate for an inverted calcaneus. In observing the rear foot, a compensated rear foot vars will appear perpendicular in subtalar neutral but averted in standing (left). Uncompensated, it will appear inverted in both ranges of motion (right).

With the subtalar joint in inversion, the foot must pronate more to clear the heel from the ground. Once clear, the foot is forced to rapidly supinate to be effective in propulsion, creating a whip-like effect, which has been implicated in Achilles’ tendonopathies. Additionally, the first ray of metatarsals becomes an inadequately stable base for propulsion (remember the joint by joint approach) and the big toe begins to lose mobility.

Finally, remember that the subtalar joint translates this rotation (pronation) to the tibia and the tibia translates rotation higher in the body. Excessive relative internal rotation of the foot, tibia, and subsequently femur can cause femoral head position changes and scarring of the deep hip rotators. This can ultimately lead to a grab bag of pain and pathology of the knee, hip, and low back.

I don't know if this is an accurate description of half of my foot's problems, but it sounds right.

Next up is an excellent descriptive video from "The Gait Guys" which descibes rearfoot varus, which I think is the same thing as an inverted heel.

Finally, I am putting up (hate to do this) some videos the chiropractor wanted of me running. It shows my stride Tuesday (after one day of ART treatment) and after an 8 mile run. It shows the weird things my left foot and leg does even at a slow jog. I would guess it looks much worse at a faster pace.

Now you can see why running is so much fun for me!

Here's a link to the stretches for my feet and ankle that the chiropractor says I should do. The first is pretty much a Z-Health Toe Pull. I now have better informed instruction on how to do it. The tops of my toes are really stiff.

Now about jammed joints and how I seem to get relief from hip problems when the joints in my feet are mobilized. Here is a video on the arthokinetic response showing how a jammed foot joint affects the glute medius muscle (the muscle that the postural restoration therapist said was one of my weakest muscles on the left side).

I also posted about Z-Health and jammed joints here, where Dr. Eric Cobb (Z-Health) demonstrates the affect of jammed joints here. Mike T. Nelson of Extreme Human Performance (blog on my list to the left) wrote about jammed joints here.


Anonymous said...

I am a recreational marathon runner who enjoys reading your blog. The following link is to a discussion of how the foot is supposed to operate during running. The presenter is Gary Gray, who is a physical therapist. Gary always views the body, and the foot in this presentation, in all 3 planes of motion (sagittal, frontal and transverse planes). I hope this info is helpful to your situation.

Running Fool

Jim Hansen said...

Thanks Running Fool,
I look forward to viewing and studying this. I bought Gary Gray's DVD called Core Conversion and the Tri-Stretch last month. It looks like a good video to help me learn about the 3-planes of motion in the foot rather than just the body.
Thanks for the link!

Jim Hansen said...

I received this email post from Dr. Ivo of The Gait Guys (see video in post). For some reason it won't post on Blogger when I OK it. Here is what he said,

"Hi Jim

Nice website and great video! You have a condition called external tibial torsion. I posted details and a full response and explanation to your post in the forum there, so many can learn:

Dr Ivo"

The forum post that I asked a question on is found here along with Dr. Ivo's response:

Anonymous said...

Hi Jim,

I'm Alwin here and I think I have the same problem as you do while running. Take a look at this picture.
Did you finally manage to recover your stride using the strecthes?

Jim Hansen said...

Hi Alwin,
When I wrote this post, I was just a month or two away from having to stop running due to a labral tear in my hip. I had read enough to tell the doctors that that is the problem. I had surgery to repair it a year later, and am still trying to run again.

Whenever I try a new therapist, I am trying to figure out if the thinks if my foot drive my hip problems or my hip drives my foot problems. The last guy I saw up until last week thinks that the hip drives the foot problems (this is just me -maybe not anyone else).

I am learning some things to help with the foot and hip. I feel great, except if I run, the next day I am sore and my hips feel like they have been torn apart. My stride is still somewhat messed up due to my bone structure and years of compensation. I have recovered my stride enough to ride an ElliptiGO full time instead of running. I love it. I have done a 100 miler each of the past two weekends and I feel great without any of the issues I would get from running. One thing that helps is because it is on wheels, I think I can shift the bike a little to compensate for the awkwardness of my left foot and hip.

Good luck! I have had some help in the past with a podiatrist doing manipulations of my feet. I found these a couple months ago and sometimes they help my foot.