I talk a lot during the Clinical Biomechanics Boot Camps about many different design features that get used in foot orthotics such as the MOSI, the Kinetic Wedge and the Cluffy Wedge to name just a few. They are all useful features and have their places depending on what affect you are wanting.
For example, the Cluffy Wedge is deigned to hold the hallux in a slightly dorsiflexed position. This tenses up the windlass mechanism in the foot and brings on that windlass effect earlier. That is only going to be useful if you want to or need to bring it on earlier. If the windlass mechanism is functioning fine, then the Cluffy Wedge is probably not going to make any difference. That does not stop some clinicians using it as a ‘cure all’ and using it in in most orthotic prescriptions. The Cluffy wedge or a similar foot orthotic modification is indicated when it indicated and not indicated when its not indicated.
One big thing I get from running the Clinical Biomechanics Boot Camps is the feedback that I get when clinicians change their clinical practice based on what I teach on the course and its works!
One of these is the treatment of anterior compartment syndrome. My previous clinical experience in dealing with this problem is an almost 100% failure in its treatment. It really was a challenge. Anterior compartment syndrome is when the muscles expands its volume as it normally does on exercise and the fascial compartment that the muscle is in is particularly tight, so it hurts. Nothing really used to seem to help except the surgical outcomes were always pretty good.
In 2013, this study was published and I immediately started doing it in clinical practice and teaching about it in the Clinical Biomechanics Boot Camps. By changing from a heel strike to a more midfoot or forefoot strike with a lower touch down angle meant the activity in the anterior tibial muscle did not have to work so hard (but keep in mind that to do this requires other muscles to work harder and put them at increased injury risk if this is not done carefully).
This means the rationale was there. Even more surprisingly was that the results were often quite dramatic clinically. It worked. I enjoyed the feedback from course participants who went back to their clinics and tried it and contacted me to tell me it worked.
So much of the use of foot orthotics is based on compromises. The ideal foot orthotic and the ideal foot orthotic prescription is often modified away from that ideal to take into account the footwear that they are to be used in. This is particularity a problem in things like tight football boots or ballet flats when you need some form of arch support. These types of shoes are not designed for any sort of support or foot orthotic to go into them. They are minimalist by design. Often what I do for these types of patients is use a self adhesive silicon gel arch support which takes up very little room, but does give some support. There is a little bit of trial and error to get the placement in the shoe right for comfort. It is less than ideal, but better than nothing.
This is one of those pet peeves and annoyances. Arthur Lydiard was probably one of the greatest or most influential distance running coaches. I often see his name used in many ways and miss-quoted or have things credited to him that he did not say.
I knew Arthur Lydiard. I did some work with him. This means my ears pick up when people say what he might of thought of something related to running.
On running shoes I have seen him quoted as saying that minimalist running shoes are better. I seen it said that he would have supported barefoot running if he was around when that fad took hold. Wrong. He never said anything like that.
Here is what he wrote about running shoes:
In most of his books he advocated for the use of padding in running shoes to reduce impacts: “…check that they have good rubber soles that will protect you from the impact..” (pg 7; Run, the Lydiard Way; 1978) and “Well-rubbered shoes are essential to eliminate jarring effects” (pg 212; Run, the Lydiard Way; 1978). He also believed that forefoot strikers were “more susceptible to foot troubles” (pg 116; Run, the Lydiard Way; 1978) than those who flat-foot or heel strike. In an interview with the website RunWashington, he went on to say “We like flexible shoes, to let your foot function. Shoes that let your foot function like you’re barefoot – they’re the shoes for me, as long as they have some rubber underneath to alleviate the jarring.”
Arthur Lydiard also collaborated with Converse and EB Brutting to make well padded running shoes. He was not a minimalist – he wanted padding in running shoes. He thought forefoot striking was problematic.
It may be somewhat voyeuristic, but I periodically head over to YouTube to check out if there are any new videos of athletes getting an Achilles tendon rupture. They hurt you to watch them. Here are a few:
For more on the Kevin Durant rupture, see this write up. One thing I do find interesting about Achilles tendon ruptures is that if you follow the literature, the outcomes between surgical outcome versus conservative care outcomes are about the same; so how does clinician make a decision as to which is the best approach? There is this very log thread on Podiatry Arena with all that literature (you can sign up to watch that thread and get notified of new updates). Some research can be followed here.
The mechanism of action in all these videos is similar. There is a simultaneous extension of the knee and flexion of the ankle as they accelerate.
There is no doubt that Abebe Bikila is a legend. He was a late selection for the Ethiopian team for the marathon at the 1960 Rome Olympics. Because of his late inclusion the teams sponsor, Adidas did not have shoes in his size, so he decided to run barefoot. On September 10, 1960 he got the gold medal. It was no fluke as he then went on to win the 1964 Olympic marathon in Tokyo. He ran faster in this one wearing running shoes.
My interest in him is two-fold: Firstly, he really is a legend and his running achievements are legendary.
Secondly, it has been interesting to follow the use of that legendary status by the barefoot running community during the fad on barefoot running. He was held up as a hero of that community for his barefoot achievements. He was used to promote the benefits of barefoot running. That is fine and he is anecdotal evidence that a marathon can be run barefoot. What you never see mentioned in that barefoot community that he subsequently ran faster to win the Tokyo marathon wearing running shoes. I did point that out on a number of occasions and all I got in response was hate mail. What does that tell you?
The abductory twist is an observation that is frequently made during a gait analysis. Just recently I have started to notice a common terminology issue and I am somewhat confused if they are the same thing or separate things. Most people seem to use the term ‘abductory twist‘ as the same thing as a ‘medial heel whip‘. I believe they are probably different things and they get confused as to what the entity actually is.
I consider an abductory twist to be that sudden medial or abductory movement of the heel just as the heel come off the ground. I wrote here about the possible reasons for this, one being an ‘overpronation’ and the other being a functional hallux limitus. I do not consider that this comes from a more proximal problem like others do. Some people also call this a medial heel whip. They only way to help this is to deal with the ‘overpronation’ or functional hallux limitus. Exercises can not help this.
However, when you listen to or read about what some people consider to be a medial heel whip they are talking about the heel being whipped medially, especially in runners, after the foot has come off the ground. That is something different to the abductory twist that has been previously described. I do consider that this medial heel whip could be due to a proximal problem around the hip and pelvis. The only way to deal with this is deal with the proximal causes and exercises may be very helpful.
If you hear or read someone talking about an abductory twist and/or medial heel whip try to ascertain which one of the two entities they are talking or writing about and just when in the gait cycle that they are observed.