Tuesday, 6 January 2015


‘Overpronation’ is usually a badly used term that is frequently thrown around in running groups and media in regards to runner’s feet and the selling of running shoes. Pronation is a natural normal motion that the foot goes through when running and walking. This is the foot rolling inwards at the ankle joint and the mid-foot ( arch ) of the foot flattening. The body needs to do this to help absorb shock. Overpronation is when there's seemingly excessive pronation. There is not any consensus amongst specialists just how much is too much and even whether it is actually a problem or not. There are lots of runners who overpronate that do not have problems. It is a common thought that overpronation increases the risk for overuse injury in runners and the evidence is that it does, however it's only a tiny risk factor and several variables go into runners getting an injury. Due to this alleged risk for overuse injury running footwear have been normally manufactured for minor, moderate and severe overpronators. The most rigid motion control running shoes are made for the most severe overpronators. Runners who have no or minimal overpronation are considered to be better off in neutral or stability rather than motion control shoes. This model for the prescription of running footwear is not based on the research and some data disagrees with it. Overpronation is only thought to be a problem if the forces related to it are enough to harm the tissues. In these cases foot orthotics usually are indicated in the short to medium term after which based on the cause of the overpronation, gait retraining and muscle rehab can be used in the medium to long term. Where issues also arise around the use of the name, there is also the problem that there is not just one cause of overpronation. There are many different causes and no one size fits all. Foot orthoses will work in some people long term. Muscle therapy and gait retraining can work in the long term in others. For this reason you should work out the cause to start with and target the intervention at this.

Monday, 29 December 2014

The Lunge Test

The ankle joint is such an important joint for normal function as it is really how the body moves forward over the foot that is planted on the ground. For this to happen the motion at the ankle joint has to be sufficient and smooth. There does seem to be quite a lot of inconsistency in the literature as to what is the most appropriate range of motion for the ankle joint and I really can’t find any definitive answer to what is normal. To make it more complicated some ranges of motion studies are done with the subtalar joint relaxed and some with the subtalar joint in neutral, as some dorsiflexion is available at that joint. To even further complicate it, some range of motion assessments are done non-weight-bearing and some are done weight-bearing. We do not really know how valid the non-weight-bearing methods of assessing the ankle joint range of motion are. The lunge test is one test that is done weight-bearing and with the subtalar joint in a relaxed position. While we have some general impressions as to what the normal range of motion for the lunge test should be, these are only general impressions with no definitive answer as what is normal. I just find it incredibly intriguing that joint that is so important for normal function especially running and walking, that we really do not know what is normal range should be.

Friday, 26 December 2014

Set up of the cycle for injury prevention

The set up for a bike is not only important for cycle performance, but also injury prevention. It needs to be done properly and done by a professional. Many different interventions are needed to help get it right. This varies from stretching exercises, strengthening, retraining and foot orthotics. Get it right from the start before problems develop.

Tuesday, 23 December 2014

Kinesio Tape

Kinesio tape is not something that I have paid a lot of attention to. This is that bright coloured tape that you often see on athletes that became prominent during the London Olympic Games. It is a flexible tape that is claimed to have your neuro-mechanical effects but not necessarily supportive effects. The support is said to come from changes in muscle activity due to the nature of the taping. There are so many conditions that are claimed to be helped with Kinesio taping, but from what I have read of the research the actual evidence supporting the use of Kinesio taping is not that good. Furthermore research has shown that the quality of information on the web on Kinesio taping is also not very good. I have no problem using traditional tape for support when indicated, I am just not convinced that Kinesio taping is any better.

Friday, 28 November 2014

The Medial Heel Whip

The medial heel whip is a finding during a gait analysis in which the heel has a slight medial movement to it as it comes off the ground. As to what casues it, its not totally clear. Most physiotherapists I talk to about this say it come from the hip muscles. Most Podiatrists I talk to tell me its due to overpronation and they tend to call it an abductory twist. There is no evidence either way on this and I guess it depends on which profession you are from as to which one you are more likely to believe in. Either way, it probably pays to check both the hip and the foot and do it properly. Abductory twist or medial heel whip? Foot or hip?

Tuesday, 29 October 2013

Plantar Fasciitis and it Management

Plantar fasciitis is a very common painful condition that affects the bottom of the foot. Its not really a fasciitis, with -itis meaning inflammation except in the early stages. Most cases are more of a degeneration of the ligament. The plantar fascia is a long ligament that goes across the bottom of the foot and supports the arch of the foot. As it supports the arch of the foot, then anything that puts an extra load on teh arch of the foot, such as tight calf muscles, high activity levels or obesity is going to increase the risk for plantar fasciitis. The typical symptoms of plantar fasciitis are pain under the heel and pain that is worse after getting up from rest where it can be quite disabling for those few steps. I like the treatment approach discussed here, especially the approach to not get taken in by the recent minimalism fad to treat it. The key to the treatment is to reduce the load in the plantar fascia with strapping, foot orthotics and reducing the activity levels or substituting other activities. The next step is to condition the plantar fascia to take the loads that get applied to it as well as reduce or eliminate the risk factors that caused it in the first place. If that does not help, there are a number of modalities that physical therapists can use to work on the tissues to help them heal.

Wednesday, 26 December 2012

What are Toning Shoes

Toning or work-out sneakers gained popularity as a group of shoes recently, however they appear to be losing some of that initial interest. By far the most well-known footwear in this category would be the MBT shoes, Skechers Shape Ups, Reebok Easy Tone, Chung Shi and the New Balance Rock 'n Tone. This category of shoe is deliberately made unstable with the aid of design characteristics such as rocker sole or 'wobble board'. The objective of this instability would be to make the muscles work much harder. It is claimed that this will provide an added 'tone up' when using this footwear, hence the name 'toning shoes'. Since the footwear also affect the way we move, the shoes can change the alignment of the posture, so have the prospect to aid some postural complications .. In spite of this, there's a lot of incongruity involving the advertising and marketing statements for these footwear and the precise clinical research that backs up the assertions. This has got to the position where some of the firms have had to settle for substantial amounts of money for the assertions they have been making in their marketing and advertising. Many are also confronting lawsuits from customers due to injuries which occurred with the shoes.

The clinical evidence is pretty clear on most of the alignment effects of this type of footwear. They've been demonstrated to boost activity of the muscles and they've been shown to vary the function of the gait in people wearing them. Whilst these kinds of variations are clear, just what the research isn't obvious on is if the outcomes linked with changes that actually are merely theoretical. By way of example, there is no doubt the muscles do tend to work harder when using this footwear, but there is simply no data this may lead to an improved tone up. Additionally there is no doubt that these shoes can alter the biomechanics, but there's not any information that this alteration will be a good or a detrimental adjustment. The advertisers took the lab based functional research and speculated a theoretical benefits change to buzz up precisely what these shoes can do. In the extreme cases, there were claims that they can deal with cellulite and also increase the circulation. It was this particular jump that got the businesses in trouble with the regulatory government bodies.

So just where may that now leave the toning shoes sector? There's no question that a lot of individuals have been helped with the usage of these shoes and the customer reviews confirm this. Additionally there is no doubt that a number of individuals are actually harmed by this footwear. What is absent is clear guidelines to help choose who might and won't gain from the usage of toning footwear. For instance, several specialists suggest them for lower back pain; others don't. Some foot doctors like them for uncomfortable arthritis of the great toe joint. It is actually obvious that there's a decent future for these shoes. This long term does need to be without the advertising hoopla and backed up with more good medical data in addition to obvious principles on who should and probably should not be utilizing the shoes.