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Are you a runner? Do you do the “twist” when you walk? Reduce the risk of foot pain and shin splints with Worthing Physiotherapy Physical Revolution

July 6, 2014 by physicalrevolution No Comments »

Are you a “twister” when you walk?  if you want to reduce your risk of lower limb injuries such as plantar fasciitis, medial tibial stress syndrome (shin splints) and sinus tarsi syndrome (lateral ankle pain) when running then read on….

Are you constantly getting lower limb injuries when you run?…symptoms such as Iliotibial band syndrome”, “shin splints” (Medial tibial stress syndrome) and “plantar fasciitis” may well be due to the position of your foot throughout ground contact during running. Many symptoms such as “Iliotibial band syndrome”, “shin splints” (Medial tibial stress syndrome) and “plantar fasciitis” may well be due to the position of your foot at ground contact during running. We have all heard about the terms “pronator”, “pronated”, “supinator” and “supinated” but we need to understand these terms to understand why we may be experiencing certain lower limb injuries when we run…

So what is pronation? What is Supination? Let’s have a look at the video below:

 

As our foot hits the floor it undergoes a process called pronation whereby the arch lowers towards the ground. This serves to absorb and store energy (to propel you forwards) and create a stable base from which you can take your next step. The foot is an amazing bit of kit in how it achieves this – it uses mainly non-contractile tissue on the under surface of the foot to do this – namely the “plantar fascia” which is a band of tissue that extends from the undersurface of the heel to the heads of the metatarsals.plantar fascia

 

 

 

 

 

 

 

 

 

 

 

As the foot hits the ground, there is an equal and opposite force which acts back up underneath the foot (according to the revolutionary theorist “Newton”) called “ground reaction force” (GRF). This ground reaction force pushes the foot into pronation. In normal gait the ground reaction force will “encourage” the arch of your foot to drop towards the ground which causes the foot to pronate. This serves to stretch the plantar fascia which becomes very taut – this taut fascia then compresses all of the small bones in the foot as well as the ligaments on the under-surface to create a very solid and stable base. As the arch drops into pronation – then your hip, knee and shin all rotate inwards in a bid to follow the movement of the foot.

Now at the mid stance phase ie as you begin to push off the foot to propel yourself forwards, the foot arch begins to lift (the foot supinates) and the heel begins to lift off the floor. As this happens the hip, knee and shin reverses and rotates outwards.

Problems begin to arise when we cannot control the amount of pronation that occurs. Timing is key to this process, we need to supinate at the right time to ensure we reduce our risk of injury. We need to pronate to create a stable base but if we pronate too much then we reduce the ability to push off effectively when we run or walk.

How so?

If the arch lowers too much then there is too much force pushing up underneath the big toe at the head of the metatarsal – this is bad because it limits our ability to then push off through the big toe. This is because the plantar fascia attaches to the base of the big toe. If the base of the big toe is pushed up then the big toe is pulled downwards because the fascia becomes too tight – try it:

In the video you will see that as you push up underneath the base of the big toe the result is that the end of the big toe is pulled downwards.
So, if you pronate too far look how you are unable to load through your big toe:


If you are then unable to push off via your big toe in this manner then our ability to re-supinate the foot is limited which means that our hip, knee and shin struggle to rotate back outwards (ie the whole of the leg). Look at this video – this is the same gentleman before and after altering his foot position in his shoe:

You will notice that in the left video his foot pronates…and then continues to pronate ! – he actually re-supinates the foot very little IF at all. On the right, however, you can see the foot begin to re-supinate (this is after he has had a Worthing Physio temporarily tape the foot into a better position). This means that the plantar fascia becomes overly stretched leading to painful conditions like plantar fasciitis. This whole mechanism of using the plantar fascia to ensure stability through the foot to ensure the COREECT use of the big toe when pushing off is known as the “windlass mechanism” – if we do not use this mechanism correctly then our muscles in and around the calf have to work extremely hard in their “outer range” (see The shoulder blades part 2 for an explanation of muscles working in their outer range) to attempt to resupinate the foot for effective propulsion. If you get the “windlass mechanism” to work FOR you correctly then you reduce your risk of foot and lower limb injuries AND reduce your energy consumption when running !!! (You would be surprised at how much energy you lose by not getting the extrinsic and intrinsic foot structures at the right length with each foot strike when running…more on that in later blogs!)
If you cannot re-supinate the foot then one of the compensations is to twist the foot in order to rotate the hip back outwards in the manner below – this is a tell tale sign that you may not be getting the “windlass mechanism” to work correctly for you:

So if you are a twister and if your physiotherapist is not looking at the mechanics of the foot if you are presenting with any lower limb injuries outlined above then you need to join the Revolution !

One possible fix may come down to the type of footwear that you use. If you are a twister and have poor foot control then you may look for a pair of trainers that has what is called a “medial heel post”.  Obviously i do not promote any specific makes of trainers but i will be running a blog review on different types of trainers for running soon. If you are in any doubt then drop us an e mail or give us a call and we will try and help you as much as possible.

Healthy running !

Matt

 

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