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Instep Dance Magazine Articles

Reprints of monthly column as first appearing in Instep Dance Magazine.

November 1998

Orthotics - Giving Your Feet A Lift - Part 3 - Assessment

By Rick Allen, DC

"Better health leads to better dancing."

So far we have reviewed conditions that may benefit from special support of your feet and the options for foot support, including off the shelf and custom orthotics and shoes. This month I'll go over the points I check with each patient to determine their postural stability and possible need for foot supports or orthotics. Your doctor will probably perform a similar exam.

As the patient comes into the examination room, I observe their walking gait. In particular, I'll watch for toes pointing out, arches collapsing, and any signs of limping. I'll carefully examine their shoes, looking for excessive wear on the lateral (outer) or medial (inner) edges of the heal, distortion of the shoes, or differences in the patterns of wear between the two shoes.

I observe the patient's overall standing posture. From the front and back, I check to see if the head, shoulders, pelvis, knees and ankles are all symmetrical and level. From the side, I note if the head and shoulders are forward both standing and sitting. I'll take photographs for my records and to share with the patient.

[ Diagram of knee / Q-Angle ]

I'll check the knees for varus (bow-legged), valgus (knock-kneed), and rotational deformities. The patellae (kneecaps) should be pointing straight ahead. If the patient pronates excessively (flat feet), the patellae may point inward and the medial aspect of the thigh, just above the knee, may be tender. I may check the Q-angle of the leg, measuring from the point of the hip to the knee in comparison with the leg (Figure 1). Optimum measurement for males is 8 to 12 degrees; for females, 12 to 15 degrees. Q-angles higher than 15 degrees for men and 20 degrees for women are considered clinically abnormal.

Moving down the legs, I'll note if the Achilles tendons bow inward, indicating excessive pronation with low or "fallen" arches, or outward, indicating excessive supination with high arches.

[ Photo of Arch test ] Moving further down to the feet, I'll feel the medial arches, checking for excessive pronation. If I suspect this to be the case, I'll perform the Navicular Drop Test to determine the height of the arches (Left). This is a simple measurement of the position of the navicular bone of the medial arch of the foot relative to the floor when sitting (unweighted) and standing (weighted).

According to John Hyland, DC, DACBR, DABCO, CSCS, the orthotics advisor for Chiropractic Products, if there is a difference of 10 mm or more in the arch between sitting and standing, or if there is an obvious asymmetry from left to right, the patient has objective evidence of a significant biomechanical problem of the foot: excessive pronation/collapse of the medial arch. In his experience, a variance of 7mm or more requires intervention, and even 5mm of drop can be a problem for athletes or others who are on their feet for long periods. This condition is best treated with custom-made orthotics designed to be worn during all weightbearing activities.

I'll also check the feet for corns, calluses, bunions, and deformities. I'll feel the foot for overall flexibility.

Lastly, I'll check the strength of three key muscles of the legs:

  • anterior tibialis -- a muscle located in the shin that dorsiflexes the foot,
  • psoas -- a pelvic muscle that flexes the leg and has a tremendous impact on pelvic distortion and low back pain, and
  • gluteus medius -- a buttock muscle that helps keep you upright when standing.

If I suspect hidden problems of the feet, knees, hips or back, I'll order the appropriate x-ray views.

As you can see, many factors can be an indication for the need for foot orthotics. This examination, excluding any x-rays, only takes a few minutes and yields a wealth of information. You may discover that long-lasting improvement for your problem requires special support for your feet.

In conclusion for this month, let's check our feet, get any support we may need and keep on dancing!

Next article: Let's check out the important, and often overlooked, role that the psoas muscle plays in posture, movement and low back pain.

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