September 22, 2022 3 min read

The Significance of Foot Function

Author Scott Pensivy, PT, LAC, ATC / September 22, 2022

What happens when your car is out of alignment? Among the many signs of poor alignment, one clear indication is your car shaking rhythmically and a thumping sound produced when you accelerate. This gives it away every time and signals an urgent need to balance your tires.

Our bodies are certainly a lot more complex than a car, similar telltale signs hold true for the foot as well, which could be viewed as the “wheels” of our bodies. If you are challenged in this area of your body, it is most important to look at three important factors:

  1. Trauma - Did an injury occur?
  2. Weakness - Is there an obvious strength deficit?
  3. Biomechanics – Is there something not moving as it should?

Initial Diagnostics:

If someone has experienced trauma, the most important thing for the therapist is to identify the source of the trauma, whether it is a single event or recurrent, and most importantly, how to remove the source of the trauma and allow for primary healing to occur. In the case of weakness, a therapist must treat the cause and not the symptom. Some of this is managed through removing the source of trauma (if present), but the remaining focus is on identifying whether the weakness is purely strength related, or perhaps it is related to the inability of a muscle to properly lengthen; could it be muscle guarding or a neurological phenomenon. Finally, if poor mechanics appear to be the driver, which could include hyper- or hypomobility issues, manual therapy, external corrective devices, or other biomechanical-targeted techniques should be utilized.

 

The Rest of the Vehicle

When the feet are not functioning as designed, the entire lower extremity will suffer from both overcompensation in the surrounding areas and the abnormal forces and vectors that can occur as a result. These abnormal forces and vectors that are distributed to the body can cause many issues, but in the long term, the main concern is joint damage, a common precursor to osteoarthritis. The wear and tear that can be attributed to repetitive trauma, unresolved weakness or poor foot biomechanics will accelerate this phenomenon. In most physical therapy practices, despite prescriptions for, and complaints about knee, hip and low back issues, the foot is quite often the driver.

Corrective Techniques

In the case of most foot issues, a common solution to both biomechanical correction and the desire to normalize foot strength (assuming the source of trauma is resolved of course) is a custom foot orthosis. If an orthosis is fitted correctly, it can improve abnormal wear and tear of the low back, hip, and knee joints by creating a corrective path from the foot to the spine. A property selected and fit appliance can prevent these abnormal forces and vectors, while allowing proper length and tension relationships to be restored. But what if it is not appropriate for the patient?

The Right Wheel for the Right Vehicle:

Unfortunately, for even those therapists trying to do the right thing, getting the orthotic correct is often difficult. For example, a hard orthotic for a foot that is already stiff and rigid won’t be tolerated for long. Often, these patients simply stop wearing these orthoses because they are perceived to be too hard and incredibly uncomfortable. In other words, a new source of trauma has been introduced. In this situation, what often is effective is a soft and semiflexible orthotic. This same intuitive approach must be applied to all patients and the practitioner must understand the importance of frequent, meaningful communication with the patient while they adjust.

Always Evolving:

As the world of rehabilitation evolves, these three considerations remain the same. The right approach is to both stay on top of evolution and how it is being played out while always keeping a firm hold on the fundamentals.

 


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