I had a great patient who I treated recently. She’s an 8 year old girl whose parents brought her in wondering why her shoes were wearing out oddly and why she walked “funny.” The examination was very revealing, and relevant to ALL parents with young children. She only complained of some discomfort occasionally in the ankles and does admit to getting tired easily when running around. Her feet pronate, or collapse inward, slightly and she has tight calves that are obvious when she walks. The treatment that most everyone would prescribe would be either orthotics (corrective shoe inserts), stretching or do nothing and let it resolve as she grows out of it.
My treatment was based off exam findings not typically done by Podiatrists. In performing gait analysis, it was evident that both hips were somewhat weak and incapable of supporting the body properly in a single leg stance. Her left shoulder was held high and her right foot was more pronated than the left. Her arm swing was out in front of her torso and asymmetric. Static testing (standing, not walking) reveals her to be unable to touch her toes which is almost unheard of in an 8 year old, though when a yoga block was placed between her knees, her flexibility was improved. Squat testing showed a complete inability to keep her feet on the ground during a squat unless the heel heights were elevated several inches. So, are her hips and ankles really tight? If they were really tight, then she wouldn’t be able to assume a squat posture in any position, vertical or horizontal (standing or laying down). When I had her lay on the ground, I was able to put her body into a perfect squat posture with ease. This indicated that her joints aren’t tight, which would be unusual in a young person. Her problem was with gravity! When she tried to move her body, certain muscles were firing that weren’t supposed to be, and the timing or sequence of which muscle is supposed to fire and when, was off. Thus, the muscles that should be relaxed to allow joint mobility were engaged, thereby preventing joint mobility.
Why does this happen and how do we fix it?
Two of the worst things we can do to our children, we do without thought. We put shoes on their feet and we send them to school where they will be sitting in chairs for hours each day. If shoes and chairs were part of a human beings “master plan,” don’t you think we would be born into them? Humans are hunter-gatherers and are supposed to stand, walk and run. Especially the growing body! Shoes do two dangerous things: they do not allow the foot to use all of the smaller muscles that allow fine tuning within the foot, and more importantly, they interfere with the connection between the brain and the earth. As we start school, our bodies are going through rapid growth and change. When we sit, our pelvis tends to become fixed forward slightly and it relatively shortens our hip flexors (psoas muscle). This is the muscle that is supposed to lift the leg and it originates off the lower spine, attaching the the femur (thigh bone). If we lose our ability to use our core (sitting creates poor posture which leads to loss of core awareness), then we can no longer stabilize our spine, and our hip flexor has nothing to leverage against when trying to contract and lift the leg. The muscle then becomes shortened and further adaptations will occur. The brain will begin using other muscles that flex the hip and lift the leg. Unfortunately, these muscles are also knee extenders and we end up lifting our leg and extending the knee at the same time. This forces us to lift the toes, stride out in front with walking which ultimately encourages heel striking. This brings us full circle with shoes as they enable the heel strike by cushioning the heel. For those who believe what you have been told about heel to toe walking, you should think again. It’s not efficient, nor is it desired in proper mechanics.
Now back to our case. With further questioning, she happens to be the tallest kid in her class. Her feet have been growing fast and she has very long legs as well. Therefore, in addition to the poor timing of her muscles, her body is continuing to change and force the brain to make constant adjustments. This, of course, is in addition to the dysfunction in her body that is created by sitting and wearing shoes.
Our patient will be sent to a physical therapist who will work on neuromuscular re-education to help with the sequencing of muscle contraction. Stretching will be useless as her muscles and joints aren’t actually tight, they are just not working at the right time. Also, she will be casted for orthotics, which will serve to stabilize her heels (not arches), which have been turning out and forcing her feet to function in an unstable manner. By providing stability to the feet, we will provide the consistency that her body needs in order to re-learn how to walk over those feet. Orthotics alone would miss the real cause of her “walking funny” and her leg fatigue. Though orthotics, stretching and “tincture of time” may resolve some of the symptoms, her body’s dysfunctional patterns would ultimately lead to degenerative changes in the hips as they haven’t been moving, the feet because of the force through them are greater than it should be, and the back, which will be forced to adapt for the hips that are not moving. If she does her work and continues to practice good movement habits as her body continues to change, there should be no long term consequences, or at the very least, they should be greatly reduced. My fingers are crossed…This entry was posted in Conditions, Dr. Neil Feldman, Worcester Podiatrist. Bookmark the permalink.