Knee & Foot Pain Limiting You?

 
 

Knee or Foot Pain? Food for thought …

Knee or foot pain when walking? Could your knee pain be a result of your walking technique? Watching a person walk can reveal several aspects about their muscular imbalances. These abnormal walking patterns can be a primary contributor to a person’s knee pain. More often than not, a person cannot tell exactly what’s off, but they know their walking or gait isn’t right.

Here are a few clues to look for if you think your gait is off and you have knee pain: 1. Look at the wear pattern on the bottom of your shoe. Many patients with knee pain have a wear pattern on the outside of their shoe. This means that the person is not performing the correct biomechanics of the foot, leading to the inability to recruit the correct muscle firing sequence of the leg and trunk. Every human foot must “pronate” at the “midfoot” or middle of the foot (arch), during the “midstance” phase of gait, or the phase when the foot is flat. There are many reasons why people do not pronate or are limiting themselves from pronating. This is almost always a functional problem NOT a structural problem. Which is great, because physical therapist can help to teach patients how to control pronation again.

2. Are you a “stomper”? Can people hear you walking a mile away at home? These people are heavy heel strikers and typically take too long of a step and then strike the back of their heel with an extended knee. These heavy heel strikes are difficult for structures to attenuate forces and ultimately can cause some knee pain.

3. Do your calves always feel tight? They probably are! If your wear pattern on your shoes show that you “push off” on the outside of your shoe instead of more on the inside, then you are performing “push off” on the wrong area. This abnormal gait sequence will cause the calves to become tight secondary to not using the entire muscle length of the calf. When the calf is tight, this will cause the knee to shear in towards your body to account for the lack of mobility in the foot/ankle.

What can you do to change your walking pattern? Here are a few external cues to get the right muscles on at the right time, and decrease stress at the knee. Watch the video below for walking cues

1. Heel strike- strike the center of your heel just about a half a foot length in front of your body. Also, do not heel strike with a straight knee but rather a soft knee to absorb the forces through the muscles. Heel striking closer to your body instead of further in front of your body allows you to control the movement and forces are more efficiently distributed through the leg and pelvis.

2. Pronation at midstance-Right after heel strike the mid-foot or arch of the foot must pronate. This means that the arch must flatten so that the tarsal bones of the foot unlock and conform to the ground. Pronation allows the foot to be in the right position for push-off or toe-off of the 1st and 2nd toe. Controlling pronation at the midfoot also engages the correct sequence of muscle firing patterns of the pelvis, which includes gluteus medius.

3. Push-off-once you have proper pronation at the arch, you are set up to push-off the 1st and 2nd rays of the foot and 1st and 2nd toes. Proper push-off engages gluteus maximus and helps propel you forward. Make sure you are not pushing off on the 4th or 5th toes, which is a common gait dysfunction with knee pain. Changing your gait or walking pattern can be very challenging and does not happen overnight. Make sure that your footwear allows your foot to move naturally and avoid motion control shoes. Contact us with any questions or concerns. If you would like to come in and have us evaluate your knee pain and walking, email us at movementismedicine@ancpt.com

Shoes? … Are “man heels” just as bad as “high heels”?
YES! Both types of footwear could be a large contribution to a musculoskeletal problem. Let’s compare the two:

Man heels vs. High heels
Both put the foot in plantarflexion or toes down position: this position increases pressure on the metatarsal heads and causes the calves to become tighter. This can cause foot, ankle and knee problems.

Both increase lumbar lordosis or hypertension in the low back: having this increase in extension all day long increases compression on the spinal structures. This compression leads to all sorts of spinal dysfunctions.

Both have narrow toe boxes: wearing a shoe with a narrow toe box can lead to not only foot and ankle problems but knee problems as well. In order for the foot to fit in the narrow space, the person ends up laterally weight bearing or walking on the outside of their foot. This lateral weight bearing causes the loss of pronation at the arch. When a person walks without pronation, it’s impossible to recruit the correct muscle firing pattern, leading to imbalances and pain.

What kind of shoes should I be wearing?
Here are the 4 things to look for:
(1). No heel-make sure the incline from toe to heel is eventually 0 mm. If just starting out can start with 3-4 mm and then transition to 0 mm over the next 6 months gradually.

(2). Flexibility in the toe box to bend where your toes would bend. Also flexibility in the middle of the shoe. You should be able to twist both ways so that you are able to pronate.

(3). A wide toe box-make sure the toe box is wider than your toes, so that you have space for those tootsies to spread out. 

(4). Make sure to get shoes long enough for the longest toe. Don’t assume that’s your big toe, sometimes it’s the 2nd or 3rd toe. The space between the end of that toe and the end of that shoe should be 1/2-3/4 of a thumb length. As long as the laces are holding your mid-foot, and the back of the shoe isn’t sliding, the shoe length is good.

Here are some brand name suggestions for men dress shoes:
Lems (Pic 1)
Softstar (pic 6)
Altra (Pic 4)
TODS (pic 7)
Vivo barefoot (pic 3)
Plae (pic 5)
Here are some suggestions for women:
Lems
TOMs
Softstar
Vivo barefoot 
Plae
Nordstrom’s shoe department-look for cute flats!

Contact us with any questions! www.ancpt.com