10/24/2016. The Puzzle of Pain NMT and the Dynamic Foot Judith DeLany, LMT. Judith DeLany, LMT. NMTCenter.com. NMTCenter.com
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1 The Puzzle of Pain NMT and the Dynamic Foot Judith DeLany, LMT NMTCenter.com Judith DeLany, LMT NMTCenter.com Define gait cycle and its periods Consider key elements in gait Discuss foot design Consequences of pronation Review screening tests Refer for corrections 1
2 Webinar Goals The Gravity Game Stretch your brain! Know the periods of the gait cycle Know at least 4 key elements in gait Know at least 3 determinants of gait Name at least 3 consequences of pronation Screening for pronation Perform a navicular drop test Spot when to refer for corrections Webinar Credits The Gravity Game Images Maunger stockfreeimages.com Books and Software References Fink et al 2003 Journal of Craniomandibular Practice 21(3) p Getting there One step at a time. Mmulligan Stockfreeimages.com 2
3 Passenger unit Head, neck, arms, trunk and pelvis (HAT) Locomotor unit Pelvis and lower extremities Locomotor HAT 3
4 COG - HAT COG -Whole Dual job Falling forward while alternately thrusting out a limb to stop the fall. 4
5 Step Mmulligan Stockfreeimages.com Step Stride Mmulligan Stockfreeimages.com Step Stride Base Mmulligan Stockfreeimages.com 5
6 Step Stride Base Cadence Flavijus StockFreeImages.com Free Speed Bobb StockFreeImages.com From initial contact of a limb, until initial contact occurs again for that same limb Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. 6
7 s of the Gait Cycle Each gait cycle is divided into a Stance period and a period s of the Gait Cycle Stance = foot is in contact with the surface. s of the Gait Cycle = limb is moving forward, usually not in contact with the walking surface. 7
8 Walking Gait Cycle Stance DL Double limb support = both feet are touching the surface (20-25% of the time) Running Gait Cycle Stance No double limb support when running! Stride (2 Steps) Stance 8
9 Stride (2 Steps) Stance Weight acceptance Single limb support Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response 9
10 Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Tsian StockFreeImages.com Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Terminal stance Midstance Pre- 10
11 11 Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Midstance Terminal stance Pre- Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Midstance Terminal stance Pre- Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Midstance Terminal stance Pre- Initial swing Midswing Terminal swing
12 12 Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Midstance Terminal stance Pre- Initial swing Midswing Terminal swing Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Midstance Terminal stance Pre- Initial swing Midswing Terminal swing Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Midstance Terminal stance Pre- Initial swing Midswing Terminal swing
13 Stride (2 Steps) Stance Weight acceptance Single limb support Limb advancement Initial contact Loading response Terminal stance Midstance Pre- Initial swing Midswing Terminal swing And it all happens in about one second. Key Elements in Gait Weight transfer is continuous 13
14 Key Elements in Gait Weight transfer is continuous Correct angle of toe orientation Angie68 StockFreeImages.com Key Elements in Gait Weight transfer is continuous Correct angle of toe orientation Angie68 StockFreeImages.com Key Elements in Gait Weight transfer is continuous Correct angle of toe orientation No excessive supination or pronation Podiatric Medicine & Surgery, Primal Pictures Ltd 14
15 Key Elements in Gait Weight transfer is continuous Correct angle of toe orientation No excessive supination or pronation Arms swing equal bilaterally Key Elements in Gait Weight transfer is continuous Correct angle of toe orientation No excessive supination or pronation Arms swing equal bilaterally Symmetrical motion 15
16 Key Elements in Gait Weight transfer is continuous Correct angle of toe orientation No excessive supination or pronation Arms swing equal bilaterally Symmetrical motion Width of the base Base of support Mmulligan Stockfreeimages.com Key Elements in Gait Weight transfer is continuous Correct angle of toe orientation No excessive supination or pronation Arms swing equal bilaterally Symmetrical motion Width of the base No sign of a limp Key Elements in Gait Weight transfer is continuous Correct angle of toe orientation No excessive supination or pronation Arms swing equal bilaterally Symmetrical motion Width of the base No sign of a limp Center of gravity 16
17 View in multiple directions Principles of Manual Medicine (Greenman 1996) Gait analysis in multiple directions Principles of Manual Medicine (Greenman 1996) Instead of pathology, look for functional capacity of the gait. Pay particular attention to cross-patterning and symmetry of stride. Podiatric Medicine & Surgery, Primal Pictures Ltd 17
18 Gait Determinants Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Gait Determinants Pelvic rotation Pelvic tilt Pelvic shift Knee flexion in stance Knee extension after midstance Foot mechanisms Without Gait Determinants Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. 18
19 Pelvic Rotation Drake et al 2009 Gray s Anatomy for Students, 2 nd Edition. Churchill Livingstone, Elsevier. All rights reserved. Pelvic Rotation Drake et al 2009 Gray s Anatomy for Students, 2 nd Edition. Churchill Livingstone, Elsevier. All rights reserved. Pelvic Shift Drake et al 2009 Gray s Anatomy for Students, 2 nd Edition. Churchill Livingstone, Elsevier. All rights reserved. 19
20 Pelvic Tilt Drake et al 2009 Gray s Anatomy for Students, 2 nd Edition. Churchill Livingstone, Elsevier. All rights reserved. Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Trendelenburg Gait Pelvis sags on the side opposite the affected hip during single leg stance on affected side. 20
21 Trendelenburg Gait Compensation involves leaning the torso toward the involved side during stance phase of the affected side. Trendelenburg Gait Primal Pictures Knee Mechanisms Drake et al 2009 Gray s Anatomy for Students. Churchill Livingstone 21
22 Podiatric Medicine & Surgery, Primal Pictures Ltd 22
23 The Rocker System 23
24 The Rocker System The Rocker System The Rocker System 24
25 The Rocker System 25
26 The Talus The Talus TaloCalcaneoNavicular (TCN) Joint 26
27 TaloCalcaneoNavicular (TCN) Joint Muscular Support of the Spring Plantar fascia 27
28 Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Plantar fasciitis Heel Spur Podiatric Medicine & Surgery, Primal Pictures Ltd Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Plantar muscles Flexor digiti minimi brevis Abductor digiti minimi 28
29 Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Plantar muscles Abductor hallucis Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Plantar muscles Flexor digitorum brevis Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Plantar muscles Quadratus plantae Tendon of flexor digitorum longus 29
30 Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Plantar muscles Flexor hallucis brevis Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Plantar muscles Adductor hallux Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Plantar muscles 30
31 Extrensic Trigger Pts Mediclip Manual Medicine 1 & Williams & Wilkins. A Waverly Co. Functional Hallux Limitus Normal Dorsi-flexion Lost range in FHL Podiatric Medicine & Surgery, Primal Pictures Ltd 31
32 Podiatric Medicine & Surgery, Primal Pictures Ltd 32
33 Navicular drop test Non-weightbearing Weightbearing judithdelany nmtcenter.com 33
34 Corrections Foot Exercises Corrections Foot Exercises Corrections Foot Exercises Short foot 34
35 Corrections Foot Exercises Short foot Corrections Foot Exercises Short foot Orthoses Still photos from video in Sports Injuries Foot & Ankle Primal Pictures Ltd Heel Lift Used unilaterally to compensate for a structural short leg Used bilaterally to alleviate Achilles tension and Plantar Fasciitis
36 Corrections Foot Exercises Short foot Orthoses Microwedges Morton s Foot Syndrome Short First Metatarsal Bone Deeper First Web Space Elevated First Metatarsal 36
37 Posture Kinetic & Proprioceptive Chain Restoring the Information 37
38 A Timing Device Instant response For all kinds of shoes 38
39 Balance Training Wobble board Rocker board Foam surface Corrections There is no doubt that these concepts are important pieces of the puzzle 39
40 Let us help you solve the Puzzle of Pain. Visit NMTCenter.com for seminar training information Anatomy for Manual Therapies 3D software (Primal Pictures), available at nmtcenter.com Let us help you solve the Puzzle of Pain. Visit NMTCenter.com for seminar training information Anatomy for Manual Therapies 3D software (Primal Pictures), available at nmtcenter.com The Puzzle of Pain Judith DeLany, LMT NMTCenter.com The Benjamin Institute
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