Normal gait requires at least 10 degrees of ankle dorsiflexion, with maximum dorsiflexion occurring closed chain during late midstance. Limited ankle dorsiflexion can result in a myriad of compensations both proximally and distally.

From knee hyperextension to midfoot over-pronation, the deforming forces caused by tight calves is enough to make any Movement Specialist cringe. I refer to this lack of ankle joint dorsiflexion as a "Podiatric Epidemic" as a majority of people assessed lack adequate ankle joint range of motion.

For clients or athletes who have adequate pelvic flexibility but demonstrate decreased gastrocnemius range of motion, we want to integrate posterior group stretches.

When recommending posterior group stretches some classic stretches include the wall stretch, downward facing dog and dropping a heel off of the step. When performing theses stretches have you ever considered the role rearfoot position may have on the effectiveness of each stretch?

Impact of Rearfoot Position on Stretching

A 2009 study by Jung et al. evaluated the impact of rearfoot position on the effectiveness of gastroc stretching. Due to the prevalence of tight gastrocs in an over-pronated foot type, Jung et al. wanted to determine if the everted calcaneal position altered the effectiveness of the stretch.

Jung et al. evaluated 30 patients with both a neutral foot type and an over-pronated foot type with increased calcaneal eversion (average 4 degrees). Subjects performed a gastrocnemius wall stretch both in their relaxed calcaneal stance position and while wearing orthotics which placed the calcaneus in a neutral position.

Ultrasound technology was used to evaluate the degree of stretch as determined by the change in myotendinous length. It was observed that rearfoot position had a significant impact on the effectiveness of posterior group stretching. A 3mm difference in gastroc lengthening was achieved while stretching with the everted rearfoot shifted into a neutral position.

Considerations for the Movement Specialist

When considering articles to review and share on the EBFA Blog, I like the above study for several reasons:

1. It emphasizes the impact subtle adjustments in body positioning can have on stretching effectiveness. As evidence-based fitness professionals, if we can apply research studies such as this into our client's programming we may begin to see better results.

2. It re-emphasizes the concept of foot-specific programming which I integrate into my Barefoot Training Specialist workshops. In an over-pronated foot type with increased calcaneal eversion you want to consider the impact ankle stretching may have on the weakened posterior tibilais tendon.

3. When the calcaneus is brought out of the excessive eversion the stretch becomes more isolated to the Achilles tendon and gastrocnemius/soleus - with little stress to the posterior tibialis.

Want to integrate this evidence into your client's programming?

1. For any clients with an over-pronated foot type, isolated gastroc stretching should be performed preferably non-weight bearing to minimize the impact of rearfoot position during the stretch.

2. If a client uses orthotics that control rearfoot motion, perform closed chain gastroc stretches while wearing the orthotics and then remove the shoes for the barefoot training exercises.

3. For any clients with an over-pronated foot type and wear Vibrams or minimal footwear for daily use and training, frequent evaluation of the posterior tibialis tendon should be performed.

To learn more about this, make an appointment online or visit a podiatrist at one of our convenient locations.

By: Dr Emily Splichal, DPM

It is believed that many factors play a role in the development of athletic performance. From cardiorespiratory capacity to skeletal muscle function, can our genetic and musculoskeletal makeup predict our talent as an athlete?

With many sports performed in closed chain environments our foot is highly integrated in lower extremity kinematics, postural stability and force production. Exactly how important is the foot type in determining athletic skill? With most attention on the association between foot types and risk of injury, what if instead we took a moment to look at certain foot variances and the advantages each may have on athletic performance?

Foot-Typing

Due to the variances in foot type and arch height we need to begin with a classification system that is reliable and consistent. Simply classifying a foot as a high arch or low arch does that reflect the dynamic biomechanics of an athlete's foot-type.

One such foot-typing system that does provide validity and reproducibility is the Foot Posture Index. The Foot Posture Index is a 6 point static foot assessment performed in multiple planes which is used to classify foot-type and degree of severity (Cornwall 2011).

A 2011 study by Cornwall et al. evaluated the reliability of the Foot Posture Index to predict dynamic foot function. After evaluating 203 subjects it was concluded that the Foot Posture Index can predict dynamic foot mobility. Those subjects with the greatest foot mobility correlated with the over-pronated or low arch foot type. Conversely those with decreased foot mobility were associated with a more supinated or high arch foot type.

Over-Supinated Foot Type

In the over-supinated foot-type the heel and subtalar joint are in an inverted position with a lateral shift in body weight and slight adduction of the forefoot on the rearfoot. Typically we think of an over-supinated foot type as more rigid with an increased risk for stress fractures, tendonitis and plantar fasciitis. But could there be any advantages to this supinated foot position?

Advantage #1 - Rapid Re-Supination

In sports such as soccer, changes in direction and cutting maneuvers require rapid activation of the posterior tibialis in order to create a rigid foot lever and push off. Although it is purely anecdotal, perhaps a more supinated foot type allows the athlete to quickly change direction and push off of the ground.

Advantage #2 - Decreased Contact Time

For a runner or athlete the ability to decrease contact time, not only makes them faster but also decreases the risk of injury. In endurance sports, time spent in contact with the ground is when the athlete gets injured.

A 2007 study by Hasegawa et al. found that when comparing different foot strike patterns, running speed and contact time, those runners with a midfoot and forefoot strike had a shorter contact time when compared to runners with a rearfoot strike.

In addition it was observed that regardless of foot strike pattern, those runners who had the greatest degree heel inversion at foot strike also had the shortest contact time. Because an over-supinated foot type has increased calcaneal inversion this may provide an advantage in reducing contact time when running (Hasegawa 2007).

Over-Pronated Foot Type

In the over-pronated foot-type the heel and subtalar joint are in an everted position with a medial shift in body weight and abduction of the forefoot on the rearfoot. This foot type is typically associated with increased plantar pressures and force distribution over the plantar foot. Typically we think of an over-pronated foot type as more mobile with an increased risk for posterior tibial tendonitis, knee pain and bunions. But could there be any advantages to this pronated foot position?

Advantage #1 - Improved Balance

A 2002 study by Hertel et al. compared balance and stability in different foot types. Interestingly it was found that the over-pronated foot type had better balance when compared to the over-supinated foot type. It was hypothesized that eue to the increased plantar contact in an over-pronated foot type there was an increase in plantar cutaneous feedback which is critical in stabilization. Sports requiring balance, such as karate, boxing or gymnastics may benefit from this foot type.

Outside of increased plantar distribution, the over-pronated foot type may not be as advantageous when it comes to athletic performance. Since many athletics are dependent on force, speed and agility - all of which relate to rapid foot contact time - the delayed strength and activation of the posterior tibialis may put this foot type at a disadvantage.

Conclusion

Although much of this information is anecdotal due to the lack of research, it does provide important considerations for the coach or parent of an athlete. We are all born with a specific foot type, so it is up to us to understand our foot type and use it to our advantage whether it be for agility or balance & stabilization!

***

To learn more about foot-typing and how to create a foot-specific program for your clients and athlete's – consult a podiatrist at Midtown Podiatry, or make an appointment online.

By: Dr. Emily Splichal 

Its time to say goodbye to 2011 and say hello to 2012! As the New Year rolls in there are many things to get excited about for this upcoming year; the year of the Dragon according to the Chinese, the 46^thSuperbowl, the Presidental Election of the United States and the return of the Olympics! With the Olympics in mind, a particular Gold medalist has been bringing light to a disorder that is frequently looked over. Peggy Flemming, who won the Gold Medal in 1968, has a passion for spreading awareness about PAD, a disorder commonly seen in our office at Midtown Podiatry.

What is PAD?

Peripheral Arterial Disease or PAD is a disorder of the blood circulation of the extremities where the blood flow is decreased. This is usually caused by narrowing of the arteries by a buildup on their interior wall called plaque. This condition resembles clogged pipes in your home. If the pipe is partially blocked, flow is decreased. If the pipe is completely blocked, flow stops. We don't want our blood flow to stop!

How do I know if I have PAD?

Some symptoms of PAD are foot and leg cramps while walking, coldness of the toes, loss of toe hair, nail irregularity and redness when the feet are down. Late signs are rest pain, non healing wounds and gangrene. PAD is easy to identify by one of the podiatrists at Midtown Podiatry. A physical examination will reveal clues and a simple, non-invasive test can give a picture of circulatory health in minutes.

What can be done about PAD?

In the early stages, exercise is the most common recommendation. Exercise increases the overall blood flow to the extremities and can cause blood vessels to form around the blocked area. Smoking cessation is a must if you are a smoker. Nicotine causes blood vessels to constrict, making them even more narrow. Medications which improve the flexibility of the red blood cells have also been shown to decrease symptoms of PAD. In later stages, intervention by a Vascular Specialist may be needed. Recently there have been many recent advances in the surgical management of PAD. Most exiting has been the endovascular removal of those plaques. Endovascular means working inside the blood vessel. It is a minimally invasive technique that can be performed with minimal or no hospital stay.

Should you or a loved one be concerned about PAD, make an appointment online today at Midtown Podiatry, with locations in Midtown, Gramercy, Union Square, Wall Street and Glen Cove immediately for a circulatory screening. We are offering it free of charge to all our patients and to anyone that you know!

*PAD can be a marker for circulatory problems in other parts of the body as well, like kidneys, heart and brain. This test could be a real life saver!

By: Paul J Betschart, DPM

Are you embarrassed of your toenails due to unattractive discoloration? If so, Midtown Podiatry has the solution for you! Using the Cutera Genesis Laser, our podiatrists have perfected the laser surgery technique for getting rid of fungal nails!

Dr. Joseph Larsen discusses what fungal nails are caused by and some treatment options that can be performed to control the fungi. He also mentions other problems the laser surgery can correct such as removal of scars, tattoos, and warts.

To watch the video, click here. 

If you would like to speak with our doctors more about laser surgery and discuss options that are best for you, please contact the podiatrists at Midtown Podiatry, with locations in Midtown, Gramercy Park, Union Square, Wall Street and Glen Cove.

Feel free to browse our laser website for any additional questions.

          Zumba has quickly become the new craze not only in NYC but throughout Hollywood as well; celebrities such as Kirstie Alley, Madonna, and Jennifer Lopez have all expressed their love for the new workout routine. Zumba is an intense fitness program that gets you into shape while you dance away to sensational Latin and International inspired beats.  It combines upbeat, irresistible music, created by Grammy-Award winning producers, with dynamic movements and cardio training to get visible results.  But can this contagious, body-firming, calorie-burning phenomenon take a toll on your feet??  Not if you allow the podiatrists at Midtown Podiatry to help keep you prepared and take the right precautions!!

            I’ve had several Zumba-fanatic patients present in the office with severe foot pain.  Some of the common complaints have been toe cramps, numbness, burning sensation during class, pain on bottom of feet (plantar fasciitis), ankle sprains, blisters, and knee pain.  Of all of these, the most common complaint in my experience has been a burning, numbness feeling in the toes.  The reason this pain occurs is because of to too much pressure on the toes, since most of the movements in Zumba require staying on the balls of your feet.  Several criteria can cause excess pressure, among these are:

• Ill-fitted shoes
• Internal tendon imbalances and joint mal-alignments
• Too much or too little room in the toe box of your sneaker. 

These can all be avoided if you just follow some simple rules and take some precautions:

            The type of sneaker that you choose is crucial.  Many beginners will think that any good quality sneaker is sufficient.  However, due to the types of movements required in Zumba coupled with the aerobic type of activity, improper shoe gear can put you at risk for various foot and ankle injuries.  You need a sneaker with a low tread, something that is light weight, has good shock absorption, and enough support for medial/lateral (side to side) movements.  The low tread will allow you to do the dance-like moves without causing excessive torque to your ankles and knees. 

            A running shoe is a definite no.  This has too much tread and is made particularly to control front to back motion (not side to side).  Contrary to popular belief, a dance shoe is also not the best choice (although better than a running shoe).  A “typical” dance shoe does have low treads and is light weight; however, its thin soles lack shock absorption and support.  Therefore the best sneaker is an aerobic sneaker made for dance.  This shoe will have a thinner sole, few treads, good shock absorption, and support for medial/ lateral movements.

            Also important is to make sure you take at least 5 minutes extra to stretch before and after your workout.  Stretching before exercises will warm up your muscles and will reduce the strain on them during your exercise routine.  Stretching after exercise will allow your heated up and tight muscles to gently cool down to prevent soreness a few hours later.  Doing both of these will drastically reduce your chance of foot injury.

            Lastly, custom molded orthotics can address any structural or functional mal-alignment of the joints, tendons, and muscles of your feet and ankles.  These custom foot inserts made specifically for your feet can easily replace the inserts that come with your sneaker.  At Midtown Podiatry, with locations in Midtown, Wall Street, Union Square, Gramercy Park and Glen Cove we have the proper equipment to make custom orthotics in all of our offices.

            So, there it is folks.  Continue with your irresistible, contagious Zumba programs! Have fun and rewarding workouts, but don’t forget to make an appointment with the podiatrists at Midtown Podiatry to keep those feet Zumba ready!

By: Lisa Shah, DPM