Foot Posture and Alignment
Our feet are amazing machines, managing without complaint most of the time to transmit the weight of the body as we propel ourselves around at varying speeds, all the while keeping balance and a secure connection with the surface. While foot posture can vary quite greatly without particular painful problems, many alterations in foot posture can result in painful symptoms and significant levels of disability. The levels of force transmitted through the feet demand strong and flexible joints, muscle strength and neuromuscular coordination for balance and control.
The changes which occur in the feet can be postural and relate to the positions of the anatomical structures in weight bearing, or be dynamic in that the postural abnormality occurs fleetingly but regularly in walking or running. The rear of the foot, the hind foot, is commonly affected in that the heelbone can be angled outwards to a degree, stressing the inside joints of the ankle and throwing the weight of the foot inwards. The main, or longitudinal, arch of the foot can be reduced naturally from early on in life or can reduce with time as the ligaments stretch and the position of the bones maintaining the arch changes.
The forefoot arch can also reduce, forcing more pressure from the first metatarsal head onto the second and third metatarsal heads, causing callouses and pain to develop under the ball of the foot, which along with thinning tissues in this area in pain can give significant problems. Physiotherapy assessment of the foot starts with looking at the foot in static standing to get an idea of the main posture tendencies of the foot, then look at the patient walking to assess the dynamic patterns of movement and joint stability. The physio will manually assess the individual joints for their anatomical and accessory movements and stress the joints to test that they can cope with that without pain.
Physiotherapy management can involve mobilisation techniques to restore joint movements, strengthening exercises for the general muscles and arch stabilisers, alterations in gait pattern and choice of footwear and prescription of insoles. Ready made insoles can be heat moulded to the desired shape of the patient''s foot and small corrections applied to realign the joint complexes correctly for the desired mechanical alignment of the joints. Insoles are easy for the physio to apply and can be adjusted until the patient feels they are getting a good result.
Author: Jonathan Blood-Smyth