Human Locomotion – Thomas C Michaud

This deformity is referred to as a plantarflexed forefoot and it most likely results from strength imbalances present between the long and short digital flexors and extensors present before skeletal maturity. The plantarflexed forefoot typically produces a marked clawing of the digits secondary to the increased metatarsal decline angle, and is often responsible for injury to the anterior talocrural articulation and/or posterior knee, because the ankle is unable to provide the dorsiflectory range necessary to compensate for the plantarflexed metatarsals (Fig.

4.74). Conservative treatment of this deformity requires a heel lift of sufficient height to allow the tibia to tilt a minimum of 10° forward from vertical. Rarely, the forefoot may be so severely plantarflexed that surgical intervention is necessary to realign the metatarsals. Figure 4.74. Mechanical dysfunction associated with a plantarflexed forefoot. When a normal metatarsal decline angle is present (A), the ankle will readily supply the range of dorsiflexion necessary for noncompensated function during late midstance (B).

However, when a plantarflexed forefoot is present (C), the entire rearfoot is tilted posteriorly, and the ankle, which typically possesses a maximum of 20° dorsiflexion, is often unable to allow the leg to reach vertical (D). This forces the knee into hyperextension and predisposes to impingement exostosis, because the anterior tip of the lower articular surface of the tibia repeatedly collides with the neck of the talus (star).

The plantarflexed forefoot deformity may be so great that even with compensatory hyperextension of the knee (E), the heel is unable to make ground contact, and the individual may walk and stand with weight supported entirely by the plantar forefoot. Lastly, although uncommon, it is also possible to have a deformity in which one or more of the metatarsals are dorsiflexed relative to the common transverse plane. As with plantarflexed metatarsals, the dorsiflexed metatarsals may be congenital or acquired and can be differentiated by checking the available ranges of dorsi and plantar motion.

The congenital deformity (which is usually larger but quite rare) possesses equal ranges of upward and downward movement (Fig. 4.75A), while the acquired deformity presents with asymmetrical dorsi-plantar movement patterns that vary between the two feet (Fig. 4.75B). When the first metatarsal is dorsiflexed relative to the lesser metatarsals, it is also referred to as a metatarsus primus elevatus. While the acquired form of this deformity occasionally results from tonic spasm of tibialis anterior, more often it results from first ray compensation for a chronically everted heel (refer back to Fig.

4.36). Over time, bony and soft tissue changes occur that maintain the dorsiflexed position of the first metatarsal. Assuming the dorsiflexed first ray associated with an everted heel is able to return to the level of the lesser metatarsals, treatment should include a functional orthotic that lessens subtalar pronation.

All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. Neither the author nor the publisher assumes any responsibility for injury and/or damage to persons or property resulting from or related to the use of this book or any material contained in it. This publication contains information describing specific treatment protocols that should not be construed as instructions for individual patients.

The treating practitioner is solely responsible for prescribing patient treatment protocols, based on independent clinical expertise and knowledge of the patient. Michaud, Thomas C. Human Locomotion: the conservative management of gait-related disorders/ Thomas C. Michaud p; cm. UUID 49ee9d26-554f-45fe-acce-1aa2b80b1229 ISBN 978-0-615-51645-5 (hardcover) 1. Human locomotion-bipedality. 2. Gait analysis. 3. Orthotic devices. 4. Manipulation, chiropractic techniques. OceanofPDF.com ABOUT THE AUTHOR Since graduating from Western States Chiropractic College in 1982, Dr. Michaud has published numerous book chapters and dozens of journal articles on subjects ranging from the treatment of tibial stress fractures in runners, to the conservative management of shoulder injuries in baseball players.

In 1993, Williams and Wilkins published Dr. Michaud’s first textbook, Foot Orthoses and Other Forms of Conservative Foot Care, which was eventually translated into four languages and continues to be used in physical therapy, chiropractic, pedorthic, and podiatry schools around the world. This ebook is the digital version of his latest textbook, Human Locomotion: The Conservative Management of Gait-Related Disorders. It has over 1100 references and is one of the most detailed reviews of running biomechanics ever published.

Dr. Michaud has written a lay version of Human Locomotion, entitled Injury-Free Running: How to Build Strength, Improve Form, and Treat/Prevent Injuries, available in print and ebook versions. In addition to lecturing on clinical biomechanics internationally, Dr. Michaud has served on the editorial review boards for Chiropractic Sports Medicine and The Australasian Journal of Podiatric Medicine. Over the past 30 years, Dr. Michaud has maintained a busy private practice in Newton, Massachusetts, where he has treated thousands of elite and recreational runners.

You can find links to Dr. Michaud’s articles and interviews, and order his textbooks online at www.humanlocomotion.org, or at Amazon.com.

This is a short excerpt from the opening of “” by Unknown, quoted for review and introduction purposes. All rights belong to the copyright holders.

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