To continue with the sole and heel a bit, it helps to think of the foot from the point of view of the ground itself. You leave a real impression on it, you know. Well, at least when it's the bare earth. But there are several things that occur when you take a step, besides what your body appears to be doing. First, there is the force of gravity. When your foot hits the ground, it does so with motive force (that's the part you put into it,) and gravitational force (that's the part gravity's force upon your body adds to the mix.) You might think the earth doesn't notice such an insignificant force as your stepping on it, but in fact, it does so through something called the "ground reaction force." Essentially, this is the effect of you pushing on the earth and the earth pushing back. And it is this ground reaction force that helps propel you on to your next step, as well as contribute to the responding shock wave that occurs as your foot impacts the ground. Various factors can amplify or reduce the degree of impact - body weight, shoe materials, heel height and shape, and your specific biomechanics.
It helps to view the heel and sole of your shoes, and, when they are included in the mix, your orthotic devices, as mediators or translators between the shape and composition of the type of ground you are walking on, and your specific bio- or patho-mechanics. That is, these interceding materials (sole, heel, orthotic) either reinforce the interaction, or change it. Think of what happens when you walk on a sidewalk that is tilted toward the street, as most are (to varying degrees.) If the street is to your right, then your right foot is lower than your left relative to perpendicular - you are no longer walking at 90 degrees to the earth, but offset by x-degrees. And, because you are bi-pedal, it forces one leg into a longer relationship with the ground, and the other leg into a shorter one. Of course, you could try to walk at 90 degrees to the tilted sidewalk, but that is not a simple proposition (I'll explain this more later.) The altered shape of the sidewalk has changed your entire biomechanics - temporarily, of course. But for the most part, our bodies can adapt to such a (relatively) short-term change - we are an adaptive animal. And it is the way our bodies were evolved to deal with uneven surfaces that makes us unique among bi-pedal creatures.
But here's the problem - we walk on uneven surfaces less frequently than on hard, flat, unyielding surfaces due to the modern world's obsession with paving and other materials to "manage" our interactions with the planet we walk upon. So that great adaptive mechanism of our body deals less with continually changing forces and more with repetitive forces. Concrete, wood, tiles, etc., all produce more direct and harsh ground-reaction forces than the bare earth ever does. And, we pay a price for this with every step we take. When we add to this mix poor biomechanics, as we clubbies are pretty good at doing, we have even more negative impact - on joints, muscles, tendons, ligaments - and this can lead to early arthritic changes due to this "translation" of force and response. But what it we insert something between our feet and the ground? Let's start with our shoes.
As I said in the last post, the heel raises your rear foot higher than your forefoot. It therefore changes the relationship of your body's center of gravity (COG) relative to the ground - it shifts the COG forward. This causes your body to make certain adjustments, all quite subtle, but clearly measurable. First, you bend your knees slightly, which per,its your pelvis to settle back a bit, thereby keeping your spine aligned perpendicular to the ground. If your body didn't make these adjustments, you would feel like you were always falling forward. Obviously, that would be hard to tolerate for very long. It turns out there are two things the body must maintain according to their specific original designs - our inner-ear balance, and our visual horizon line. If the visual horizon appears un-level, we will always adjust our posture and gait to restore this visual perception of the horizon - side to side, as well as forward and backward. That 90 degree relationship to the ground is critical to our being able to function in relative comfort, so the body is designed to compensate in many ways to maintain that relationship.
As for our inner ear - if you've ever had the misfortune to have an inner- ear infection, and get vertigo, you will understand quite easily why it is so important. If our "vestibular balance" is thrown out of whack by vertigo, we cannot properly perceive where the ground is from one step to the next. So too should our biomechanics get off-kilter, and we will adapt, or compensate, in order to eliminate this imbalance. So by changing the relationship between the ground and the body, via heels, orthotics, or via the shape of the ground, our body uses this idea of compensation to mediate that relationship.
Try this little experiment - tape some materials, say, some stacked cardboard, to the sole of your shoes - same amount, both shoes, but not to your heels. Use enough to make the soles higher than the heels. Now, walk around the room a few minutes. What do you notice? Your knees? Your hips? Your back? How about your balance - what happens there? What this does is to reverse the usual experience of having your shoe's heels higher than the soles, and now you can see the demands any change to your relationship to the ground makes on your body. But don't continue this experiment too long - it will actually cause your kees to "hyper-extend" and can cause some real issues over time. back in the 70's, a shoe called the Earth shoe tried to convince everyone this was a better way to walk, just because that is how your foot acted when you walk on the beach. But how much time do you actually spend walking on the beach?
OK, next time, we'll look at what happens when you alter the relationship between your body and the ground side-to-side. For now, you have enough information already to do your own experiments - observe how you walk, and try to get a sense of how one side of your body might respond differently than the other side - more impact at heel strike, more or different muscle use on one leg as compared to the other. Observe your pain - is it greater in one area on one foot than on the other. If you are a uni-clubby, this should be an easy experiment, compared to us bi-clubbies, but even with bi-CF, there will be some differences. See you soon.
It helps to view the heel and sole of your shoes, and, when they are included in the mix, your orthotic devices, as mediators or translators between the shape and composition of the type of ground you are walking on, and your specific bio- or patho-mechanics. That is, these interceding materials (sole, heel, orthotic) either reinforce the interaction, or change it. Think of what happens when you walk on a sidewalk that is tilted toward the street, as most are (to varying degrees.) If the street is to your right, then your right foot is lower than your left relative to perpendicular - you are no longer walking at 90 degrees to the earth, but offset by x-degrees. And, because you are bi-pedal, it forces one leg into a longer relationship with the ground, and the other leg into a shorter one. Of course, you could try to walk at 90 degrees to the tilted sidewalk, but that is not a simple proposition (I'll explain this more later.) The altered shape of the sidewalk has changed your entire biomechanics - temporarily, of course. But for the most part, our bodies can adapt to such a (relatively) short-term change - we are an adaptive animal. And it is the way our bodies were evolved to deal with uneven surfaces that makes us unique among bi-pedal creatures.
But here's the problem - we walk on uneven surfaces less frequently than on hard, flat, unyielding surfaces due to the modern world's obsession with paving and other materials to "manage" our interactions with the planet we walk upon. So that great adaptive mechanism of our body deals less with continually changing forces and more with repetitive forces. Concrete, wood, tiles, etc., all produce more direct and harsh ground-reaction forces than the bare earth ever does. And, we pay a price for this with every step we take. When we add to this mix poor biomechanics, as we clubbies are pretty good at doing, we have even more negative impact - on joints, muscles, tendons, ligaments - and this can lead to early arthritic changes due to this "translation" of force and response. But what it we insert something between our feet and the ground? Let's start with our shoes.
As I said in the last post, the heel raises your rear foot higher than your forefoot. It therefore changes the relationship of your body's center of gravity (COG) relative to the ground - it shifts the COG forward. This causes your body to make certain adjustments, all quite subtle, but clearly measurable. First, you bend your knees slightly, which per,its your pelvis to settle back a bit, thereby keeping your spine aligned perpendicular to the ground. If your body didn't make these adjustments, you would feel like you were always falling forward. Obviously, that would be hard to tolerate for very long. It turns out there are two things the body must maintain according to their specific original designs - our inner-ear balance, and our visual horizon line. If the visual horizon appears un-level, we will always adjust our posture and gait to restore this visual perception of the horizon - side to side, as well as forward and backward. That 90 degree relationship to the ground is critical to our being able to function in relative comfort, so the body is designed to compensate in many ways to maintain that relationship.
As for our inner ear - if you've ever had the misfortune to have an inner- ear infection, and get vertigo, you will understand quite easily why it is so important. If our "vestibular balance" is thrown out of whack by vertigo, we cannot properly perceive where the ground is from one step to the next. So too should our biomechanics get off-kilter, and we will adapt, or compensate, in order to eliminate this imbalance. So by changing the relationship between the ground and the body, via heels, orthotics, or via the shape of the ground, our body uses this idea of compensation to mediate that relationship.
Try this little experiment - tape some materials, say, some stacked cardboard, to the sole of your shoes - same amount, both shoes, but not to your heels. Use enough to make the soles higher than the heels. Now, walk around the room a few minutes. What do you notice? Your knees? Your hips? Your back? How about your balance - what happens there? What this does is to reverse the usual experience of having your shoe's heels higher than the soles, and now you can see the demands any change to your relationship to the ground makes on your body. But don't continue this experiment too long - it will actually cause your kees to "hyper-extend" and can cause some real issues over time. back in the 70's, a shoe called the Earth shoe tried to convince everyone this was a better way to walk, just because that is how your foot acted when you walk on the beach. But how much time do you actually spend walking on the beach?
OK, next time, we'll look at what happens when you alter the relationship between your body and the ground side-to-side. For now, you have enough information already to do your own experiments - observe how you walk, and try to get a sense of how one side of your body might respond differently than the other side - more impact at heel strike, more or different muscle use on one leg as compared to the other. Observe your pain - is it greater in one area on one foot than on the other. If you are a uni-clubby, this should be an easy experiment, compared to us bi-clubbies, but even with bi-CF, there will be some differences. See you soon.
As always very practical and useful articles. Thank you .
ReplyDeleteThank you, prozac and clubfoot, or should I say, Flood Law Group? I appreciate your interest, but feel I must take exception to an item posted on your practice area page for clubfoot, and I quote:
ReplyDelete"Long-Term Outlook
If a baby with club foot is treated properly early-on, he or she will most likely wear normal shoes, participate in sports, and lead a normal life. The affected foot, however, is in general 1 to 1 ½ shoe sizes smaller than the other foot and the calf may be a bit thinner."
I am afraid this is essentially incorrect, though it is the "party line" of the medical establishment.
Even by the standards of the best outcomes via the Ponsetti approach, there remain a negative long-term outcome between 10-15%, and that is by one of the Ponsetti Institute's own studies. When you look at the outcomes from more traditional techniques, where far more surgical intervention occurs, the results are even more dismal (See Dobbs, et. al) I appreciate the need on a law web site to "thumbnail" the content (you would be surprised what my day job is!), you do a disservice to thousands of us clubbies who deal with the failures of the medical community every day of our lives.
It is, I think, one thing to pursue aspects of causation from sources other than genetic carry, and for that, I applaud your efforts. But please try to not continue the misinformation we clubbies have to deal with daily. I, through this blog, and many others, struggle against this misinformation with bureaucrats and doctors continuously, because the "party line" still says we have been "corrected" and this is simply not the case. Re-configured, yes, but "corrected?" Not on your life, counselor!