Pathomechanics of the foot are responsible for disruptions in the normal functioning of the lower limbs and the musculoskeletal system.
The resulting alterations to gait not only limit the ability of the lower limbs to achieve maximum levels of efficiency during motion, but also create asymmetries that become visually prominent in the feet and the rest of the body.
A good measure of identifying postural instabilities is the structure of the foot, particularly the height of the medial longitudinal arch.
A pes cavus foot will exhibit signs of oversupination in addition to the calcaneus being medially displaced to the talus; there is a misalignment between the rearfoot and forefoot which is seen either as a plantarflexion of the forefoot on the rearfoot or a dorsiflexion of the rearfoot compared to the tibia.
Pes planus is characterised by a collapsed medial longitudinal arch and a valgus positioning of the heel to the forefoot; this results in the calcaneus being displaced laterally, which in turn, causes the tibiotalar contact area to also shift laterally.
There is a marked increase in the valgus load on the lower limbs, particularly the subtalar joints and the knees.
The effect on the knees was investigated in detail in a study conducted by K. Douglas Gross of the MGH Institute of Health Professions, by studying the frequency of knee pain and the occurrence of cartilage damage in the planus feet of older adults.
He observed that in comparison to other types of feet, the planus foot was 30% more susceptible to knee pain and 40% more susceptible to medial tibiofemoral cartilage damage.
In order to restore the optimal alignment of the joints in the lower limbs, it becomes essential to allow for the movement of all the articulations through their functional range of motion; this can be achieved through the use of customised orthotics which are designed to accommodate individual specifications, unique to each foot structure.
The medial longitudinal arch can be stabilised by building up strength in the intrinsic and extrinsic musculature of the foot through strengthening and stretching exercises; this would help in regulating the rate of pronation and giving motion control to the foot while adding more stability to the foot and promoting a normal gait.
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