Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Early heel lift with a ankle normal range?

Discussion in 'General Issues and Discussion Forum' started by lorenzo, Sep 21, 2012.

  1. lorenzo

    lorenzo Member


    Members do not see these Ads. Sign Up.
    Hi everybody,
    recently I had a boy about 25, sent to me by a Surgeon Orthopaedic.
    This guy in good health and no neurological deseases, is affected by bilateral plantar fasciitis located on medial tubercle of the calcaneus, pain in the Achilles tendon for about 4 years and in the last year also lumbar spine pain.
    He’s still using arch support without pain decrease.
    The ankle joint range dorsiflexion’s movement with the subtalar joint in neutral position, knee extended and the patient supine is 8° bilateral.
    I did not notice a rocker bottom or subluxation of V metatarsal during the measurement.
    Rearfoot is varus : 4°
    Knee is mildly varus
    RCSP: perpendicular (0°)
    Forefoot: 6° supinated
    NCSP: 8° inversion.
    The gait analysis shows clearly a very evident early hell lift and a pronation syndrome.
    He confirmed that it was noted by his mother since he were a child.
    I advised him, howerever, to use shoes with 2 cm heels.
    In order to reduce the syndrome pronatoria I’d realize a functional orthoses balanced inversion, with 3mm thickness polypropylene and rearfoot posting.
    During the Neutral Suspension Casting I will provide to reduce the forefoot’s supinatus deformity.

    Do someone have any idea about how can be possible early heel lift with a ankle normal range?

    According to your experience do you think I should consider the possibility of any non-biomechanic’s issues?

    Thank you for your kindness
    Best regards.
     
  2. David Smith

    David Smith Well-Known Member

    Your biometric figures seem unlikely are you sure they are correct?

    8dgs ankle dorsiflexion is not particularly good, I would mobilise to get more.

    What is the lunge test like?

    What is the hamstring length like, is there a good hip flexion RoM.

    If the NCSP is inverted 8dgs, why? is the 1st MPJ low or is the stj axis lateral?

    What are thehip levels like, is there and LLD?

    If the hamstrings are tight and if the 1st ray is low then this may lead to a functional ankle dorsiflexion stiffness and manifest as an early heel lift.

    Also some people choose to walk more on their toes - idiopathic toe walking = walks on their toes for no reason we can find.

    Regards Dave
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    We have unpublished data that how far the tibia moves over the foot before the heel comes off the ground has nothing to do with the clinically measured range of motion.

    Some people have a full ROM at the ankle and simple lift the heel off the ground when the tibia becomes vertical; other people do not lift the heel off the ground until the tibia as move 15 or so degrees over the foot.

    It is not a problem unless there is an underlying neuro or behavioral problem causing the earlier heel off.
     
  4. lorenzo

    lorenzo Member



    Thank you for your kindness and excuse me not to be able to answer you earlier.

    In my opinion values are quite reliable. I do not have a thorough knowledge of this Lunge test, about ankle range’s evaluation I refer to Root’s theories.
    This guy had no LLD, hip flexion was normal and NCSP(8° INVERT) was caused by rearfoot varus (4°) with a tibial stance 3° varus, STJ in neutral.
    Could be a pronation syndrome caused by rearfoot varus, totally compensated (RCSP perpendicular) .
    Maybe this could be one of those exception you and Dr. Craig referred to.

    Best regards
     
  5. lorenzo

    lorenzo Member




    Egregious Doctor Craig
    thank you very much for your helpful explanation.

    Best regards
     
  6. davsur08

    davsur08 Active Member

    Hi Craig,
    In reflection to the study you mentioned would ankle equines and early heel lift are non-related? I havent found any study (in my search) that proves this assumption is right but i was taught in pod school this is right. considering in a patient with no osseous resistriction in the ankle, manipulation of the ankle joint (which is documented and discussed here on arena) has no clinical relevance?

    Can i plaese have a copy of the study??

    Many Thanks
     
  7. David Wedemeyer

    David Wedemeyer Well-Known Member

    Lorenzo,

    Probably pain avoidance a tight tendoachilles and possibly overactive or unopposed posterior tibial tendon may be contributing?
     
  8. lorenzo

    lorenzo Member

    Hi David,
    I do suppose the possibility of a tight tendoachille’s pain avoidance, but the patient told me that it was noted by his mother since he were a child.

    Thank you so much
     
  9. efuller

    efuller MVP

    The Achilles tendon has a muscle attached to it that is activiated by the Central Nervous System(CNS). This activation may occur before the joint has reached its passive end of range of motion. Additionally, you may see the early heel off in some active runners, where they will have a pronounced contraction when testing reflexes. So, a "conscious" or reflex contraction of the muscle could prevent dorsiflexion to the tested end of range of motion.

    Eric
     
  10. lorenzo

    lorenzo Member

    Hi Eric,
    thank you for your explanation,
    according to your experience about people with a normal ankle range and an early heel lift, do you think could be correct to recommend the use of heel’s shoes to those people who generally don’t play any sport?

    Thank you.
    Best regards.
     
  11. fabio.alberzoni

    fabio.alberzoni Active Member

    hi everybody.

    1 - Did you ever asked him if he used a baby walker?("girello" in italian language). There's a lot of articoles talking about neurology's desease linked with the use of the baby walker...This studies links it to alteration in gait (with early heel lift) and even links it to autism.

    2 - If in RCSP the calcaneus results vertical that obviouvsly means that STJ is pronated of 7° (3° of tibial stance varus + 4° of NCSP). I think that plantar fascia is in tension and the linkage with the fibers of Achilles tendon could be one of the etiology's factors.

    Probably I'm wrong with the II point...but could be interessing to see a lateral RX to see the position of the calcaneus...

    fabio
     
  12. efuller

    efuller MVP

    sorry I missed the question earlier. People can have an early heel lift without having pathology. If they came to you complaining of arch strain or forefoot pain then you could consider adding a lift of some kind. I wouldn't worry about verticality of the calcaneal bisection. The person might have pronation relatetd problems if they have a medially positioned STJ axis and an early heel off. They might have pronation related problems if they have a medially positioned STJ axis and they dont have an early heel off.

    Eric
     
Loading...

Share This Page