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One flat foot

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Footsies, Jun 18, 2007.

  1. Footsies

    Footsies Active Member

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    Hi all :D

    I am just going to throw this one out there.....What are ALL the possible reasons that one foot can be more pronated then the other in stance and gait? For example - the left foot has too many toes sign, navicular bulge, medial to off etc, and the right foot is fairly neutral.

    Limb length discrepancy is the obvious one (functional and anatomical)

    What other reasons could there be??

  2. DaVinci

    DaVinci Well-Known Member

    Surely every single cause of a pronated/flat foot can be assymetrical in its effect!!
  3. Craig Payne

    Craig Payne Moderator

    Actually its NOT. A structural LLD is not compensated for by assymetrical foot pronation. Its just another one of those podiatric myths.
  4. conp

    conp Active Member

    Please elaborate Craig.
  5. GarethNZ

    GarethNZ Active Member

    Post tib dysfunction causing progressive change with the signs that you mention...
  6. Craig Payne

    Craig Payne Moderator

    Its a myth that the foot on the long side in a structural LLD pronates more than the foot on the short side. See this thread.
  7. Peter

    Peter Well-Known Member

    Tarsal coalition
  8. conp

    conp Active Member

    Thanks Craig for redirecting me to previous thread on LLD and pronation.

    Although (it seems from the thread) many believe or have been wrongly taught increase pronation occurs in the foot of the longer side with structural LLD, I was always of the belief that the shorter side is more likely to pronate in SLLD(no scientific evidence OR clinical evidence as I have not seen enough Structural LLD to ascertain this- just purely biomechanical thinking on my behalf)

    As a sufferer of scoliosis, i understand how my right foot belonging to the 'longer limb' of this FLLD pronates more than my left. This is predictable as proximal forces hold down my R hip lower than my L. Therefore the simplest mode of adaption is for R internal rot etc etc.

    However in SLLD the hip on the shorter side is at a lower position than the longer side and therefore (depending on the amount of proximal accomodation) would have a tendancy to bear more weight as the centre of mass may deviate to this side. Again this is dependant on what is happening proximally and of course at the knee level of the longer limb.

    Of course it could be suggested that the longer limb may attempt to internally rotate to address discrepancy but I cannot see this happening as readily as it does in FLLD. Importantly we cannot dismiss the fact that scoliosis (as in my case) is a 3D problem and the rotational component can significantly promote the internal rotation of longer limb in FLLD. So I am not suprised with the results of your literature and study findings. I thought it may be 'tilted more' :) the other way

    Am I completely 'left' :) (in my case right) field on this one????
  9. tarik amir

    tarik amir Active Member

    with associated peroneal spasm
  10. I had'nt seen that before. Interesting stuff. Craig, Did you every get around to publishing the data you talked about in that thread? The link to the isb abstract seems to be dead.

  11. conp

    conp Active Member

    Hi All,
    I have not been shot down over my last post so I suppose that this podiatry myth is no longer.
  12. elena

    elena Welcome New Poster

    How old is the patient?Adult flat foot or dysfunction tibial posterior...
  13. Any functional or structural abnormalities of the foot and lower extremity that cause either increased subtalar joint (STJ) pronation moment, and/or increased dorsiflexion and abduction moment of the midtarsal joint (MTJ) may manifest itself as asymmetrical pronation on one foot more than the other.

    These causes of asymmetric pronation may be lumped into the following six categories:

    1. Congenital malformation of osseous segments/joints of the foot/leg.
    2. Traumatic/postsurgical malformation of osseous segments/joints of the foot/leg.
    3. Congenital weakness of muscles that cause STJ supination and MTJ plantarflexion/adduction moment.
    4. Acquired weakness of muscles that cause STJ supination and MTJ plantarflexion/adduction moment.
    5. Neurologically induced weakness of STJ supinators/MTJ plantarflexors/adductors and/or spasticity of STJ pronators/MTJ dorsiflexors/abductors.
    6. Traumatic stretching or tearing of plantar fascia or other plantar ligaments of medial longitudinal arch.

    By the way, even though limb length discrepancy may theoretically possibly cause asymmetric foot pronation in some patients, I agree with Craig that this idea that a long leg always causes more foot pronation is a common podiatric myth. I believe this myth persists because the above six main categories of asymmetric foot pronation were probably never taught as other potential causes of asymmetric foot pronation in podiatry school and therefore were never considered as reasons for asymmetric foot pronation by the examining podiatrist.
  14. Stanley

    Stanley Well-Known Member


    You bring up some good points. The key is to evaluate your patient properly and to be able to utilize the information you obtain. You can have several possible patterns and therefore any study that looks at just pronation and leg length will not see a relationship.
    In your case of scoliosis, you have a shortage due to the concavity of the spine. There is a raised pelvis on the functional short side. Depending on what joints compensate, determines whether there will be pronation or not. Someone who just looks at the hips to the ground would incorrectly call your functionally short leg a long one.
    The key thing is to look at the patient. Determine if the asymmetry is above the pelvis or below, check for equinus, and see what happens when you put the foot in neutral.
    Anything can cause an asymmetry. I had a figure skater that couldn't do a mandatory figure on one leg. I stood her up and she had a noticeable curve in her spine. There didn't seem to be any reason for it, as she had flexibility in her spine, so I had her close her eyes and I wiggled her by the arms. She stood up straight as a poker. When she opened her eyes and focused on my finger, she started curving again. I sent her to an optometrist for some eye exercises, and this cured her problem. Will you see this? Probably not. I have only seen it once in 30 years.
    Just as a simple rule (and this applies only if you have ruled out scoliosis and sacroiliac dysfunction) is if the ASIS and PSIS are level in neutral calcaneal stance position and both drop on the same side in relaxed calcaneal stance position, then primary foot pronation is causing the asymmetry (so look at the foot as the cause). If the ASIS and PSIS are high on the same side in neutral calcaneal stance position and become level during relaxed calcaneal stance position, then pronation is a compensation for the asymmetry (so look at the asymmetry as the cause).
    Regarding short leg pronation versus long leg pronation, if ankle equinus is the compensation for a shortage, then eventually pronation will develop on this side. So we end up with a short leg with pronation. We can also see pronation as a compensation for the long leg by the evaluation above. So if you take a population and just look at pronation and leg length, you will not see a correlation between long legs and pronation.


  15. Footsies

    Footsies Active Member

    Thanks Kevin, that info is really helpful - that's the answer I was looking for when I started the thread.
  16. conp

    conp Active Member

    Hi Guys,
    Just saw a patient and had to smile as he presented with unilateral foot pronation. HOWEVER does not fall into Kevin's '6' catergories for causes of unilateral foot pronation. Any guesses???
    I have given you a slight hint ("I had to smile")
  17. Footsies

    Footsies Active Member

    did he only have ONE foot?
  18. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Must have been hysterical gait then. ;)

  19. conp

    conp Active Member

    'HOLE IN ONE'!!!!!!!!!!!
    well done footsies!

    and I like your thinking LL.
    Of course I had to hide my smile as this would have been completely inappropriate.
  20. CraigT

    CraigT Well-Known Member

    Did you get the standard question that patients with only one foot always ask...

    'Will you only charge me half price?'

    Your smile may have been inappropriate, but I find that these are the patients that are most likley to share a joke with their Pod...
  21. Footsies

    Footsies Active Member

    it's like the 9 toe discount question!
  22. conp

    conp Active Member

    Your right CraigT, they do take a joke very well and (yes) when I was asked the question of discount I used my barber's line "No discount because there is a search fee" He laughed!

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