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Supinated heel strike early heel lift

Discussion in 'Biomechanics, Sports and Foot orthoses' started by g-lo1, Feb 15, 2020.

  1. g-lo1

    g-lo1 Member


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    Bi- lateral supinated heel strike with bi-lateral early lift.
    How do I explain this to a client?
    Yes the heel strike is inverted but the heel contact is minimal.
    ???
     
  2. gary wain

    gary wain Welcome New Poster

    Sounds like possibly a tight calf complex?
     
  3. efuller

    efuller MVP

    Two completely different reasons for an inverted heel. One, it is maximally everted at the subtalar joint at an inverted position relative to leg or ground. This is lack of eversion range of motion. Another reason is that the STJ is in a position inverted from its maximally pronated position. To differentiate, maximum eversion height test or coleman block test.

    Early heel off: two reasons:1) bony block at ankle joint (more often with cavus foot). 2) Tension in the Achilles tendon (active or passive)

    If your question is why do you see supination with an equinus, it helps to understand what an equinus does to the location of center of pressure. There was a time that it was thought that the "compensation" for an equnius was pronation of the STJ. However, this simplified explanation does not look at the moments that cause the motion. What an equinus does is shift the center of pressure anteriorly sooner in gait. What this shift does is dependent on the location of the STJ axis. The Achilles tendon tension is medial to the STJ axis and the direct pull of the tendon will cause a supination moment. In most feet, or feet with an average STJ axis location, the anterior shift of the center of pressure will create a pronation moment from ground reaction force. For most feet the pronation moment from ground reaction force is greater than the supination moment from the direct pull of the tendon and a net pronation moment is created. (This ignores input from the peroneal and posterior tibial muscles that may add moments that change the net moment to something different.) In some feet, with a more lateral than average axis of the subtalar joint, the anterior shift in the center of pressure caused by the early heel off, may not cause a pronation moment because the center of pressure may not be lateral to the STJ axis. In these feet there would be a net supination moment (ignoring the effect of other intrinsic muscles.)
    It would help if your patient was a mechanical engineer when you try to explain that to them.

    Eric
     
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