Biomechanical examination at Auckland Sports Podiatry.

Each initial consultation involves a multi-step process, including:
  • Thorough injury and medical history taking
  • General alignment assessment while lying down – non weight bearing
  • Manual muscle testing and range of motion analysis non weight bearing
  • Lower leg and global alignment assessment while weight bearing
  • Functional muscle testing and range of motion analysis weight bearing
  • Motion analysis using video gait analysis software
  • An explanation for the problem/condition and prognosis
  • Treatment plan discussed verbally
  • Possibly initiate first phase of treatment

First ‘hands-on’ step involves testing the foot and ankle with the yourself lying down, looking at the rear foot and forefoot alignment and the amount of ankle dorsiflexion. You are then examined in a standing position to determine how the foot and lower leg are aligned during weight bearing. These are the basic sports podiatry tests to help diagnose various longstanding problems.
Additionally, your posture, stability and flexibility in the leg, hips and back are assessed. This information helps the sports podiatrist to understand more about your condition more than simply what is occurring in the feet. For example, a lordotic posture with the pelvis tilted forward causes an inward rotation of the knees which in turn inwardly rotates the tibia which promotes an everted ankle (pronated position). Additionally, tight calf muscles are related to over-pronation, as the foot compensates for a lack of dorsiflexion range by rolling inwards.

The sports podiatrist tests the strength of the four main ankle movements - plantar flexion, dorsiflexion, eversion and inversion - with the use of manual muscle tests. The purpose is to assess the ability of the ankle joint to resist various external forces and control eccentric motion. For example, one contributory factor to excess pronation could be weak invertor muscles. When the foot strikes the ground it rolls inwards; this is called ankle eversion or pronation. It is the ankle invertor muscles that act eccentrically against gravity to control this pronation movement, and if these are weak the pronation movement may be too fast or too great.

Motion analysis

Your biomechanics in motion are then analysed, using highly effective gait analysis software. Lines are placed on the front of the leg and rear of the heel and Achilles to help determine the range of motion of the various joints in the lower leg with normal function.
Initially, this simply involves watching the foot motion during walking on the floor, with your Sports Medicine Podiatrist making subjective judgments about the gait pattern. Your movement, walking and running is then analysed on a treadmill with a digital video camera from the rear and side view. The digital camera allows for freeze-frame analysis of specific points in the gait cycle.

Your Sports Medicine Podiatrist is particularly interested in the degree of supination of the foot at contact, the degree of pronation during stance, the timing of pronation and the degree of re-supination at toe off.
For example, the foot is meant to pronate to absorb the energy of landing. This pronation is normal and necessary (4-6 degrees), but if the foot stays fully pronated throughout the stance phase and does not re-supinate, then the foot is less rigid during toe off and the adjacent structures have to work harder to compensate, thus increasing overuse injury risks. Think of it this way - The vast majority of forces should dissipate nicely through the skeleton – the body’s hardest structure, whereas various ligaments, tendons and muscles should act as temporary reinforcing structures. Yet in an overuse context, these temporary reinforcing structures are now consistently under strain, rather than mildly and temporarily being under strain. The sports podiatrist is also analysing the degree of pelvic drop on the free side during swing phase and the postural alignment during running and walking. For example, if there is an obvious amount of pelvic drop this can cause internal rotation of the knee and promote pronation.
If necessary, the sports podiatrist also analyses the motion during a sports specific movement, eg, moving to catch netball or kick a soccer ball, to check for any problems in these non-linear positions.

From the results of this comprehensive analysis, your sports medicine podiatrist can paint a picture of the various causes of the problem. These causes are usually a combination of factors, such as poor flexibility, strength and mis-alignment of the foot or lower leg. The main purpose of an orthotic is to place the foot in a position in which it can move naturally and remain stable. Therefore, the orthotic tackles only the mis-alignment problems. The flexibility, strength and core stability deficiencies discussed above, which can all contribute to poor foot mechanics, will not be improved by prescribing orthotics alone. These aspects require an active rehabilitation programme which the patient must follow. The components of a typical programme could include the following elements:

Flexibility exercises: various stretches for the gastrocnemius/calf muscle, soleus and any other leg, hip or back muscles which are found to be tight.

Strength exercises: dorsiflexion, plantar flexion, eversion and inversion exercises using resistance bands and closed chain ankle plantar flexion exercises standing, with static inversion and eversion.

Core stability exercises: abdominal hollowing to improve the lumbar control and posture, standing pelvic tilting to improve the gluteals' ability to keep the pelvis level during the swing phase.

Your sports medicine podiatrist also helps you decide on the correct training shoes, recommending the shoes that suit your particular foot type and problem, and checking the effectiveness of the shoe using the digital camera.

Modern sports medicine podiatry must recognise the individual patient's needs and customise the prescription accordingly, you’ll be happy to know that every step of the treatment process is documented. It is company policy to have your images saved for future reference; you can rely on Auckland Sports Podiatry to provide an exceptional service and get to the bottom of all your biomechanical problems.