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People with this foot-type walk very toe-out. Picture how a gunslinger from an old western movie made his entrance into the local saloon! If you’re not a fan of the westerns, think of a penguin or a duck! The primary consideration here is simply that the rearfoot cannot pronate at the subtalar joint. Why? Because it is uncompensated which means that calcaneal eversion is not possible! Furthermore, if a person with this foot-type attempts to stand with their feet straight ahead, they will complain that their hips hurt! Why? Since an individual with this foot-type cannot pronate at the subtalar joint, loading the inner aspect of their feet is extremely difficult. As a result they will attempt to acquire the necessary motion by externally rotating at the hips. The muscles that externally rotate the hips become chronically shorted as a result of this gait pattern. Thus, standing with their feet straight ahead is extremely uncomfortable.
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Contact Phase
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At initial contact, the calcaneus strikes the ground in an excessively inverted alignment relative to the floor. Since the rearfoot deformity is uncompensated, very little subtalar joint pronation is observed as the forefoot is lowered to the ground to conclude the contact period of gait. Limited subtalar pronation results in a lack of normal shock attenuation and difficulty loading the inner (medial) portion of the foot. The hips remain externally rotated, resulting in a large toe-out gait. In other words, the feet and knees are pointing away from each other.
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Midstance Phase
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As weight moves forward over the foot, the arch and midtarsal joint remain rigid, with excessive pressure borne along the lateral column of the foot. Note that you cannot easily see the arch from the back due to the large toe-out limb position. If you compare contact to midstance, there is little to no change in foot position since this foot-type is unable to pronate (note persisting heel inversion). |
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Propulsion Phase
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As the heel lifts off the ground to initiate propulsion, the 1st metatarsal head should normally be in full contact with the ground and ready to accept weight. In cases of very large uncompensated RF deformities, this is not possible since the varus alignment of the rearfoot elevates the entire inner (medial) border of the foot from the ground. Instead, at heel rise, the foot and ankle must first tilt inward to complete loading of the 1st metatarsal head. The toe-out nature of this gait means that final propulsion will occur off the medial edge of the hallux, resulting in a pinch callus on the inside edge of the big toe. In addition, you may often see large, red “bumps” on the back of the heels, known as RCB’s, or Retro-Calcaneal Bumps. They develop as a result of repetitive, frictional forces that occur between the severely angled heel and the back of the shoe. You may often notice a hole worn through the inside lining of the shoe as well. As a final note, observe that at heel rise the lateral column (midtarsal joint) has stayed straight and stable, unlike what is seen in the D and F foot-types.
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