Clinical Pilates in Practice: Biokinetic Analysis of the Foot & Ankle (February 2021)

 

This literature review argues that clinically we need to observe functional - rather than conventional - biomechanics at the ankle and foot. Functional biomechanics observes that all segments in a joint can be simultaneously mobile. The authors suggest that:

 "The reader should be able to understand how the 3-dimensional biokinetic analysis of the ankle and foot can contribute along with imaging examinations to the clinical setting, thus allowing the construction of a more complete proļ¬le of the patient."

 

Metsavaht L, Leporace G. Current trends for the biokinetic analysis of the foot and ankle. J Foot Ankle. 2020;14(2):191-6.

 

KEY POINTS: BIOKINETIC ANALYSIS OF THE FOOT & ANKLE

  • The central nervous system works as the generator of complex movement patterns based on muscular synergies; the control of active joint stability is coordinated by the neuromuscular system and not by isolated muscle strength or range of motion.
  • Functional ankle stability is mostly related to the capacity of triceps surae muscle to generate functional strength.
  • The main structure that generates stability in gait is the foot; functioning as a stable base of support for movements of the proximal segments, the foot assists in the absorption of ground reaction forces and is a powerful lever arm for the ankle muscles during the propulsion phase of gait.
  • The medial longitudinal arch (MLA) is essential for the proper functioning of the foot, working as a spring system, changing foot stiffness and allowing deformation for absorbing loads while transferring forces to the ground.
  • The MLA works as a three-dimensional rather than two-dimensional structure.
  • Resection of the plantar fascia can reduce foot stiffness by 25%; removal of the transverse arch can reduce foot stiffness by more than 50%.
  • The functionality of the plantar fascia can be observed via the windlass mechanism, whereby hallux extension produces a tension in the plantar aponeurosis, creating a lever arm for propulsion.
  • The role of eccentric control synergies is increased in running vs walking. 

Gait Cycle; Biocinetica Laboratório do Movimento Ltda, Rio de Janeiro, Brazil.

Running Cycle; Biocinetica Laboratório do Movimento Ltda, Rio de Janeiro, Brazil.

  • Chronic ankle instability can lead to changed movement patterns at the hips and knees.
  • Issues at the proximal end of the chain can also influence the foot and ankle distally.
  • Inhibition of peroneus longus is associated with continued ankle instability, even when triceps surae strength has returned.
  • Ankle stability is task-dependent, and therefore direction-dependent.
  • The functioning of foot and ankle is dependent on activity of passive tissue and muscles and neuromuscular control of local and distant joints.

CLINICAL PILATES IN PRACTICE

  • There's reason that we often start with footwork - but make it dynamic!
  • For "toes on" footwork, ensure that the MTPJs are on the bar, encouraging a press into the forefoot to find hallux extension and wind up the plantar fascia to raise the heels. 
  • Encourage eccentric support and control of the feet and ankles through load.
    • Jump Board on the Reformer.
    • Calf Raises.
  • Build foot posture and positioning into all hip/knee and lower limb work.
    • Feet in Straps and Leg Springs.
  • Be sure to work on peroneal support around the ankle.
    • Foot Waving.
    • The Foot Corrector and the Toe Gizmo can be integrated into standing work.
  • Ensure hip and knee alignment and strength are addressed, rather than focusing solely on ankle stability.
  • Change it up: wide stance, split stance, hip internal rotation, knee flexion, dorsiflexion.
    • Change foot and ankle position to reflect the functional task.

 

REFERENCES

1. Cavalin, GA; Zeitoune, GG; Leporace, G; Nadal, J. Coordenação intersegmentar do quadril e do tornozelo em corredores recreacionais. In: 26o Congresso Brasileiro de Engenharia Biomédica, 2018, Búzios. Anais. Rio de Janeiro: SBEB; 2018

2. Venkadesan M, Yawar A, Eng CM, Dias MA, Singh DK, Tommasini SM, et al. Stiffness of the human foot and evolution of the transverse arch. Nature. 2020. 579(7797): 97-100

 

Keep up to date with research relevant to your clinical Pilates practice.

The Calibrate Pilates team translates research into clinically relevant information so that you can build your core practice and improve client outcomes. 

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