CEP
Some in the field might argue that pieces of the information in this article fall outside the scope of practice for a pedorthist . To that , I pose the counterargument that anyone with an understanding of the triplanar axis of the foot and the biomechanics of gait will similarly recognize the impact the foot has on the other aspects of the kinetic chain . Additionally , I posit that making use of external resources to help an assessment rather than practicing in a void is a unique and rewarding experience . It is my hope that this research will serve to add more evaluative tools to the toolbox and provide a frame of reference for pedorthists , trainers and physical therapists to deliver the best and highest level of care to whichever piece of the chain is driving the equation .
This process starts with the classification of people into groups . There are those who are too loose , too tight , just “ right ” and every combination in between . The “ too loose ” individuals , those characterized by lax ligaments , are very prevalent in typical patient populations . Testing with the Beighton and Horan test ( Foss et al , 2009 ) offers input on laxity through testing nine different movements , including :
• flexion of thumb to touch volar aspect of forearm ;
• hyperextension of the fifth digit to be parallel with the forearm ;
• hyperextension of the elbows beyond a straight angle ;
• hyperextension of the knees ; and
• placement of the palms to the floor with the feet spread shoulderwidth apart .
Successful completion of each of these movements beyond normal range garners one point . A score of four or more classifies hypermobility , which is often associated with torsion of the spine , shoulder instability , instability of the patella and compensated forefoot and / or rear foot varus . This ligament laxity also results in torsional abnormalities in the limbs . The lack of proper muscle pull on bones may influence the degree of torsion of bones .
There are various torsions of the long bones of the leg that impact the way the foot hits the ground . In addition , hypermobile patients may have either coxa vara or coxa valga . Such changes in angulation will be discussed in the following case studies .
The following case studies are illustrative examples of the biomechanical reciprocity between the foot , knee , hip and back . There is a paucity of literature in this field , but observational analysis and biomechanical findings argue that future research in biomechanics is necessary to defend theories of the effects of asymmetry on the lower kinetic chain .
Hip Retrotorsion
The angle of the medially rotated position of the femoral shaft in relation to the position of the head and neck of the femur is called the angle of torsion .
Read This Article , Take Survey to Earn Continuing Education Points
The Pedorthic Footcare Association ( PFA ) offers Continuing Education Points ( CEPs ), approved by the American Board for Certification in Orthotics , Prosthetics & Pedorthics ( ABC ) and the Board of Certification / Accreditation International ( BOC ), via specially designated articles within Current Pedorthics magazine .
To take advantage of the program , thoroughly read the adjacent article , “ Who is the Boss — the Back or the Foot ?,” and then visit www . pedorthics . org and click on the Continuing Education Opportunities tab to purchase the 10-question quiz associated with this article . CEP quizzes cost $ 15 for members and $ 25 for non-members . The quizzes are worth 1.0 Scientific or Business CEP , depending on the content . Successful completion of the quiz will result in 1.0 CEP reported directly to ABC and BOC at the end of each quarter .
Look for additional CEP-eligible articles in future issues of the magazine ; previous articles are available in the magazine archive at www . pedorthics . org .
If you have any questions , contact Lauren Kemp , PFA education coordinator , at ( 800 ) 673-8447 or email info @ pedorthics . org .
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