Podiatry: Foot and leg mechanics

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Foot and leg mechanics - the basics of how we walk

When a patient first visits me, one of several routine steps is a short "teach-in", designed to educate the patient in foot and leg function, and how problems may develop from poor or faulty foot mechanics.

Let's correct a common misconception

We were not designed for life on concrete, but for slow or rapid movement on a mixture of soft, hard, and undulating surfaces. To suggest that we have somehow evolved over a few hundred years for life on a hard, flat surface is absurd. Yet there are many examples in Western Medicine where the clinician ignores the fact that the concrete we live on is probably responsible for our health problems, rather than some nebulous disease process.

Some examples of this are:

• Foot pain. The clinician, probably a podiatrist, will diagnose faulty foot mechanics, and fit shoe inlays. The faulty foot mechanics probably don't exist! The problem is that the patient is walking around for 80/90% of the time on hard, flat surfaces - surfaces which, except for short periods, are alien to our lower limb geometry. This doesn't negate the fact that shoe inlays will help the problem, by allowing the foot to work a little less hard, but the problem lies with the ground, not the patient.
• Knee pain. The clinician this time may be an orthopaedic surgeon. In a badly worn knee there is always the option of putting a replacement knee joint in. Post-op problems with function can often be traced back to foot function against a hard, flat surface. The surgery may be technically perfect - however, if there as a mild twist in the foot (as there is to some degree with most normal feet) this will transmit up the leg, causing the kneecap to ride slightly out of its groove when the knee is bent, or causing hip problems because there is no give in the nice tight new knee joint.
• Back pain. How many times have I had a patient come to me and tell me their Chiropractor/physiotherapist/osteopath has told them they have one leg longer than the other? This is said in such a way that the patient has obviously been given this information in such a way to make them believe that they are unusual. What's interesting is that there is no scientific evidence to show that having both legs the same length is normal. In fact the only time having two legs exactly the same length would be advantageous would be if we spent most of the time on a hard, flat surface.

Normal walking on a flat, hard surface

Having reached the point where we recognize how harmful the terrain is that we spend most of our time on, we can then relate that to normal walking. From a standing position, the subject stretches out the right leg, The outside of the heel is the first part of the foot to contact the ground. The left leg is then stretched forward. The right foot is now flat on the ground, the leg twisting outwards as the left leg swings forward. The right foot pushes of with the ball of the foot and the toes, and the left heel hits the ground. The same process is repeated with the left leg and foot now taking the weight, and the right leg swinging forward. The whole process is very punishing to our joints, muscles and spine, partly because there is no natural shock absorption in concrete, and partly because we are not adapted to a life on concrete.

What to do

Spend as much leisure time as possible on different terrains. This can mean grass, tracks or woodland or hills.

If you run or jog, do the least amount of roadwork you can get away with. Stretching techniques, such as Pilates, are an excellent way of realigning muscles and joints.

If you have a back, hip, or lower limb problem, it may be due in whole or in part to the ground you are walking on, and you should consider seeing a podiatrist as well as the relevant health professional for that body-part.

Please feel free to use the enquiry form at www.ortho-pedclinic.com for all foot-health and foot-related matters.
David Holland BSc(Hons), MSc(Dunelm), MChS
Consulting Podiatrist.