This week’s spotlight is on Kylie. She is a rockstar runner who has developed forefoot pain in her right foot. Here is her run before we assessed anything else.
Overall she has good running form, but what jumps out the most is a slight toe out on the right foot and increased circumduction of the right lower leg (swings in a circular motion out to the side, instead of straight forward). These are subtle, but signs of poor push-off on the right side. Here are other tests we did to tease out how her foot is working.
The above video is assessing her foot stability in the frontal plane (side to side motion). Notice after a few reps how her big toe and medial forefoot starts popping up off the ground. This is often a sign of poor joint mobility or weakness in the peroneus longus muscle, but more on that muscle at a later time!
Again, notice how far her right knee goes into a valgus position (knock-kneed) in this test. This is usually a sign of lateral hip weakness and/or limited forefoot stability.
We also checked for specific joint mobility on the table which demonstrated limited right big toe extension. Before progressing into exercises, we spent a few minutes loosening up the medial arch of her foot and big toe joints. Once this became more symmetrical, we progressed into exercises to improve the push-off and forefoot stability of the foot, as well as working the entire leg to make sure the hip is on the same page with the foot.
In this exercise, the goal is to promote clean push-off by driving the calf and tibia into external rotation, while encouraging the forefoot to stay planted on the ground, this works the forefoot and especially the big toe into the ranges it needs to be in fore push-off.
Next, she did a single leg drill to simulate the transition to pushing off through the hip and foot, notice a slight heel raise on the right side, which we encouraged again to load the forefoot.
Lastly, she did a simple drill to locally train the forefoot stability and mechanics for push-off using a half roller. To do this one most effectively, it’s important to have the foot angled from one corner to the opposite, which will encourage the intrinsic foot motion needed.
After all this, here’s what she looked like on the treadmill.
In the after video, her right foot and lower leg look more graceful, which indicates she’s getting a more effective load and push-off through the forefoot. There are certainly other factors that can be present which can assist with foot mechanics (i.e. hip strength, core strength, spinal mobility), but she responded well to our session today without having to monkey with form drills. Great job Kylie!