Knee, hip and back pain

The interrelationships between the foot, leg, hip, back and upper body are important to allow fluid dynamics during walking and gait. Normally during walking, the leg rotates internally bringing about pronation (lowering of the foot’s arch) required for shock absorbtion, and then the leg rotates externally bringing about supination (raising of the foot’s arch) required for the stability of the foot during the propulsive phase of gait.

Different models have been used to best describe how human gait works including an inverse pendulum (Dananberg). In this model the base of the upside down pendulum is the foot and the three points that it pivots on are the heel, the ankle joint and the big toe joint (1st MTPJ).

Hip to toe podiatry

When assessing a patient’s biomechanics, it is important for us to check there is enough range of motion in these three pivots, otherwise the pendulum will not swing correctly and compensations will occur eventually leading to problems.

The hip, knee, ankle and big toe joint (1st MTPJ) all extend and flex in opposing direction to their adjacent joint. Therefore if the mobility in any one of these is “blocked”, it will affect the others, and be compensated by the other foot or the next joint up the body, if not both.

The compensations podiatrists are most interested in addressing are within the foot and ankle, but as the scissor-jack model demonstrates, if we optimise the function of the feet, we can also play an important part in treating biomechanical problems of the knee, hip and back.

Podiatric biomechanical assessment and treatment works very well with physiotherapy and osteopathy particularly for knee and back problems.