Importance of Foot Function in the Gait Cycle
by Dr. Kirk A. Lee, D.C.
An essential part of our chiropractic examination should include evaluation of the gaitcycle, with special consideration toward the patientwho has chronic musculoskeletal-related pain.
In previous articles we have discussed several components of the gait cycle. Our most recent article talked about how abnormal patterns of movement through the foot and lower leg created abnormal stress on the knees. This article will focus on normal foot pattern movement of the gait cycle (heel-to-toe transition) and how abnormal movement patterns affect the muscles of the lower leg and foot, which ultimately will affect the whole kinetic chain.
Let us remember that, during the gait cycle, each leg alternates between stance phase (when the foot is contacting the ground) and swing phase (when the foot is not contacting the ground). The gait cycle involves three primary components in the stance or weight-bearing phase, the first being heel strike, followed by midstance, finalizing with toe off. This normal movement pattern can be described as a heel-to-toe transition. When a person walks, we should see some form of heel strike, terminating in toe off. Abnormal patterns of movement would include the patient who walks with a “flat footed” gait, where they tend to lift the whole foot up following a heel strike or even the less common “toe walker.”
When we consider the foot as it transitions towards heel strike, the foot is slightly supinated and dorsiflexed due to the function of the anterior tibialis, extensor digitorum, and extensor hallicus. As the foot goes into midstance, the weight bearing mechanism transitions from lateral weight bearing to medial weight bearing. This mechanism is most commonly referred to as pronation. During this medial movement, the peroneus muscles assist in stabilizing the foot. This mechanism of pronation is necessary to shift the weight bearing forces to the medial cuneiform and base of the first metatarsal, to allow a normal toe off. This function is performed by the tibialis posterior, flexor digitorum and flexor hallicus.
When this transition from heel strike to toe off is a normal “innate” pattern, all the muscles work in harmony to allow normal movement. When a patient does not perform this movement pattern, due to injury, compensation from a vertebral subluxation complex or complexes, poor posture, wrong-fitting shoes, etc., the muscles of the lower leg and the intrinsic muscles of the feet become inhibited from lack of normal movement. Other compensatory issues that can take place would include muscle imbalances between the antagonist and protagonist, when one muscle group is worked more than the other.
An essential part of our chiropractic examination should include evaluation of the gait cycle, with special consideration toward the patient who has chronic musculoskeletal-related pain. If, when addressing our patient’s heel-to-toe gait pattern, we determine that the patient does not transition normally, we must find out what the causative factor is. Is the abnormality due to a muscle imbalance that has resulted from postural changes as a result of previous pain syndromes? If a muscle imbalance is determined, is one group too strong while another may be too tight? Do we know how the muscle group is being injured or inhibited? Is it in the concentric or shortening phase of the contraction, or is it in the eccentric or lengthening phase of the contraction? This is important to determine how we consider our rehabilitation options. Is the patient a candidate for custom-made stabilizing orthotics, which provide additional support of the three arches to assist in a normal heel-to-toe transition?
Our consideration for rehabilitation must include gait training, if our patient is walking with a limp or presenting a flaring in or outward of the lower extremities. Work to achieve a normal heel-strike, midstance and toe-off positioning. To help stimulate inhibited muscles of the feet, consider functional activities, such as picking up marbles with toes, performing a towel scrunch, or using a foot wheel. When strengthening the muscle groups, we must consider which mechanism of contraction the muscle was in, either concentric or eccentric, and more focus should be placed on those functional movements.
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan. Dr. Lee can be reached at
[email protected].