Gait, Posture, and pain

Your walking gait and posture provide insight to chronic pain issues:

I see many clients who walk with their feet in some degree of either internal (slightly pigeon-toed), or external (slightly duck footed) rotation. Often one foot has more rotation than the other. Some clients will have one foot is externally rotated, while the other is internally rotated.

This client has almost zero pelvic tilt. Ideal for women is 10 - 20 degrees. Client walks pigeon toed (internal rotation).

This client has almost zero pelvic tilt. Client walks pigeon toed (internal rotation).

Approaching 100 % of the time, foot rotation is also linked to pelvic tilt. I assess pelvic tilt by placing 1st finger of one hand on the ASIS, and 1st finger of the other hand on the PSIS. This establishes a visual line and makes it easy to visually asses the approximate amount of rotation on that side of the pelvis.

Internal foot rotation usually accompanies a posterior pelvic tilt. External foot rotation usually accompanies an anterior pelvic tilt.

Normal pelvic tilt for men is 10 – 15 degrees anterior. Normal for women is between 18 and 25 degrees anterior. I believe posterior tilt can, and should be corrected with exercise.

Your posture is not related to bad posture habits, or not balancing books on your head as your grandmother might have suggested. Posture results from the Biotensegrity tensions distributed throughout our bodies by the way we stand, sit, and walk. The book “Anatomy Trains” by Thomas W. Myers goes a long way towards explaining the various lines of tension found in our body.

According to Dr. Eric Dalton a one inch heel often results in 25 – 30 degrees of anterior pelvic tilt. A 2 inch heal often results in up to 45 degrees anterior pelvic tilt. A 3 inch heel can result in up to 60 degrees of anterior pelvic tilt.

pelvis high on one side results in uneven leg lengths

pelvis high on one side results in uneven leg lengths

It is easy for me to visualize how excessive pelvic tilt would lead to lumbar pain, or how more tilt on one side than the other would lead to sacroiliac pain. I believe that biotensegrity tensions reflected by less than normal pelvic tilt are associated with almost all myo-fascial pain from plantar fasciitis to migraine headache, and everything in between.

More than normal anterior pelvic tilt will cause a more than normal lumbar curve. The result is lumbar pain and slipped disks.

When one illium rotates more than the other, the sacrum has to tip. The result is functional scoliosis, unequal leg length and sciatic pain.

Reducing and equalizing tilt almost always results in an instant reduction of lumbar or sacroiliac pain symptoms.

The foot is designed to carry weight on the 1st and 5th metatarsal heads and the heel bone. When the 1st metatarsal is shorter than the second, the foot naturally rotates so weight can be transferred from the long 2nd metatarsal head to the 1st head (duck foot). Sometimes, the foot rotates inward (pigeon toe) so weight during gait push off is transferred to the outside 3 metatarsals. The result is abnormal pelvic rotation.

I believe there is a link between having a short first metatarsal and pain symptoms.

I believe there is a link between having a short first metatarsal and pain symptoms.

The foot with more rotation, results in more illium rotation on the same side.

The name for the condition of a shorter 1st than second metatarsal is “Morton’s Toe”, named after Dr. Dudley Morton from the 1920’s and 30’s. He described the relationship between Morton’s Toe and pain symptoms clear back then.

I am pretty sure there is some relationship between Morton’s Toe and chronic pain. However, I recently attended an orthopedic bodywork workshop. I discovered that there was almost no movement in my sacroiliac joint. I started performing a simple SI joint exercise a few times a day. The next day, I was totally astonished to discover that my feet tracked pretty straight, even without Morton Toe shims in my shoes. I am reassessing my (until recently) passionate belief that $0.50 felt shims inserted under the ball of the 1st metatarsal is actually necessary.

I now believe that a shim under the ball of the foot, behind the big toe. MAY be useful in helping to control inversion and foot rotation. In almost all cases, this shim, placed inside the shoe, may decrease or eliminate foot rotation.

A package of self adhesive felt that will shim about 10 pairs of shoes sells at Home Depot for under $5.00. How much are you spending trying to resolve your chronic pain issues? This is an inexpensive experiment. However, I caution you, if any pain increases, or you start to develop ankle, knee, or hip pain; remove the shim.

In any case, orthopedic body work, coupled with a few minutes of daily self care exercises dramatically speeds the process of improving posture and eliminating (myo-fascial) pain symptoms.

It is very easy to self assess for Morton’s Toe and create a correcting shim from a piece of self adhesive felt. If the felt shim does not give relief, I suggest finding a body worker that knows about, and understands how to treat “lower cross syndrome”. Click this link to go to a YouTube video that may provide a self treatment for lower cross syndrome. I have over 20 years experience as a prior personal trainer. However, I have not kept up with current changes in the industry. However, I believe the exercises indicated are probably both safe and effective.