The Evolution of Foot Biomechanical Paradigms

Abstracts

By understanding the evolution of theoretical biomechanical models we can better appreciate today’s science and how to best utilise it for our patients’ benefit. Here are some key features of the most well-known theories:

Subtalar Neutral Theory:

- Subtalar axis is neutral, meaning neither pronated nor supinated
- Bisection of posterior calcaneus is vertical
- Metatarsophalangeal joint line is perpendicular to the bisector of posterior calcaneus
- Foot is rotated outward approximated 7-10 degrees

Sagittal Plane Facilitation Theory:

- Hallux limitus is a dysfunction for full propulsion
- Lack of full propulsion can lead to other pathologies such as plantar fasciitis, flat foot, chronic back pain, etc
- Hallux limitus results in full body compensation such as a propulsive gait with delayed heel lift- off, overload to lateral column of foot, flexed body position, etc

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Tissue Stress Theory:

- Focuses on a kinetic view of the gait cycle
- Increased load on tissues causes deformation of change
- If damage occurs faster than healing, then symptoms occur

MASS Posture Theory:

- This theory is not single axis but looks at postural biomechanics
- States that a healthy medial arch is at maximal supination at mid-stance
- Mild inversion of the calcaneus at heel strike allows for anterior facet to be parallel to the ground, preventing over pronation
- 1st MTP must have full range of motion and accept approximately 60% of weight through gait

As seen above, science continues to advance our understanding of the human foot and its biomechanics. If we continue to apply these evolving, multidisciplinary, holistic-approach models we will improve the clinical outcomes of those we treat.

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References:

Daniel P. and Colda A. Foot Functioning Paradigms. Proc Rom Acad, Series B, 2012, 14(3), pp. 212–217
Glaser E., Bursch D., Currie S. Theory, Practice Combine for Custom Orthoses. Biomechanics. 8(9):33-39, 2006.

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