Motion Is My Passion
November 2011 Issue
Motion is my passion. I grew up skating and playing hockey; as a young adult I skied, walked, hiked, and ran. My favorite sport currently is longboarding.
My son, Gunnar, wanted a longboard for his 13th birthday; he got one and loved the sport. While he was at school one day, I jumped on his board and rode. Now, three years later, we both race and skate as often as we can. What I have learned from being in motion has made me the pedorthist I am today.
While skateboarding I found that you use all core, adductor, and abductor muscles, and understanding this has shifted my focus from the foot up the kinetic chain to the pelvis. Skateboarding has allowed me to understand what type of torque to put into an orthotic—either clockwise or counterclockwise—to achieve the balance needed to carve turns. Skateboards come in many shapes, each having a different cup or cradle similar to an orthotic. Standing within the cradle attempting to balance on one foot, I noticed that if I rotated my foot either in or out (causing me to use different muscles or compensations) my knee alignment and my balance changed, either making it easier or harder to balance.
I took this observation to the lab! To find the relationship between the orthotic and the floor, I started torquing the orthotic, rather than just raising or lowering the medial or lateral longitudinal arch. I found this adjustment created a greater effect on the pelvic rotation and allowed me to resolve more back, knee, and foot issues, depending on the pathology. By torquing the rearfoot valgus more, the forefoot varus draws the hip forward and the rearfoot varus, forefoot valgus draws the hip back more, depending on the femoral and tibial torsion. This allows people to find security in balance that they have lost due to structural breakdown over time.
I believe that every acquired foot deformity is driven from the hip. I ride the skateboard left foot forward since my left side has more internal tibial torsion and my right is more femoral externally rotated or retroverted; this allows me to put my upper body into the fall line more easily because I can twist my left femur to a more internal than external position. If your hips are not aligned within the pelvic rotation during gait, one foot comes through too fast, which causes either hammer toes because you are trying to draw the foot to the ground, or gripping or claw toes because you are trying to hold the forefoot in varus. If the foot moves through too slowly and has normal ranges of motion, the result is more often a bunion and/or hammer toes as well due to an attempt to speed up or slow down the hip rotating through. The foot placement on the cradle of a skateboard or an orthotic can be torqued to obtain the structural alignment that is needed to offset the relationship between femoral torsion and tibial torsion/varum.
I have found that right-handed individuals more often have right hip anterior rotation and left hip posterior rotation. In most cases, a slight amount of rearfoot varus or forefoot valgus or a combination of both will torque the orthotic and slow down the rotation on the right. To speed up the left, a touch of rearfoot valgus will push the hip forward or a little forefoot varus will pull it forward. Try it. When a patient is wearing his shoes with his orthotics, have him balance on one foot. Use the eye doctor approach, comparing which is the better choice: 2mm varus "A," 2mm valgus "B," 2mm forefoot valgus "C," or some combination. Then refine the torque of the orthotic to allow the foot to find its lateral locking mechanism to stabilize the foot in a tripod.
When I have a challenging day, I try to take a break and skate. For me, skating is a place of calm where I can feel and understand the effects of change in balance and attitude through motion. As my career as a pedorthist advances, I continue to explore ways to solve difficult physical issues with orthotics. Longboarding has helped take my orthotics fabrication to a new level. Work has become my play.
Peter Morin, CPed, is the owner of Foothills Pedorthics in Golden, Colorado. He has 18 years of experience in practice as a pedorthist. He also makes custom hiking and western boots that can accommodate orthotics. He can be reached via his website, www.foothillsped.com