As a ski boot fitter, I was taught to find neutral in a foot, something I notice that very few therapists are taught and something that has given me lots of insight over the years.
This video discusses:
- finding neutral in the foot via the talus bone
- using the big toe to guide you to where neutral is
- How being able to access both sides of neutral benefits the body as a whole
Every foot has a medial arch, a lateral arch and a transverse arch. Neutral would be where these three arches line up and bring all the bones into alignment. Too much movement towards the inside will gap the joints on the inside and too much movement to the outside will gap the joints on the outside. Similar, if not, EXACTLY the same as the spine; as it laterally flexes left, it gaps the joints on the right hand side and is laterally flexes right, it gaps the joints on the left hand side. Obsessed with getting the spine neutral, why should it be any different for the foot?
By lifting the big toe you should see the structure change and move towards neutral (for a pronated foot). In WTF I use a two finger test as a rough guide to help me visualize the sub-talar joint axis, or get an idea of which way the talus is facing (there are more accurate ways of doing it of course).
With the toe extended you can see the two finger test shows the foot is pretty close to neutral…
…but as he is asked to relax you’ll notice the talus moves more medially and begins pointing more medial toward and beyond the big toe on a rotational axis.
This tells us that in stance he prefers to rest with the inside bones gapped and the outside bones closed. What’s important is how similar this test is on both sides as this will show as we observe the movement and posture of the bones as which are influenced above.
In the video I’ll also use a different way of finding the talus bone which takes a little more practice and guidance for many. Both ‘tests’ show that he is happy to rest in a pronated position; this is quite normal. The question is, is can we change his whole body structure in a way that means that in rest his body chooses to be in a less pronated space on both feet as this would contribute to improved overall alignment.
Good information we can get from this: How far from neutral is he? This gives us an idea of how open the joints are on the medial side, how much the adjoining structures are influenced (this can run all the way up to the skull) for instance how medial the talus bone is and how this affects the rotation of the leg, pelvis, spine etc.
To find neutral, we know we can lift his toe up in an attempt to bring the toe back in line.
In pronation look for the ‘creases’ on the outside of the foot in front of the ankle and in supination look for the creases on the inside of the ankle (basic observation skills). When lifting the toe to find neutral you should notice that the creases go away as a neutral point is found. The amount the foot moves back towards neutral gives you a good idea of how far he has to travel to attain neutral.
As a check, once you think you have the client in neutral, you can ask them to lift their toe(s) and you will see minimal movement in the foot bones, if any at all. The closer you are to neutral the less motion you will see. Again once you have him in neutral, you can ask the person to return to standing and observe by how much they pronate back to their resting position.
A final observation worth considering is that when bringing a foot towards it’s neutral posture, we often notice that a person loses their tripod, this is observed as their first metatarsal head (MTPJ) floats up and off the ground. This would further influence change in the timings of the gait cycle. When we walk we search for that tripod on the ground, the higher the first metatarsal sits off the ground, the more it will have to pronate into the ground to bring contact at the 1st MTPJ. If pronation is the brains hunt for a tripod, then we may just have to change the brains perception of where that tripod is so as to reduce the amount of time it takes to get that first metatarsal on the ground. It might not need an orthotic, it might just need some movement, some muscles to work better in the skeletal system and kinetic chain or perhaps just some awareness of what pronation is, where centre in the foot is and critically is it can use its muscles to get out of pronation into supination. A healthy foot is able to experience both sides of the spectrum where it’s comfortable pronating and supinating and critically being able to resupinate the foot back from a pronated position to a supinated position and to do that it has to move through centre so it helps us to know and find that centre or neutral point as and when we need it.
Timing in pronation: the more pronated they are, the further they have to travel to get a real supination of the foot (i.e. travelling past neutral into supination). The longer it takes to achieve this the later and later one’s supination will happen in the gait cycle. Here lies the value of neutral in the foot, it creates the potential to pronate from neutral, return through neutral via the resupination and benefit from an actual supination and all the benefits this brings to the human body at large – namely extensor chain activation potential and effortless motion; not things we would prefer to go without… but do!
In stance, if one foot pronates more than the other we would be able to observe how the structures are influenced up the chain. Pronating feet internally rotate the legs but the foot that pronates the most will rotate it’s leg more and normally have most impact on the pelvis… Hip internal / external rotation problems? Check that talus and it’s ability to find centre and move through the gait cycle.