PT on the Net Research

Club Foot


Question:

I have a client who was born with a club foot. She had it corrected, though she still has limitations. She has developing arthritis, problems with heel toe strike when walking/running and decreased strength in that calf due to an under developed muscle. She was advised by her doctor not to run due to her gait pattern and the pain it can cause. She wants to know how this will affect her fitness programs down the line because her hips and back seem to be compensating for lack of range of motion. For example, we have to put plates under her heels when she squats so that she can put force through her heels during the movement. If we don't use the plates, she has to do a plie squat, wide enough so she can use her heels (though her hips still seem to shift to the side a bit as she tries to get full ROM). Any advice?

Answer:

Most people with club foot correction will continue to have a smaller calf on the side of the club foot. Lack of dorsi flexion is also a common long-term problem with this condition. The need to raise her heels in squats would immediately draw our attention to the gastroc-soleus complex along with the plantar fascia. These structures will definitely be involved. But you can not ignore the peroneals. These muscles are often part of the surgical correction.

Any tightening in the gastroc-soleus will also involve tightness through the entire myofascial sling, from the plantar fascia all the way up to the spinal erectors. Therefore, your client will need to address the restrictions in her dorsi flexors as well the rest of the affected chain.

Many people have led lives without limitations from club foot correction. You might be surprised that about one in every 1,000 births involves club foot. There are professional athletes, past and present, who have overcome any limitations including Kristi Yamaguchi, Troy Aikman and Mia Hamm, to name a few.

If your client has never noticed these limitations until she started working with you, I’m assuming she has lived her life unaware of these compensations until now. In any event, if your client has never given the needed extra attention to her affected leg, she should now.

She would benefit from myofascial release locally to the plantar flexors. This would involve manual work by a licensed professional. You may suggest she look into an Active Release Technique (A.R.T.) practitioner. In conjunction with the manual work, she should utilize self myofascial release techniques along with local flexibility at the ankle joint in all three planes of motion. This would involve improving sagittal plane dorsi flexion as well as incorporating the subtalar joint motion to give dorsi flexion with some transverse plane and frontal plane motion.

A global flexibility program should also include the posterior myofascial line, which would include the hamstrings and spinal extensors. Keep in mind also that a lack of dorsi flexion at one ankle will limit eccentrically loading of the ipsilateral (same side) hip flexors during gait. This will lead to secondary tightening of that muscle group.

During resistance exercises, it may be wise to initially refrain from performing exercises where she must compensate for her lack of dorsi flexion. One strategy is to temporarily remove the ankle joint from the equation by having the client sit or kneel during certain movements. Or during standing movements, avoid sagittal plane movements that are dependent on dorsi flexion and instead work in the frontal and transverse planes.