Ankle, knee and SI joint relationship…
Hello to all…I did an hour and a half presentation at Dr. Maekawa’s office and teaching clinic in Kona Hawaii on Feb. 4th, 2010. I got there just in time, I did not want to be late, I heard she’s a stickler for time! Anyway, without one minute to spare, I arrived, parked and made my entrance. The presentation was video taped with professional cameras and we even had some skype participants from Washington. I started my presentation with the foundation of the human body, the foot. We are bipedal creatures and our motion during walking is rhythmic. Any aberration in fluidity becomes a source of irritation. One very important problem we face as aging people is a condition called Pes Planus. Pes Planus is a dropping of the first metatarsal bone in the foot. It is a dropped arch, if you will, causing the ankle to drop on the inside. So when you look at the ankle from the back, you will see an medial inversion of the ankle making the instep closer to the ground comparing one side to the other. As the ankle inverts medially, you will also see a compensatory change in the big toe. The big toe is primarily there for stability.
It’s reason for existence is not to paint it, although nice…it’s reason for existence is for weight baring. As the ankle bends inward on the side in question, caused from a dropping of the arch, the big toe and the first metatarsophalangeal joint takes a beating. When looking on the patient’s foot from above, you will see the big toe, as the disease progresses, go’s out lateral at a 45 degree angle. This pressure on the metatarsophalangeal joint causes this joint to swell and harden. This is called a bunion. This is very often the cause of foot operations for the patients experiencing Pes Planus. Often times, the medical doctors do not explain to the patients why, in the first place, their problem started. What I see in my office over the years, is that patients don’t do anything to keep the problem from coming back and the old problem returns and the patients have to get another surgery. The cure for this problem is: A) Wear an orthotic or an arch support. B) Wear running shoes during the day and something to support the arch at night. C) Wear simple arch support in their shoes. Some arch supports can be glued into their shoes. Even when this condition is just beginning, you can see a change in the first metatarsophalangeal joint. You will also see an immediate shift in the angle of the big toe. If you look at the patient from the back, looking at the back of the ankle, you can see a deviation of the achilles tendon. Comparing one ankle to the problem ankle, you can see that the good ankle’s achilles tendon is straight, while the ankle in question has a bend with the achilles bending outward, causing the achilles to bow out on the inside. Of course this is due to the instep dropping and the ankle becoming closer to the ground on the medial side of the foot. Pes Planus causes the knee on the same side to have strain on the medial side of the knee. Which brings us to the next topic. Knees….to be discovered next time.