This document discusses lower limb biomechanics and orthotic prescription. It provides an overview of normal gait and running cycles, common biomechanical abnormalities like excessive pronation and supination, and injuries associated with these abnormalities. It also outlines the components of a biomechanical assessment, including gait analysis, and interventions like taping and orthotics. The key message is that lower limb issues often have a biomechanical element, so a full biomechanical assessment of the kinetic chain is important to identify factors and consider multi-faceted interventions.

1. Lower Limb Biomechanics
& Orthotic Prescription.
Lorraine Carroll MPhty(Manips), BPhysio, MISCP, BMAS
Chartered Musculoskeletal Physiotherapist
Mount Merrion

2. Happy Feet .....

3. Aim
 Lower limb biomechanics – what is
involved
 Normal gait and running cycle
 Biomechanical abnormalities
 Common lower limb injuries
 Biomechanical assessment
 Interventions

4. Lower Limb Biomechanics
 Whole kinetic chain
 Foot, knee, hip, pelvis
 Static and dynamic
muscle control
 Joint mobility
 Ability to stabilise the
components
adequately in a
controlled manner
 Gait analysis
Schamberger, 2002

5. Normal gait and running
cycle

6. Normal Gait Cycle

7. Normal Gait Cycle
stance phase
STANCE PHASE

8. Normal Gait Cycle
stance phase

9. Normal Gait Cycle
swing phase

10. Normal Gait Cycle
Pronation / Supination

11. Supination / Pronation

12. Normal Gait Cycle
Mobile Adapter V Rigid Lever
MOBILE ADAPTER
(Pronation)
Shock absorbency
Adapt to changes in the
ground & upper body
RIGID LEVER
(Supination)
Stability for propulsion
Strong & Rigid enough to
lift body weight

13. Normal Gait Cycle
stance phase

14. Normal Running Cycle
 Phases are similar to walking
– Stance phase
– Swing phase
– Flight Phase: neither foot is in contact
with the ground between phases

15. Normal Running Cycle
 Slower running
 Faster running
 Sprinting
 Stance phase>flight
phase
 Stance phase ~
flight phase
 Flight phase >
stance phase

16. Normal Running Cycle
 Slower running
 Faster running
 Sprinting
 Heel toe manner
 Heel & forefoot or
FF initially then heel
prior to toe off
 Usually maintain
weightbearing on
the FF from contact
to toe off

17. Biomechanical
abnormalities

18. Anatomy of the foot

19. Biomechanical Abnormalities
Excessive Pronation
 Most common
 Occurs at subtalar joint
 Abnormal – when
excessive or occurs
when should be
supinating
 ↑ demand on
numerous structures
 Unstable

20. Biomechanical Abnormalities
Excessive Supination
 Foot less mobile, rigid
type foot
 Poor shock absorption
 Less plantar surface
contact – high pressure
points
 Clawed toes
 Lateral instability

21. Common lower limb
injuries

22. Common Lower Limb Injuries
50 %
recreational
runners will
sustain an injury
that disrupts
their training
regimen in a 1
year period
(Fredericson & Anuruddh, 2007)

23. Common Lower Limb Injuries
Risk factors
 Intrinsic factors
– Muscle strength/
flexibility/control
– Biomechanics
(alignment)
– Previous injury
– Limited running
experience
 Extrinsic factors
– Training methods
– Training surfaces
– Running shoes

24. Injuries associoated with
biomechanical abnormalities
 Sesamoiditis
 Plantar fasciitis
 Achilles tendinopathy
 Peroneal tendonopathy
 Medial shin pain
 Patellar tendonopathy

25. Injuries associoated with
biomechanical abnormalities
 Patellofemoral pain
 Iliotibial band friction syndrome
 Hamstring strain
 Metatarsal stress factors
 Navicular stress factors
 Fibular stress factors
(Brukner & Khan, 2007)

26. Biomechanical
assessment

27. Biomechanical assessment
Practical - an overview
 Walking / running
 Functional tests: single leg stance,
squat, hallux extension, hop
 Leg length measurement
 Diagnostic taping
 Posting required

28. Interventions

29. Interventions
Low Dye Taping
 Taping frequently
applied to control
excessive foot
pronation
 Diagnostic to see if
orthotics are
indicated
 Must get at least
50% reduction in
patients symptoms
(Vicenzino et al, 2005 & 2006)

30. Interventions
Orthotics
 An insert placed in the
shoe to alter foot &
lower limb function
 Off the shelf devices /
custom made devices
 The clinical
effectiveness of foot
orthoses demonstrated
for the prevention &
treatment of lower limb
injuries (McMillan & Payne,
2008)

31. Interventions
Orthotics
 Foot type
 Severity of the
abnormal motion
 Sporting activity
 Footwear
 Weight of patient

32. Interventions
 De load over
stressed tissue
 Restore muscle &
motor systems
 Control pain

33. Other pointers..
 Paediatrics
 Dancers
 The diabetic foot
 Footwear
 Clinical presentations that don’t
respond (or don’t fully respond) to
orthotic prescription

34. Key Elements
 Is there a biomechanical element to
the patients pain & dysfunction?
 Laterally think – not just structure
involved: intrinsic & extrinsic factors
 Perform a biomechanical assessment
of lower kinetic chain
 Consider interventions
 Multi-factorial approach – best practice
(Fields et al, 2010)

35. ....is everyone happy?

36. Contact details
Lorraine Carroll
TherapyXperts Mount Merrion
105 Trees Road
Mount Merrion
Co Dublin
Tel: 01-2834303 Fax: 01-2834303
Email: lorraine.carroll@therapyxperts.ie
Web: www.therapyxperts.com