Enhancing form and function are goals for elite athletes — as well as everyday patients, where custom-made orthotics insoles can give patients an edge
In 1987, while a student at Texas Chiropractic College, I had the privilege of being a student of John Nash, DC, one of the great pioneers in sports chiropractic. He enthusiastically shared his passion for all sports, as well as his passion for teaching students the complexities of sports performance and how orthotics insoles can make a difference.
His passion and dedication to his students ultimately led to the creation and implementation of the gait analysis training program at Texas Chiropractic College. Through this program, students had numerous opportunities to provide gait analysis at running events in and around the Houston area. The program was a huge success, and TCC’s sports chiropractic students were then invited to provide gait analysis to elite runners outside the Houston area as well.
One of the most memorable events for me as a student was the New Jersey Waterfront Marathon. The positive impact that our gait analysis had on so many elite runners set the stage for my own passion of studying running gait and foot biomechanics.
Sports medicine teams and orthotics insoles
Shortly after opening my private practice, the U.S. Olympic Trials track and field team asked me to serve on their sports medicine team. This experience allowed me to work with renowned sports doctors and therapists of all disciplines, as well as the elite athletes on the team. I learned so much from both the providers and the athletes, and I also realized the importance of treating every future patient as if they were a world-class athlete.
Correcting misalignments, enhancing form and function, and allowing individuals to work or perform at their best are goals for the elite athletes as well as the non-athletes performing activities of daily living. All patients will benefit when body parts are aligned properly, adequately supported, sufficiently mobile, and capable of responding appropriately to external forces.
Fitness balance and biomechanics
Fitness by definition is a balance between strength, conditioning and flexibility. These different components are important for the general population, but in elite athletes, they are vitally important for preventing injury and maximizing athletic performance.
Another critical area to address in this effort is sound foundational biomechanics. During the gait cycle, the foot initiates a cascade of events that travel up the kinetic chain. The foot’s structure greatly impacts how force travels throughout the body.
The foot has three natural arches: the transverse or metatarsal arch, the medial longitudinal arch and the lateral longitudinal arch. Collectively, these arches make up the foot’s plantar vault. This vault is a dynamic structure and is elevated to allow the foot to absorb and disperse energy at impact. It also allows the foot to transition smoothly from heel strike to mid-stance, and then finally to the toe-off phase of the gait cycle.
Technical issues of the feet such as supination, over-pronation, pes planus, flexible pes planus and forefoot valgus cause a myriad of biomechanical distortions which negatively impact the normal gait cycle as well as lower extremity alignment.
The start of the kinetic chain
During the initial phase of the gait cycle, the heel strikes the ground. How the body responds next will determine whether impact is absorbed at the foot or is transferred to other structures up the kinetic chain. Adequate architectural support throughout the plantar vault, along with proper biomechanics, will allow maximum gait cycle efficiency and minimize stress and strain on the intrinsic structures of the lower extremity.
The structure and biomechanics of the feet play a critical role in keeping athletes at the top of their game. Anatomical misalignments, poor training methods, technical errors, unfamiliar techniques, and environmental factors (including athletic surfaces) have been implicated as contributing factors to lower-extremity injuries. These factors all start in the feet. Therefore, in every athlete, examination of the feet should be paramount, noting any evidence of flattened feet, foot flare, genu valgus, or bowing of the Achilles tendons. Examining the athlete’s shoes is important as well, noting any evidence of uneven shoe wear.
Over-pronation and sprains
One of the most prevalent technical issues involving the lower extremity is over-pronation of the foot. Over-pronation places increased torque on the medial ankle, tibia and knee, causing many common foot and lower extremity injuries and conditions.
Ankle inversion sprains are the most common traumatic injury in athletes.¹
Improper jump landings and rolling over the lateral aspect of the foot while in the toe-off phase of the gait cycle are the usual mechanisms of injury. A previous ankle sprain is the single greatest risk factor for a future ankle sprain injury. Therefore, every effort should be taken to stabilize the foot’s foundation in order to encourage proper landing and reduce the risk of an ankle sprain injury.
A few years ago, a two-time world champion professional basketball player presented to my office complaining of medial knee pain and left-sided lower-back pain. After examining the areas of issue, I informed the elite athlete I would be looking at other areas that may be contributing to his knee and back pain.
I explained simple biomechanics associated with the kinetic chain and how the foundation of the foot affects the knee and back. I informed him that I would be taking a laser weight bearing image of his foot in order to determine the presence of any technical issues that could be contributing to his pain.
The results showed significant over-pronation, which correlated with my exam findings: foot flare, bowed Achilles tendon and an accentuated genu valgus deformity. Custom orthotics insoles were warranted in this case. I explained the link between his foot, knee and back, and he understood the value of incorporating custom orthotics.
His laser images were sent to the laboratory, where his custom orthotics were built. His custom orthotics arrived the following week, and ever since have been a game-changer for him. For this athlete, the orthotics addressed the technical issues with his feet and helped to drastically reduce the pain in his knee and back. He has ordered multiple pairs since I first saw him and to date, does not step on the court without his custom orthotics. This is just one example of literally hundreds of athletes I have seen benefit from wearing custom orthotics.
Preventing these common athletic injuries starts by performing a gait analysis and addressing the technical issues within the foot. A properly supported plantar vault will ensure proper alignment and allow the foot to perform its function of absorbing and dispersing energy at impact, thus preventing many common lower extremity conditions.
Custom orthotics insoles have become a popular tool that clinicians utilize to address their patients’ biomechanical issues. By using technology that provides a 3D image of the feet, athletes can easily see any areas of concern regarding their lower limb biomechanics. This visual, along with a verbal explanation of the image, clarifies how untreated malfunctions in the feet negatively impact other structures up the kinetic chain, and ultimately increase risk of injury and reduce performance.
3D foot technology
Using 3D technology to educate the athlete fosters understanding of their condition and the importance of incorporating custom orthotics insoles into their training program. Elite athletes want to do whatever it takes to compete at the top of their game. Helping them do so, and witnessing their success, stirs up the same positive emotions I experienced long ago at the New Jersey Waterfront Marathon. And I am reminded of why I’m still passionate about the running gait and the biomechanics of the feet.
Kurt Juergens, DC, CCSP, has been in private practice since 1989 and has had extensive post-graduate training in sports medicine. Juergens owns and operates Juergens Chiropractic & Sports Rehab Center in Houston, Texas. He graduated summa cum laude from Texas Chiropractic College. In 1992 he was selected to be a member of the U.S. Olympic Track and Field Trials Sports Medicine team. He has also served on the sports medicine teams for the NCAA Track & Field Championships and the ATP World Tour’s Tennis Masters Cup and U.S. Clay Court Championships. Juergens continues to treat high school, college and professional athletes in all fields from all over the world, and lectures regularly for his profession on topics related to sports rehabilitation. He represents Foot Levelers and can be contacted at drjuergens.com.