Stance & Gait Pain

What Is Podiatric Biomechanics?

Biomechanics is the science of movement — how forces act on the body during walking, running, and standing. Podiatric biomechanics specifically focuses on the mechanics of the foot and ankle and how abnormalities in their function can create pain throughout the lower extremity and beyond.

The foot is the foundation of the entire musculoskeletal system. When it functions abnormally, the ripple effect can be felt in the ankle, knee, hip, and lower back. A patient who comes to us with knee pain, for example, may have a root cause that lives in the mechanics of their foot.

The Goals of Biomechanical Treatment

When treating patients biomechanically, Dr. Ross focuses on three primary objectives:

• Relieve pain — immediately reduce the discomfort caused by abnormal mechanical stress
• Prevent injury — correct the patterns that lead to overuse injuries, stress fractures, tendinitis, and joint damage
• Prevent deformity — stop the progressive structural changes (bunions, hammertoes, flatfeet) that result from years of abnormal mechanics

Understanding Normal vs. Abnormal Foot Mechanics

The basic principle of orthotic biomechanics is to bring the ground up to the foot when the subtalar joint is in neutral position and the midtarsal joints are locked — the ideal functional position for the foot. When the foot cannot achieve or maintain this position on its own, it compensates in ways that generate pain and injury elsewhere.

Common biomechanical faults include:

• Overpronation — excessive inward rolling of the foot during walking; a leading cause of plantar fasciitis, shin splints, and knee pain
• Supination (underpronation) — insufficient inward rolling, causing excessive stress on the outer foot and ankle
• Leg length discrepancy — even small differences in leg length create significant mechanical imbalance throughout the lower body
• Abnormal tibial or femoral torsion — rotation of the shin or thigh bone that affects the entire lower extremity chain

Treatment Approaches

Non-Surgical (Biomechanical)

The preferred first approach is to realign the foot through external support and muscle conditioning:

• Custom foot orthotics — precisely calibrated to hold the foot in its optimal functional position throughout the gait cycle; the cornerstone of biomechanical treatment
• Therapeutic footwear — shoes with the right last shape, sole stiffness, and heel counter to support the correction provided by orthotics
• Muscle stretching and strengthening — targeted exercises to improve flexibility and muscular support for the foot and ankle
• Gait training — relearning proper movement patterns under guidance

Surgical

When conservative biomechanical treatment cannot adequately restore normal function, surgery may be indicated to realign joints or tendons and reestablish their intended mechanical relationships. Dr. Ross considers surgery only after non-surgical options have been given a thorough trial.