Bill Hartman 23:51–27:26
Early, mid, and late. Knowing full well that there's a point where propulsion becomes maximum, which is in that middle area, right? When the heel breaks the ground, you're at max propulsion, okay? But let's leave that off the table. Let's just make it early, mid, and late for the sake of argument, right? You've got basically then three foot shapes to deal with. But when you're, so if you're walking straight ahead, knowing full well that I have segments that rotate into ER and IR. When you get through that middle range, that would be that point where you have the greatest differential in opposite directions because they have to cancel each other out so you can go in that direction. Otherwise, if I don't have the opposing ERs and IRs through that middle range, I have to go off course. And you have to make a course correction somewhere. And people do this all the time. So the people that I see in the purple room tend to have a lack of relative motion somewhere. And then they compensate for that. So when you can see, your vision corrects your direction quite a bit when you walk. And so whenever you see if you walk across the room, you go, wow, that looks kind of weird. It's like they're making a constant course correction with every step because they probably lack some relative motion somewhere. And if it gets bad enough, then it might hurt. So through that middle range is that point where you're going to have the traditionally described closed chain pronation. So you're going to have the eversion of the calcaneus and the adduction plantar flexion of the talus through that middle range. If we're looking at the subtaler position. And that allows the tibia to go straight over the foot so you can again, it looks like you're walking in a straight line. So you have to pass through that pronated position, otherwise your tibia stays behind you. You would get stuck in early propulsion if you didn't pronate. So the talus has to move. So if the talus is still dorsiflexed and abducted as you pass over the foot, you will use a late propulsive foot position to try to pass through the middle propulsive phase, which is, again, tends to be problematic for a lot of people, because that means that they have to make a twist somewhere else to stay straight, but understand that the foot is going to behave just like all the other structures above it. So when you have an internal rotation position, which is that propulsion strategy in the foot, so is the hip, so is the pelvis. They go together because that's where the maximum push is. And so I have to have this coherent strategy up the chain because if I have an early or a late propulsive strategy in the pelvis where I should have a maximum propulsive strategy in the pelvis, now I have a problem because now I have too much relative motion occurring where I should not have relative motion, right? Then I can't produce forces the way I want to. And now I got to distribute it differently. And then that might cause a problem. So either I lack performance, I can't push hard enough, or it becomes a point of discomfort.
gait mechanicssubtalar jointpropulsive phasesrelative motionpronation