Use of Physical Therapy to Influence the Position of the Foot

Physical Therapy to Treat Foot Pain

The main focus of this analysis was to investigate a cohort of juveniles who are already receiving therapy for foot pain, as well as other causes of suffering such as injuries to their Achilles tendons, heels, knees, and back. All of the subjects of this study were analyzed using kinesiological techniques for both their gait and posture.

In our efforts, we closely examined their shoes, looking for damage, and we also witnessed malformations in various parts of their feet and limbs, including non-standard heel positioning and irregular ways of walking.

To obtain our measurements, we used a foot scan to examine both how they stand as well as how they walk, closely examining how much load they were putting on the ground. When the children were standing, we closely scrutinized the differences between the pressure on both the left and right foot. When the children were walking, we filmed them as they stood on our special analysis mat, paying close attention to how they walked, especially the way the subtalar joint moved.

After examining the pelvic area of the children, we saw that there were no significant problems. The conclusion of our study showed us how the physical therapy can be used to treat foot pain and other related kinesiology disorders.

The Problem

The way the human foot is designed, a series of arches act like a number of compound springs, that flex and extend as a person walks. When a person is standing, balance is maintained by three different arches, with the center of gravity being literally at the axis of these points.

The foot itself also has three balance areas, the first being the thick part of the heel bone, the second being the end of the big toe, and the third being the end of the smallest toe. A system of two springs formed in an arch shape crisscross between these three points, called the traverse and longitudinal arches. Previously, a standing model consisting of a kind of tripod description is no longer considered accurate, but is still used because it is generally still taught and understood that way.

In terms of how the foot actually functions, however, a better way to describe the foot is like an archery bow, where the “string” of the bow would be formed from tendons and muscles, that flex under pressure to form the arches of the foot. These tendons and muscles also serve as shock absorbers when the foot strikes the ground. The tension in the arches also serve to cushion the soft parts of the sole, as well as adding flexibility when the body’s weight is pressing down as a person stands or begins walking or running.

Looking at this from a kinesiological perspective, the key thing to focus on is that these foot movements happen in a concatenating manner. If this chain is closed, such as when the foot is put under undue pressure, it would not be possible for only a single axis to become engaged. A better description would be the open chain model, where the various movements transfer between different joints. Exactly how much these joints move is determined by the location of the talus and calcaneus. When the subtalar joint is flat, the combined axes of the talus and calcaneus as they join to the os naviculare and os cuboideum are aligned in a parallel way. Simultaneously, these two joints are perpendicular to any torsion in the tarsal joint, so as a person begins to walk, they can rotate to accommodate the change in direction. But because these two joints are designed to operate in parallel, this gives the foot less balance when the foot is rotated or twisted. As the tarsal joint begins to move, the subtalar joint begins to flatten out while at the same time the foot becomes more stable while restricting just how much range of motion is possible.

Developmental stages

When a baby is born, it’s possible to hoist it up by its armpits and the baby can sort of stand on its own, but it’s important to know that this is just due to a reflex of the spinal column. After three months pass, the baby can no longer do this, but by age 6-9 months the child will regain this ability. This reacquisition of the skill is concomitant with the child learning to become aware of three-dimensional space. After a year, as the child learns to stand and be upright, it can begin to learn how to walk. At this point, the sole of the foot begins to develop, learning how to actively grip the floor to keep the child from falling, as well as propel them forward in the act of walking. This is extremely important because these qualities quickly erode when a child begins to wear shoes.

In examining feet that have been encased in shoes for a long time, and a newborn baby, we discovered that both:

1) The longitudinal axis of the calcaneus contracts in balance to the way the talus moves from side to side; and

2) The heel is in a much higher position because the calcaneus has not yet migrated to a position below the talus. The calcaneus only descends when a person begins to stand up and walk, and is directly related to the person using the muscles in their feet. The arches will only assume their final adult position after a child is around 3 years old.

Every adult should be able to balance themselves on a single foot for about a dozen seconds. As the person gets older, the amount of time that they can do this begins to diminish. Children can only do this balancing act successfully once they are 3 years old, reaching a full 10 seconds by the time they are about 6 years old.

If an injury that causes foot pain occurs, this can change the way that the foot functions. When the foot doesn’t work like it should, this can lead to foot pain and a higher rate of tension in the arches of the foot. A person can also suffer from balance and walking problems.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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