Dominant side foot pain & bibliographical resources

[CaesarAnto]

hi all, I have been undergoing physiotherapy for my problem but while I'm getting a lot of practice, I'm lacking some theory and I need to clear my head a bit. Unfortunately I don't have the chance to actually sit down and calmly discuss my problem, I just have a number of bits and pieces of information.

So, problem: when walking, I apply too much pressure on my right foot. Apart from a general feeling of discomfort, this is proved by the fact that my right insole worns out more quickly. This problem probably started many years ago (8 and a half) when I sprained my left ankle and probably started to adapt in order to somehow bear more weight on my right side. Things were fine until a few years later I injured my right foot as well, and the problem started to emerge in its full extent. So now my right foot is symptomatic, because over the years I adapted my body by making my right side work harder than my left side.

This is the general theory which has started to dawn on me only over the last couple of years, when I started to undergo physiotherapy. Before that I tried orthotics for a number of years but to no avail (now I've gone back to walking orthotics-free).

The major muscular imbalances are in my back and hip muscles. In particolar, my therapist says that my left lats are very weak and tight, so they need to be strengthened with some eccentric exercises (so no traditional gym workouts). Meanwhile, my right (mid-lower) back muscles are usually very stiff and hardened. My right hip muscles as well appear overworked.

In general, it's as if the right side of my body is overworking, whereas my left side is not doing its share. So, what I'd like to know is:

- first of all, does this make sense in general? i.e. is it possible to adapt your body in a way that when walking more force/pressure ends up being applied to one foot rather than the other?
- secondly (this is what I really fail to grasp), how does that happen exactly? how would my stiff/hardened right back/hip muscles & weak/tight left lats affect the amount of pressure I feel on my right foot?
- lastly: I have been doing physio for a couple of years now; I can't say that I haven't seen any results, but progress seems snail-paced (forced Covid-19 inactivity and a general lack of muscle tone have played a part). Right after a session of physio I walk differently and feel some benefit, but it seems I can't keep it for long, and I soon go back to walking "the wrong way". I exercise daily, but the stuff I do (sit-ups, squats, planks, calf raises) is very generic and symmetric stuff, I feel I need something to target my "non-dominant" left side more specifically (particularly my back). My therapist showed me a couple of things, but I was wondering if you know of any exercise routines that could help me (if you could point me to any bibliographical resources about this problem I've described that would be great as well)

Thank you

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[physiobob]

Hi CaesarAnto, thanks for your email. I'd like to add some initial comments on your observations.

I think I would change the mindset from a right side (foot) that is doing too much work. Essentially the foot is the platform that the body 'lands' on as we take a step. It is a load absorber, using the mechanics within the mid-foot (arches) ankle, knees, hips etc to absorb the transfer of the weight in a smooth manner and then prepare the body for that transfer to the left side as the toes come off. So it is possible that is any part of that mechanism is not working as it should then the load will have to be shared/absorbed more in the other areas/joints. That can lead to them taken on more than they can, or wish to handle which can then lead to injury or discomfort (which then essentially is the brain telling you that those areas are not exactly happy with the situation).

The first thing to do is assess the right sided joints from pelvis to foot to see if they have normal movement. Perhaps they never have which lead to the initial injury of the right side? It is common to have torsions in the legs (rotational twisting of the bones) that can be asymmetrical which can lead to progressive issues. If the right side looks normal it could then be that an issue on the left side, such as reduced hip rotation at the left leg, which leads to the right leg landing more on the outside of the foot. That will wear out the outer side of the soles of your shoe more quickly than the inside. Now landing in this way (supinated) will lead to excessive pronation then as you transfer the weight to that foot. I am sure this reads in a rather complicated way but with your therapist they should be able to explain this in simple terms.

My advise would be to have a gait assessment. To really look at how you are moving from leg to leg and then combine that observation with the physical assessment. It is likely that some form of orthotic or a change in your trainers will be of some assistance and that your initial experience with that was just not the right orthotic selection (It can be very specific).

Lastly at 6'4" and only 75kgs it seems like you are a tall and slim in stature. This makes for long levers in the body which can predispose your to these sorts of issues. It is all very normal and you are doing the right thing in wanting to have a little more understanding about the issues and find the best way to manage them going forward.

regards
PB

[CaesarAnto]

hi, thanks for the reply. As for joint/torsions ecc. I forgot to add that on my right side my hip is a bit rotated forward, my knee is internally rotated, and my ankle overpronates. This was very apparent before starting physio, now it's much less. As for my gait, during stance phase I tend to have trouble keeping my balance on my left side, I tend to lean towards my right side as soon as possible

[physiobob]

Thanks for the extra information. Sounds then like in deed the issue us your left side and the right is just trying to absorb the load. Perhaps see if you can get a good gait video wearing shorts to really see what's going. Also film at a normal walking speed i.e. don't slow it down for the video as the gait will change at different speeds. You might find an exercise regime like Gyrotonic could be useful to balance your hips and lumbar spine to facilitate as normal a gait as is possible.

regards

PB