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Museings on Gait

There seem to be a number of “periferal” components to gait.
The first concept is that the position of the ankle is critical. There is only a small area of the sole of the foot through which the center of gravity of the body as a whole can be accepted, probably less than two square centimeters. Thus I have coined the term “posture priority” structure(s).
Any interference with the ability to dispose the CofG into that critical area will markedly impede gait.
It is, of course, possible to compensate by adjusting other parts, such as the lower limbs or the vertebrae to ensure that the CofG is placed correctly, but often at a price (for example back pain). This kinetic cascade up the lower limbs to the vertebrae and even further (look at a spastic attempting to walk), is at a price – perhaps in energy costs, but also in pain and destruction of the skeleton (Yes! But too complex to relate here. Suffice it to say that of the persons who consult me because of foot deformities – bunions, clawed toes, etc., 50% have had, or are planning to have total knee “replacements”. Yes, 50%!.)
This letter is getting too long, and so much of what I wish to say about periferal factors I will leave for another day.

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Forefoot Deformities

The cause of the commonest deformities (and the commonest incapacitating deformities) of humans is shortening of (usually) the calf muscles. I could elaborate via a PowerPoint presentation. (which I could send). This influences the necessity for posture specific anatomy as previously discussed.

But, current treatment philosophies causes other problems (See my essay “The Hallux Paradox”), one of which is an osteo-arthritis.
Back to the neurology: The “shortening” in the calf can be of the muscles controlling the forefoot (“Bunions”, clawed toes, metatarsalgia) or the hindfoot – via the triceps suri – or both.
  1. Now, the “shortening”: In young women (common, pre-menarche) it is probably a hypertonia – indeed I have treated it with Botox. We could talk about that much.
  2. In the mature (and this is usually an age related problem) it is probably a vasculitis/fibrosis. The premature incidence is high in diabetics, PVDisease, rheumatoid. Perhaps Guillaum-Barre and polio rarely. I could talk much about polio – now phasing out, but there are still the elderly who had forme fruste polio as children (usually not diagnosed).
  3. Finally there is the questionable place of the deep fascia and its pathology. Again this is a chapter in its own right upon which I could enlarge at length.
I am sorry that this is so piecemeal and abbreviated, but it is not simple (although regarded by my colleagues as mechanistic and simple, which is why it goes wrong). Of particular neurological interest is the “hypertonia”, which was demonstrated in a child who you presented who had previously been subject to epilepsy surgery..