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Training Clients with Foot Problems

Posted Sep 22 2008 10:29am

by Lesley Powell

Agony of DE-feet

“Have any of you worked with anyone who has had a proximal big toe joint fused due to arthritis? Any experience? opinions? I would imagine it would be an issue for gait - she limps a bit now.

My friend’s surgeon is recommending this since acupuncture and physical therapy haven’t worked. He said there could be a bit of a limp… She’s not a client of mine - i’ve worked with her a few times and she experiences temporary relief but doesn’t do any management herself so she’s looking for a permanent fix…” Pilates Teacher

When a client has arthritis/bunion at the big toe, the joint no longer flexes. It is painful to flex at this joint. So they will have to change their gait to adapt to this. Most probably they will have to turn out at the foot. This allows the foot to come easier through when walking.

With one of my client with a bunion, her walk was more of a shuffle. Because of the inability to push through the foot, this is one way the client develops less hamstring and gluteal strength. The hamstrings and gluteals are also necessary for standing on one leg. She never got well on her legs which is called “midstance” in gait.

Since the client is not doing a proper pelvic shift over the standing leg, they will shuffle or limp. I worked a lot on teaching the client to do a better thigh lift THIGH LIFT
to transfer the leg from back to front. This will mean still training the legs especially psoas, quadripceps, hamstrings and gluteals. Training the feet is still essential for grounding forces and alignment of the standing leg.

Psoas: thigh lifts, single leg stretch, double leg stretch, reverse kneeling abdominals on reformer, leg springs/straps to train psoas (lie opposite direction than usual training)

Quadriceps: footwork on reformer and wunda chair, sitting on physioball- bouncing, single leg lifts, squats

Hamstrings & gluteals: leg springs/straps. Bridging especially in neutral, Pilates shoulder bridge with one leg lift, standing using wunda chair, Pilates Upright

Other great exercises: single leg kick, double leg kick, quadriped with opposite leg and arm, quadriped with flexing knee in with flexed back and extending leg and back, swan

Feet: small releves to their comfort zone, footwork with toes curled over foot bar, theraband to strengthen plantar flexion (pointing foot at metatarsal joint and full foot plantar flexion, ankle circles

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