Chapter 4: Basic Components of a Lower Extremity Biomechanical Examination

This is the only chapter I have had to section into 2 parts in this book due to the 4 Book structure. I have decided to add Part I (from Book 1) back into the start of Book 2 for the ease of readers who want the entire biomechanical examination under one roof. We all learn incrementally and I would suggest adding one examination technique per month where you are committed to measuring each patient when it seems necessary, or start learning on staff, friends, and family members. One podiatrist took my advice and emailed me that he could not believe how pronated the RCSP was on his 12 year old!!! He was going to definitely change his orthotic Rx.

There are many basic examinations important to a Lower Extremity Biomechanical Examination that will be explained in this chapter. The “Biomechanical Exam” is summarized here and I will emphasize the importance of each part in relation to what we are using it for (like analyzing the Pronation Syndrome). I do not measure anything until I watch a patient walk. I want to first get a feel of the overall biomechanics from gait evaluation inorder to focus my examination. I then have 3 types of my biomechanical examination: cursory 5 minute examination (usually at the first visit), injury specific 10 minute examination (like looking for the common causes of stress to a painful big toe joint), and the complete examination (where the patient has scheduled an hour for me to pour over their biomechanics to find every clue for their pain syndromes, or why they are not responding to well made orthotic devices, or what we can improve on concerning the overall biomechanics). The biomechanical examination below takes me 45 minutes to complete, and I may have started the process on earlier examinations. Duringchapters 6 and 7 (Book 2 and 3 respectively), where I talk about many of the mechanical treatments of injuries available, I will discuss the key examinations needed for each injury (more injury specific).

Biomechanics is also taught by many brilliant minds that will stress various points in this examination, and not regard other aspects (examinations) as that relevant. Due to this, I struggled deciding what to place into this textbook that would satisfy most instructors. There are much more complicated versions of the biomechanical examination that have taken me over 2 hours to complete, and much more simple versions including deformity specific versions, that you can perform in 10-15 minutes. The examiner should be aware of all the tests listed here, and should practice them to see how they fit into their practice. In the end, this biomechanical examination is what I do and know and has helped countless of my patients. I have added Navicular Drift and Drop Tests, and Foot Posture Index Tests, to my learning curve recently. They are more research tools, and while interesting, have not affected my patient Rx writing. Weekly, in the practice of biomechanics, any aspect of this examination may prove to be crucial in my understanding of a patient’s problem, or in my education of a particular patient.