Back when I was in school, I had some pretty amazing instructors and professors who not only were teachers but practitioners themselves. One specific instructor and Chiropractic Physician I had was not only a Chiropractic Physician, but he was also a DABCO. A DABCO was one of many Chiropractic post-graduate specialties that you could acquire after graduating from Chiropractic school that entailed more extensive classes, exams/testing, a residency and board exams. DABCO stands for Diplomate of the American Board of Chiropractic Orthopedists. This is the Chiropractic version of an orthopedic specialists (without the surgeries of course). Dr. Shawn Allen was an amazing clinician with SO much knowledge to share with us students. It was one of my highlights to my Chiropractic education. Anyway, it was Dr. Allen who first introduced me to the mechanics of the foot and ankle. Some of those clinical pearls I learned was the importance of the Kinetic Chain. The Kinetic Chain is the force or energy that moves through our joints starting with the… foot. Let’s say the we were to take a step with the right foot. The force being generate would enter the right foot and continue up the foot, through the ankle into the right knee, then into the right hip, then into the right Sacroiliac joint (which is part of your pelvis), then crosses the pelvis into the left Lumbar Spine (which is your lower back), up the left lumbar spine, through the left thoracic spine (which is your mid and upper back) (unless you have a congenital or acquired scoliosis which would then be right thoracic spine). If there is no scoliosis, then it will end up crossing at the right side of the cervical spine (which is your neck), then crosses into the left occiput (which is where your neck meets your skull, on the skull side). If you followed me through that visually, nice job. I know it wasn’t easy but that explains how forces from the ground affects your whole body.
Fun facts: you have 26 bones in your foot and 26 bones in your spine. Easy way to remember the number of spine bones… Cervical Spine has 7, Thoracic Spine has 12 and the Lumbar Spine has 5. You have breakfast at 7, lunch at 12 and dinner at 5, in theory. Neat eh? Now with those facts you may say that “that was only 24 bones.” You’re correct in your math. But there are two others. The Sacrum and the Coccyx, the center of your pelvis and your tailbone. Both of these two bones have fused bones, sacrum having 5 and coccyx having 3. That would be our 26. Unless you’re 18 years or younger, then those 5 fused bones and 3 fused bones would be counted separately and now you have 32 altogether.
Now back to the foot and ankle. Dr. Allen was the first instructor to teach me that with all the bones in your foot and ankle, there is a specific movement that each of those 26 bones must go through in order for not only the foot and ankle to move correctly but for the Kinetic Chain to work the way it was intended to. That movement is called the Windlass Mechanism of Hicks. John Hicks in 1954 introduced the mechanism in which Hicks originally described the foot and its ligaments as an arch like triangular structure or truss, like in a house or building construction. The calcaneus or the heel, the mid-tarsals or the midfoot, and the metatarsals or the forefoot along with the medial longitudinal arch (the inside aspect of the plantar fascia or the spring ligament), forming the truss’s arch.
A “windlass” is the tightening of a rope or cable. As we proceed through our normal gait, we should see this Windlass Mechanism at work. Heel strike, midstance or contacting the outside of the bottom of the foot and then toe off as we go from the baby toe to the big toe for the end phase of that stride. Did you follow all of that? You can thank Dr. Allen for that one.
Why is that mechanism important you way wonder. Well, I adjust a lot of feet – maybe close to a quarter of my patients. Like the spine, its mechanics are optimized by making sure each bone is doing what it is intended to do. I have had countless runners, triathletes, basketball players, soccer players, dancers, or just regular hard-working patients who tax their feet. Making sure their foot and ankle is moving optimally is just as important as making sure their spine is moving the way it was intended. So, when adjusting with Chiropractic, I am taking into account the Windlass Mechanism and adjusting accordingly into that movement pattern. I find this Chiropractic adjusting technique helps not only get the foot and ankle get used to the way it’s supposed to move but it allows for easier manipulation to some of the harder joints to adjust, like the weight bearing articulation of the Talus and the Calcaneus which are the bones right underneath the shin bones, or the Tibia and Fibula.
Lastly, after adjusting with Chiropractic, the feet and ankles on a patient that has already had their spine adjusted with Chiropractic enough times to demonstrate some stability in function, I would then evaluate if they had knee pain and if it corrected the problem. If not, then knowing that I have optimized the pelvis, Lumbar Spine and now the foot and ankle, I could then focus on the knee mechanics specifically – usually with exercises and possibly manipulation to the Tibia and/or the Fibula. If more stability is needed, that’s where I would consider either over the counter inserts or custom orthotics – which I have both in my office to offer patients. My Chiropractic practice uses over-the-counter inserts called Tread Labs and custom foot orthotics by Sole Supports with patients who need them. This allows me to stabilize and support many dysfunctions of the foot and ankle, after they have been optimized in movement and mechanics with Chiropractic adjusting techniques.
I hope you learned something today. Thanks for reading – and stay well.
Yours in health - Dr SJ