It doesn't take long to realize that a patient who presents to my office for a walking related problem is very much aware of supra pedal manifestations or complaints associated with the manner in which they walk. In other words. it is extremely common to hear people say that their foot problems are causing their knee, hip back and/or postural complaints.

It is incumbent upon the examiner to observe and assess not only the feet when examining a patient with a gait disturbance. The entire postural complex must not be ignored. Relationships between the different segments of the legs, back neck, arms, and head need to be observed as the patient walks. Through a process referred to as joint coupling, what occurs at the foot does indeed effect more proximal body segments and influences posturally related complaints. 

In order to unlock the puzzle of how one walks and how one's walk causes pain, the entire postural complex needs to be observed. The feet are the first structures in the chain of events which interact with gravity. Antigravity fascilitation and thus the forward progression of our center of mass from point A to point B starts with the feet but the effects of the entire postural complex is called into play in a systematic fashion, thereby allowing for our  forward progression with a minimal expenditure of energy.

The iliopsoas muscle comprised of the iliacus and psoas portions contract when we walk in order to commence the swing phase of gait. If the ankle or big toe joint is limited in its motion, the iliopsoas has difficulty in contracting and adversely effects its origin on the lumbar spine causing instability. An unstable lumbar spine may result in nerve impingement and subsequent pain because of abnormal foot function.