Like a lot of other topics (eg overpronation and supination resistance), I have a lot to say about the windlass mechanism of the foot. The windlass mechanism is the foot’s own natural way of supporting it self, so it is crucial that it function well and there be nothing wrong with the way that it works. Interventions used to treat foot and lower limb problems need to facilitate rather than inhibit that mechanism
Podiatry Arena has a lot of valuable information and threads on the windlass mechanism including all of the research published over many years and I wrote about our research and all of the windlass dysfunctions at my running blog. I have just been tasked with sorting the windlass mechanism page at PodiaPaedia, so looking forward to sorting that out.
Supination Resistance is another one of those topics that I find myself writing about a lot (eg here and here)and something I have been banging on about in my Clinical Biomechanics Boot Camps for years.That is how important I think that the concept is.
The concept has its origins in the concept of overpronation probably not be all that it is cranked up to be, so rather than focus on “overpronation” perhaps he focus should be on the forces that are associated with the function of the foot and pronation. It just makes a lot more intuitive sense o be focusing on the forces rather than the motions. It is the forces that actually do the damage to the tissues rather than motion. Motion is not painful.
I have certainly done a lot of research on it and unfortunately never quite got to publishing it. I did summarize most of the research done in this post.
Severs disease (or calcaneal apophysitis) is common in kids (my kids had it) and something that I write about often (eg here and here) and participate in lot of discussions about it, so check them out for more detail.
Some issues have come out of all that:
1. We still do not know if the condition is due to the excessive pull of the Achilles tendon or excessive ground impact on the growth plate. It could be one or the other or it could be both. Interestingly, there are some quite strong opinions either way as to which one it is, but in reality, we have no idea which one it is and it could easily be either one or a combination. It could also be different in different individuals.
2. Managing workload or activity levels is key and children are children, and they don’t listen. Sports levels can be reduced, but they still run around at school or when not being supervised. This really came home to me when my own daughter got it. No matter what I did to treat her, I had no control over what running around she would do at school with her friend during the lunch break.
3. There has been a lot of commentary about it being called a “disease”, especially in the context of all the recent discussion of the use of nocebic language when it comes to managing people that are in pain. It is not a disease and probably should not be called one.
4. It’s not totally clear what it is, but I like to pretend that it’s like a stress fracture of the growth plate and treat it as though it is one. It just makes sense to think like that.
It is a condition that I often see from comments in forums that is frequently mismanaged. I do spend a lot of time on it at my Clinical Biomechanics Boot Camp course and like to tell the story about how I used to hate seeing it as my success rate used to be close to 100% failure; now its close to 100% success. The change was that dramatic once i realized what was going on with it; hence my reason for writing the blog post that I referred to above.