The C QUAD Foot-Type is sometimes referred to as a Subtle Pes Cavus foot or an under-pronator. This foot-type exists when an Uncompensated Rearfoot Varus is coupled with a relatively normal (neutral) forefoot alignment. A key distinguishing feature of this foot-type is an obvious toe-out gait pattern.
People with this foot-type walk very toe-out. Picture how a gunslinger from an old western movie made his entrance into the local saloon! If you're not a fan of the westerns, think of a penguin or a duck! The primary consideration here is simply that the rearfoot cannot pronate at the subtalar joint. Why? Because it is uncompensated which means that calcaneal eversion is not possible! Furthermore, if a person with this foot-type attempts to stand with their feet straight ahead, they will complain that their hips hurt! Why? Since an individual with this foot-type cannot pronate at the subtalar joint, loading the inner aspect of their feet is extremely difficult. As a result they will attempt to acquire the necessary motion by externally rotating at the hips. The muscles that externally rotate the hips become chronically shorted as a result of this gait pattern. Thus, standing with their feet straight ahead is extremely uncomfortable.
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Propulsion Phase As the heel lifts off the ground, the 1st metatarsal head normally should be fully loaded to prepare for push-off. In cases of very large uncompensated RF deformities, the heel may pivot medially (swing towards the other leg) at this point to complete loading of the 1st metatarsal. This pivoting occurs around the 5th metatarsal head, often resulting in a callus. Note that the lateral column (midtarsal joint) has stayed straight and stable. Final propulsion is off the medial edge of the hallux, resulting in a pinch callus on the inside edge of the big toe. In addition, you may often see large, red "bumps" on the backs of the heels in this foot type. These are known as RCB's, or Retro-Calcaneal Bumps. This occurs as the result of repetitive, frictional forces between the severely angled heel and the back of the shoe. You may often notice a hole worn through the inside lining of the shoe as well.
As weight moves forward over the foot, the arch and midtarsal joint remain rigid, with excessive pressure borne along the lateral column and the head of the 5th metatarsal. Note that you can not easily see the arch from the back due to the large toe-out limb position. Basically, if you compare contact phase to midstance, there is little to no change in foot position. The primary compensation that occurs in order to load the medial column of the foot is external hip/limb rotation.
At initial contact, the calcaneus strikes the ground in an excessively inverted alignment relative to the ground. Since the deformity is largely uncompensated, very little pronatory motion is observed as the forefoot is lowering itself to the ground to conclude the contact period of gait. This restricted sub-talar joint pronation results in a lack of normal shock absorption by the foot. The primary compensation for this foot type in order to lower the medial column to the ground is external hip rotation, resulting in a large toe-out gait. In other words, the feet and knees are pointing away from each other. Picture how a gunslinger from an old western movie made his entrance into the local saloon!