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Discussing functional hallux limitus recently has made me think about this idea of dorsiflexion load vs dorsiflexion at the 1st metatarsophalangeal joint (MPJ). How are we going to start measuring this inherent resistance of the hallux to dorsiflexion moments more accurately and possibly get away from the clinical terminology and into more scientific terminology? We seem to understand the concept for 1st ray stiffness now, how about 1st MPJ stiffness....seems like a logical progression to me!
Craig, what has your research shown in this regard so far?? Also, I was asked about a rating system for the Hubscher Maneuver at Biomechanics Summer School 2007 last week both during our panel discussion and privately...any ideas on how best to accomplish this?
__________________
Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I measure first MPJ unloaded then loaded, both in standing. Unloaded: The patient places 99% of BW onto opposite foot while feathering the ball and heel of the measured side onto the ground. The examiner passively moves the hallux to endrange DF, and the angle of floor to hallux is measured. Loaded: reverse the WB and again measure floor to hallux angle.
An alternative that I thought of but never tried is similar to the Coleman block test- medial foot off the block for unloaded.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Discussing functional hallux limitus recently has made me think about this idea of dorsiflexion load vs dorsiflexion at the 1st metatarsophalangeal joint (MPJ). How are we going to start measuring this inherent resistance of the hallux to dorsiflexion moments more accurately and possibly get away from the clinical terminology and into more scientific terminology? We seem to understand the concept for 1st ray stiffness now, how about 1st MPJ stiffness....seems like a logical progression to me!
Craig, what has your research shown in this regard so far?? Also, I was asked about a rating system for the Hubscher Maneuver at Biomechanics Summer School 2007 last week both during our panel discussion and privately...any ideas on how best to accomplish this?
Hi Kevin,
Just thinking about a rating system. To fully appreciate the maneuver, the amount of hallux dorsiflexion, the change in navicular height (or maybe the amount of inversion of the calcaneus) and the amount of external tibial rotation could be compared. Can these be expressed as a ratio ?
Clinically it does not appear that static resistance to hallux dorsiflexion relates to what is happening during walking. We have all seen many times where in RCSP the hallux cannot be dorsiflexed more than say 10 degrees, but during gait the hallux does dorsiflex much more than this.
Just as a side comment, it also appears from H. Menz's research that hallux purchase strength is more important than the amount of hallux dorsiflexion available during walking.
Hi Kevin,
Just thinking about a rating system. To fully appreciate the maneuver, the amount of hallux dorsiflexion, the change in navicular height (or maybe the amount of inversion of the calcaneus) and the amount of external tibial rotation could be compared. Can these be expressed as a ratio ?
Clinically it does not appear that static resistance to hallux dorsiflexion relates to what is happening during walking. We have all seen many times where in RCSP the hallux cannot be dorsiflexed more than say 10 degrees, but during gait the hallux does dorsiflex much more than this.
Just as a side comment, it also appears from H. Menz's research that hallux purchase strength is more important than the amount of hallux dorsiflexion available during walking.
I agree, the static measures first need to be shown to correlate to dynamic function.
N.B. Beware of research that only attempts to fit linear models and then reports poor correlations- relationships between variables are not always linear and sometimes require scale transformations to find the "hidden" relationships.
Even so, you would then need to normalise for various structural variables, e.g. length of hallux.
Taking Tarik's ideas for ratio's, again these would need to be normalised for segment lengths etc.
Personally, I think a far better approach to understanding 1st MTPJ function is to take multiple x-ray's and MRI scans
__________________ Science is the antidote to the poison of enthusiasm and superstition
Craig, what has your research shown in this regard so far?? Also, I was asked about a rating system for the Hubscher Maneuver at Biomechanics Summer School 2007 last week both during our panel discussion and privately...any ideas on how best to accomplish this?
I now back from secret business....the rating system we use for the Hubscher Maneuver/Jacks test is:
1. Hard or moderate or easy
2. Immediate or delayed
With the first MPJ dorsiflexion stiffness device we built we can measure (1) in newtons and (2) in degrees
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
First MPJ Dorsiflexion Stiffness
Linear Mode
