Lesser toe windlass and forefoot wedging
Some time ago I described a digital dorsiflexion test analogous to Jacks test (Hubscher manoeuvre) for the lesser toes. My observation was that there appears to be variation among individuals as to the response of the foot to dorsiflexing each of the digits in turn as we move from toes 1-5; in some people dorsiflexing each digit in turn might result in foot supination at every digit, whereas in other people there is a transition point, at a certain digit, where the response changes from supination to pronation.
I was just thinking about the use of forefoot wedging, if the wedging dorsiflexes the metatarsal, it might create a functional lesser digit limitus in one or more of the lesser digits, and impact on the supination / pronation moment acting on the foot via that specific digit during gait (dependent on whether dorsiflexion of the digit in question tends to pronate or supinate the foot) I'm thinking there might be implications here for wedge placement depending on what we are trying to achieve at the forefoot during gait. i.e. wedge to either side of the transition point of the digital dorsiflexion response. So if we intentional "block" those digits which provide pronation moment when dorsiflexed by dorsiflexing their metatarsals with a wedge up to the change over digit, this should increase the net supination moment...
So, say for example digits 5, 4, and 3 all tended to pronate the foot during the test and we wanted to decrease the pronation forces coming from the dorsiflexion of these toes via the windlass mechanism we might use a reverse "Mortons" but under mets and toes 3, 4 and 5 (or a kinetic wedge extending under 1 and 2).
Hope that makes sense.
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