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Functional hallux limitus and hand held dynamometry

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Petcu Daniel, Dec 19, 2016.

  1. Petcu Daniel

    Petcu Daniel Well-Known Member


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    Hello,

    How you'll use a hand-held dynamometer (HHD) to test for hallux limitus functional ?
    I remember a thread on PA where it was suggested that evaluating the tension (where?) generated by hallux dorsiflexion could be more useful than measuring ROM. I've read some articles regarding the inversion/eversion evaluation based on HHD but i didn't find something about FhL or Hallux limitus
    Thanks in advance for any thought,
    Daniel
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I had a device that measured the force to dorsiflex the hallux. See attached.
     

    Attached Files:

  3. Petcu Daniel

    Petcu Daniel Well-Known Member

    Seems that the hallux is generating the dorsiflexion force, isn't it? As in the Jack's test the tester is generating the dorsiflexion force, could we expect an underestimation of the tension in the case of the device from the image? On the other hand, if the tester will use somehow a HHD how he will feel the strength corresponding to the end of ROM ?
    Daniel
     
  4. efuller

    efuller MVP

    A functional hallux limitus is where there is range of motion of the MPJ non weight bearing and upon weight bearing there is increased stiffness of the MPJ. So, how do you measure stiffness of the mpj with a dynamometer. We will assume that the dynamometer can measure an applied force. The applied force will have to create a dorsiflexion moment of the mpj. So, you would need to apply a force a known distance from the MPJ axis to create a moment. Now we run in to the problem of lack of standardization. How far should you dorsiflex the toe to check its stiffness? Another problem is controlling for muscle activation. Often when you dorsiflex someone's hallux, you will see them contract their posterior tibial muscle. Supination of the STJ, by the muscles will decrease the resistance to dorsiflexion of the toe. What do you do when there is only 20 degrees of structural motion. How do you standardize dorsiflexion moment of the hallux versus body weight versus motion seen? There are lots of variables to assess when you check for functional hallux limitus.

    Eric
     
  5. Petcu Daniel

    Petcu Daniel Well-Known Member

    How it can be measured the stiffness of the mpj without a dynamometer or other complex methods ? If I've to 'feel' the stiffness with Jack's test, how do I know how much stiffness will indicate me a potential FHL ?
    Daniel
     
  6. efuller

    efuller MVP

    Well if you had infinite time and a large number of people willing to let you play with their toes, and approval of an IRB you could measure stiffness of the mpj in stance and then follow the people for 20 years and see how many of them developed windlass related pathology. One of the many problems with this is that you would be measuring stiffness in static stance. Stiffness in gait might be a more important predictor of who will get pathology. There are some people who have little stiffness in stance who exhibit late stance phase pronation and show signs of high stiffness in gait. They may show hyperextension of the IPJ or have a deep impression in their sock liner under their hallux. For a long time I've thought an interesting measure would be the ratio of first met head force to hallux force.

    Clinically, I like the impression of the toe in the shoe as the best indicator. However, that is very difficult to quantify. As clinicians we all have the patients complaints of pain to guide us. If they complain of windlass related pain then we can assume that they have high stress on the windlass. A more difficult problem is predicting who will get pain and then deciding how to allocate resources to prevent that pain.

    Eric
     
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