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Muscle strength and transverse arch height

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Apr 26, 2018.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Relationship between transverse arch height and
    foot muscles evaluated by ultrasound imaging
    device

    Yasuaki Nakayama et al
    J. Phys. Ther. Sci. 30: 630–635, 2018
     
  2. scotfoot

    scotfoot Active Member

    From the paper above "The TA consists of five metatarsal heads " . In my opinion it does not . The metatarsal parabola consists of five metatarsal heads but this is a quite different thing .

    The during late stance the metatarsal heads are arranged more or less on the same horizontal plane . However , during gait as the foot moves from heel off to toe off , the met heads of the metatarsal parabola move relative to each other (in the horizontal plane ) with the head of the 2nd metatarsal moving distal to the head of the 1st metatarsal . If this did not happen then the plantar pressures under the 2nd met head would become unfeasibly high .

    Granted the intrinsic muscles of the foot can alter the extent of changes in the relative positions of metatarsal heads associated with gait and I believe this is what the researchers are picking up . Intrinsic control of the "foot dome "

    This paper helps demonstrate the problems that exist with the short foot exercise . This exercise and its progressions , cause the body to learn to co- contract the toe flexors and toe extensors at the same time , to produce a" locked arch" configuration which reduces navicular drop .

    In my opinion this will increase pressures under the metatarsal heads and reduce pressures under the toes and this could be absolutely disastrous for patients already prone to ulceration . The more you practice this exercise the worse things might become .
     

  3. This whole thing keeps bugging me.

    During my lawn cutting and run I keep coming up with. You can't get there from what you found.

    I do think the paper is interesting in that it most likely showed how the intrinsic muscles help adjust pressure on the met heads.

    There is no distal transverse arch. Something keeps bugging me about the paper
     
  4. DaVinci

    DaVinci Well-Known Member

    Yes. It seems like a good study on the control of the level of the metatarsal heads by the intrinsic muscles, but "transverse arch'???
     
  5. scotfoot

    scotfoot Active Member

    In mid stance , the transverse arch exists at the tarsal/metatarsal level but not far distal to this .As stance progresses and the heel lifts off the ground and the toes become dorsiflexed . The metatarsal heads move relative to each other with met heads 2 ,3 becoming more distal . The met heads are not in contact as in an arch structure like a bridge but are liked via ligaments . The effect is to give a structure that is like an upside down piece guttering .

    Think of buying a small tub of ice cream then dropping the spoon . You could use your finger to eat or use the small cardboard lid . To use the lid you would hold it in such a way as to make it like a simple saddle shape because this is the strongest shape for scooping up your ice cream .
     
  6. scotfoot

    scotfoot Active Member

    With regard to my concerns about the short foot exercise , the paper below (1) indicates that increased peak plantar pressure under the metatarsals of the foot is significantly associated with an increased risk of ulceration in diabetics .

    Paper 1
    Diabetic foot ulcer incidence in relation to plantar pressure...

    https://www.researchgate.net/.../256467900_Diabetic_foot_ulcer_incidence_in_relation_...19 Dec 2017 - Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location. Article in Journal of diabetes and its ...
     
  7. Of course it is Scot. There still is no distal transverse arch
     
  8. scotfoot

    scotfoot Active Member

    Mike ,
    What types of strengthening exercises do you prescribe for your patients to strengthen their intrinsic foot muscles ?
     
  9. None
     
  10. scotfoot

    scotfoot Active Member

    Not ever ?
     
  11. not in 23 years
     
  12. scotfoot

    scotfoot Active Member

    The most commonly prescribed strengthening exercises seem not to work for the intrinsics . These would include calf raises , toe curls ( towel curls) and marble pick ups . In my opinion ,the short foot exercise is ill advised in general.

    However , progressive strengthening exercises ,which involve flexing the toes around the metatarsophalangeal joints , have been shown by Mickle to be effective at promoting muscle growth in older people . If she can do that the same to diabetes affected , intrinsic minus feet then the therapeutic potential is enormous .
     
  13. efuller

    efuller MVP

    The theory of the intrinsic minus foot in diabetics is that the muscles are not used, and atrophy, because the nerves to those muscles no longer conduct signals. I don't know if the study has been done that shows that you can increase strength without active contraction of the muscle. I would bet that just moving the toes without contraction of the muscle will not increase muscle volume or strength.

    If one wanted to prescribe a muscle strengthening exercise for the intrinsics, walking would be a good one.
     
  14. efuller

    efuller MVP

    I still don't see how the metatarsals grow/ increase in length. What change in position, of what structures, and in what direction, are you talking about?
     
  15. scotfoot

    scotfoot Active Member

    Eric you said
    "The theory of the intrinsic minus foot in diabetics is that the muscles are not used, and atrophy, because the nerves to those muscles no longer conduct signals. I don't know if the study has been done that shows that you can increase strength without active contraction of the muscle. I would bet that just moving the toes without contraction of the muscle will not increase muscle volume or strength."

    The loss of muscle mass and strength caused by diabetes is called diabetic myopathy and is due to metabolic problems within the muscle tissue itself . (not a theory but clearly demonstrated)

    Resistance exercise has been shown to help with these metabolic problems and so preserve/restore muscle function/mass .
    Walking does not appear to improve intrinsic muscle strength in the diabetic foot .


    You said

    "I still don't see how the metatarsals grow/ increase in length. What change in position, of what structures, and in what direction, are you talking about?"

    Please see the link below which leads to a series of posts on what I have been trying to explain .

    link; ​
    Foot stiffness and footwear - Biomch-L

    https://biomch-l.isbweb.org/threads/30292-Foot-stiffness-and-footwear
    28 Jun 2017 - 10 posts - ‎2 authors
    The following proposes a hypothesis for a mechanism by which the foot becomes stiffer as the toes become more dorsiflexed during gai
     
  16. scotfoot

    scotfoot Active Member

    Mike ,
    If you were introduced to a method that easily and significantly strengthened the intrinsic muscles of the foot , would you recommend it to any of your patients ?
     
  17. We already know that Putting a device in a shoe leads to increased muscle activity and as Eric stated get them up walking is the best strengthening program

    so very unlikely would not say no as that means 100% but basically no ;)
     
  18. scotfoot

    scotfoot Active Member

    And yet in older people sarcopenia develops in the foot intrinsics even if previous walking levels have been maintained . Resistance exercise is generally recommended in individuals with sarcopenia .

    Diabetic myopathy can develop in the foot very early in the disease process , again , despite previous activity levels being maintained .
    If Mickles study shows a reversal of this diabetic myopathy ,by a reasonable resistance exercise regime , then it would be difficult to ignore .
     
  19. efuller

    efuller MVP

    Diabetic myopathy should happen equally all over the body. In the intrinsic minus foot there appears to be more atrophy in the foot muscles than the rest of the body.



    Which would be consistent with what I said about loss of innervation of the foot intrinsic muscles.
     
  20. scotfoot

    scotfoot Active Member

    Eric ,
    I can well understand the skepticism of podiatrists towards strengthening of the intrinsics as a treatment for anything since , in my opinion , almost every trial carried out into the subject is fit only for the rubbish bin .

    Trials talking about the "short foot exercise " to correct adult acquired flat feet ... poorly conceived idea from the start .

    Trials involving toe curls or marble pick ups to help prevent falls in the elderly .... no ,these exercises do not strengthen the intrinsics .

    Electrical stimulation to improve intrinsic function .. no ,as above .

    The only realist method for strengthening /restoring the intrinsic muscles of the foot ,which are now regarded by almost ,alllllmost every relevant section of the medical community as being vital to the proper functioning of the human foot , is the movement of the toes around the MTFJ against increasing resistance .

    Mickle et al have demonstrated that using this method , sarcopenia , which affects the foot muscles more than most of the other muscles in the body , can be reversed . Completely reversed . If you can restore this vital component of the foot in the elderly ,why wouldn't you ?
     
  21. scotfoot

    scotfoot Active Member

    Actually ,and on reflection ,"almost every trial carried out into the subject ( strengthening of the intrinsics as a treatment option ) is fit only for the rubbish bin " is probably overstating things a little since negative results can help guide understanding .

    However , if you want to know what intrinsic strengthening can achieve then you really must read Mickle's paper on reversing sarcopenia in the foot (abstract below )

    Efficacy of a progressive resistance exercise program to increase toe flexor strength in older people.

    Mickle KJ1, Caputi P2, Potter JM3, Steele JR4.
    Author information

    1
    Biomechanics Research Laboratory, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia. Electronic address: Karen.mickle@vu.edu.au.
    2
    School of Psychology, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
    3
    Division of Aged Care, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia.
    4
    Biomechanics Research Laboratory, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
    Abstract

    BACKGROUND:

    Reduced toe flexor strength is an independent predictor of falls in older people. However it is unknown whether strengthening programs can restore toe flexor strength in older individuals. The aim of this study was to investigate whether a progressive resistance training program, focused specifically on the foot muscles, could improve toe flexor strength in community-dwelling older people.
    METHODS:

    After baseline testing, 85 men and women (age range 60-90years) were randomized to either a supervised, progressive resistance training (n=43) or a home-based exercise (n=42) group for 12weeks. A further 32 participants were recruited for a control group. The primary outcome measures were hallux and lesser toe flexor strength pre- and post-intervention. Secondary outcome measures were exercise compliance, components of the Foot Health Status Questionnaire and single-leg balance time.
    FINDINGS:

    Average class attendance was 89% with 68 participants from the two intervention groups (80%) completing the follow-up assessments. Participants in the supervised, progressive resistance training group significantly increased their toe strength (up to 36%; P<0.02), whereas there was no change in toe strength in either the home-based or control groups. This increased toe strength was accompanied by a significant improvement in perceived general foot health and single-leg balance time compared to the other groups (P<0.05).
    INTERPRETATION:

    Progressive resistance exercises are a viable intervention to increase toe flexor strength in older adults. A clinical trial is now required to determine whether this intervention can reduce the number of falls suffered by older adults.
    Copyright © 2016 Elsevier Ltd. All rights reserved.
    KEYWORDS:
    Elderly; Falls; Resistance exercise; Toe strength
     
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