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A different kind of midtarsal joint "locking"

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Feb 12, 2014.

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    I've been meaning to post this for a while but have been too busy of late. This was a 50 something year old female equestrian who presented complaining of her foot "locking". Basically she could put her foot into a position from which she claimed that she was unable to move it, without physically grasping the foot and manually moving it out of this position. She had problems sleeping as the weight of the bed clothes often caused this "locking" to occur. Muscle function and neuro testing showed NAD. She "locked" her foot repeatedly during the physical exam; minimal force from me "unlocked it" with no abnormality in the quality of motion being felt- no clicks, clonks, clonus or crepitus at all. Couple of photo's of the "locked" foot attached. It's almost like she's subuxing the forefoot on the rearfoot about the medial-lateral MTJ reference axis???? Anyone come across this before?

    Tension in EHL tendon is interesting.

    Attached Files:

  2. efuller

    efuller MVP

    A "locked" x-ray would be interesting. Just brainstorming. Agree the motion appears to be plantar flexion of the cuboid and navicular relative to the talus and calcaneus. It may be my imagination, but it appears the anterior tibial tendon has rotated around the medial side of the foot. In this position, it would loose leverage to dorsiflex the forefoot on the rearfoot. The extensor retinaculum holds the EDL and EHL tendons much closer to the foot, so they also have a very small leverage to dorsiflex the forefoot on the rearfoot. This explanation would be consistent with a little push from you to move the anterior tibial insertion to the top side of the "medial lateral axis" of the MTJ. Whereas in the plantar flexed locked position the anterior tibial insertion is on the bottom side of the medial lateral MTJ axis. The EHL could just be passive tension created by plantar flexion of the forefoot.
    Just some thoughts.

  3. Eric and Simon:

    Those were my thoughts also. Excessive plantarflexion of talus on tibia and of forefoot on rearfoot has created little moment arm for the ankle joint dorsiflexors. Worth considering as a possibility but can't say I've ever seen it before. Must be one of those Plymouth anomalies...;)
  4. HansMassage

    HansMassage Active Member

    Perhaps a cleat under the forefoot of her riding shoe would keep the pressure where it belongs in the sturup. I have experienced such locking myself when allowing the foot to slide forward in a narrow sturup. My sister made caps for the front of her western saddle sturups but that would not be acceptable in formal riding. Most English saddle sturups have a slot that would accept a cleat.
  5. TedJed

    TedJed Active Member

    Simon, is this the site of the 'locking'? Or is it in the ankle region? I can't quite determine the site of the locking from your description.

    I've encountered a similar-ish case with a bmx cyclist [whose foot looks similar to the pic you've added] and he had a dorsiflexed position of the intermediate cuneiform which didn't glide at all. After some specific D-P mobilisation of the cuneiforms, the motion was restored and the 'stuck feeling' cleared.

    His case was exacerbated by the EDL tendons 'clicking' over the cuneiforms though...

    Hope that helps?


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