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Ankle Joint Equinus vs Talar Equinus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Bruce Williams, Sep 14, 2008.

  1. Bruce Williams

    Bruce Williams Well-Known Member


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    Dear Forum Users;

    When I post in this forum I regularly refer to Ankle Joint Equinus, AJE, in reference to a limitation of ankle joint Dorsiflexion, DFion, range of motion.

    Unfortunately when I lecture I see many confused faces to this reference. This weekend at the Onatario Podiatric Medical Conference I raised this issue and got some positive feedback.

    I explained that many or most feel that AJE refers to a tight tendo-achilles musculature and most feel it is best treated by Achilles lengthening techniques. At that many lit up and I felt I could see agreement in their faces.

    I then mentioned considering flatfoot equinus - Talar Equinus, TE. I think the audience might have been excepting of this after I explained that essentially the talar head is in the same position with AJE or TE, but that the difference is probably in whether the MTJ is stable or not. In other words does the midfoot or MTJ dorsiflex and/or abduct more in TE, and less in AJE. I feel it does.

    I would like feedback on this concept from forum members please. I checked w/ Craig Payne and he felt it was a confusing issue as well and merited discussion.

    So, please weigh in and maybe we can come to some agreement on how to classify the differences.

    Cheers!
    Bruce Williams, D.P.M.
     
  2. Bruce,
    Did you mean "excepting" or accepting? The midtarsal joints axial positions are likely to be determined by the forces applied, thus the resultant motion observed will be dependent upon the internal and external forces acting about the the midtarsal joints. The question then becomes does ankle joint equinus result in significantly different loading than forefoot equinus?
     
    Last edited: Sep 14, 2008
  3. Bruce Williams

    Bruce Williams Well-Known Member

    Simon;
    I meant accepting.

    As to your second question, you tell me? The TN joint is part of the MTJ as is the the CC joint.

    How do you differentiate to yourself adn to your colleagues and patients the difference between AJE and Talar Equinus?


    Bruce
     
  4. Sorry Bruce, I'd edited that post before you replied. The reason I asked about the talonavicular joint is that the terminology you use "talar equinus"suggest that this is what you were referring to.
     
  5. Bruce Williams

    Bruce Williams Well-Known Member

    Simon;

    I see now, no worries!

    I'm not referring to FF equinus at all here, only talar position which will be in equinus for both the conditions I was trying to describe.

    I appreciate your edited response regarding forces and agree, but it still leaves the same question I asked initially.

    bruce
     
  6. Bruce,
    Please define: "talar equinus". Also, describe how this results in greater dorsiflexion and abduction moments at the joints of the midfoot than those in ankle equinus.
     
    Last edited: Sep 14, 2008
  7. Bruce Williams

    Bruce Williams Well-Known Member


    Simon;

    I would think a definition of talar equinus would be pretty simple to visualize, but I will try to answer your question.

    Talar equinus would be essentially synonomous with SJT pronation position and / or a maximally plantarflexed position of the Talus, much as it would be during maximal pronation position of the STJ.

    Your second question I would reverse for you, ie I think the question is, what will cause the MTJ joints, TN and CC to deform due to greater moments described above in a foot w/ talar equinus as opposed to one with AJ equinus?

    In my mind both result in limited DFion ROM at the ankle joint, but the foot function will not be the same in most aspects except in relation to availabe ROM of the AJ.

    TE will have a prolonged STJ pronated position and will effect the TN joints and secondarily the CC joint thereby increasing the moments above and allowing increased DFion and /or abduction at the MTJ to accomodate loss of AJ rom motion in the pronated foot.

    AJE will have similar positioning of the STJ but the MTJ, TN and CC, must resist for some reason the increased moments thereby allowing equnus position of the foot at the ankle thru gait.

    There is an overlap here but they are not the same. I am trying to differentiate the two.

    Sincerely;
    Bruce
     
  8. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other equinus threads
     
  9. Bruce,

    I'm just trying to get my head around what you are saying here and trying to work out how this "condition": "talar equinus" is distinct from a maximally pronated subtalar joint position and I just don't see any. Therefore, I don't see the need for this terminology. I must be missing something...
     
  10. Bruce:

    I agree with Simon and also am at a loss to see what you are saying here. I lectured on a similar subject regarding the problem with the term "ankle joint dorsiflexion" at the 2007 PFOLA meeting in San Diego and also more recently in Sydney and Melbourne. I stated during these lectures that we are not simply measuring the ankle joint dorsiflexion when we measure the plantar foot to the tibia, we are also measuring subtalar, midtarsal and midfoot motion also.

    I don't see how using the term "talar equinus" helps things at all, and probably the term "talar equinus" confuses things for many. In my mind, it is much better to continue using the term "ankle joint dorsiflexion" but to teach podiatrists to realize that the dorsiflexion motion of the plantar foot relative to the tibia does not necessarily reflect only dorsiflexion of the talus on the tibia, but also reflects dorsiflexion of the rest of the joints of the foot distal to the talus.

    Is "talar equinus" a term you made up or is it one that has already been published in the medical literature somewhere before?
     
  11. Johnpod

    Johnpod Active Member

    Perhaps the term 'talar equinus' would be best applied to the state of bony blockage of dorsiflexion by the anterior trochlear surface of the talus, whereas 'ankle joint dorsiflexion' could be used to describe the 'soft tissue' limitation of dorsiflexion by short posterior musculature? It would be useful to have specific terms for two distictly different origins of ankle restriction.

    I appreciate that the dorsiflexion test we apply to assess ankle joint dorsiflexion actually measures the sum of all dorsiflexion movements of the lesser tarsals and midtarsal joints, not simply talar head dorsiflexion. This is why we must not apply too much pressure to the forefoot when conducting the test, dorsiflexing the foot to 'resistance' only.
     
  12. Donna

    Donna Active Member

    I thought this was already called anterior ankle impingement syndrome (AAIS)? :confused:
     
  13. David Smith

    David Smith Well-Known Member

    Bruce

    Are you saying that as where Talus is maximally plantarflexed relative to the CCJ and TNJ then this represents an equinus in terms of the dorsiflexion range of motion of the fore foor on the rear foot at the TNJ and CCJ. Therefore regardless of the reason for this relative plantarflexed position this can be considered as a talar equinus.

    Therefore where, during ambulation and due to tension in the achilles, the ankle joint stiffness causes the centre of force (CoF) to progress anteriorly along the forefoot, the moments produced about the ankle joint can only increase as the talus becomes more equinus, ie the relative relative platarflexion stiffness of talus on the TNJ CCJ.

    Are you therefore also saying that it is useful to consider the Talar Equinus in terms of how it may reach a position of equinus EG in the pronated or plantargrade foot.

    I think this may be useful as long as it is clear that the position of the talus in terms of kinematics does not neccessarily indicate the stiffness of the foot at the TNJ / CCJ joints in terms of moments due to GRF and the equal and opposite internal moments.

    The pronated plantargrade foot may still be very compliant abount the tarsus and this includes all joints distal to the CCJ and TNJ , whereas the cavus foot can be vert stiff at the midfoot even tho the talus is relatively more dorsiflexed.

    So I would say that it is useful to consider that any joint in the closed chain may be more or less relatively compliant than its neighbour and in order to progress forward there must be compliance somewhere in the kinetic chain including the foot ground interface. Evaluation of the action and interaction of the joints of interest should enable assessment, pronosis and diagnosis of pathology.

    Have I understood the gist of your argument Bruce?

    All the best Dave
     
  14. Mart

    Mart Well-Known Member

    Dave

    I think this is nicely put. When doing a gait analysis I often will do a (ankle) lunge test with sychronised cameras postioned squarely on saggital and frontal axes to look at behaviour of foot as COP advances anteriorly. A fairly clear picture emerges about motion just prior to onset of 3rd rocker and this usually jives with measurements of plantar midfoot peak pressure and force/time integral during walking gait.

    I have always wondered why we use the term equinus other than when intial contact during gait is the forefoot.

    cheers

    Martin
     
  15. Bruce Williams

    Bruce Williams Well-Known Member

    Dave;

    I think you have come closest of all to understanding what I am trying to communicate.

    I suppose it could be in my mind more a matter of differentiating between available AJ range of Dorsiflexion vs the term Ankle Joint Equinus.

    I just find it difficult in teaching situations when attempting to explain to our peers that there are often two very different situations occuring that cause a decrease in AJ DFion ROM, i.e. AJE. I see this regularly when comparing the long sided LLD leg vs the short sided LLD leg.

    In most of my patients with LLD on the short leg will lead to AJE, and on the long side AJE as well due to MTJ compensation on the long sided leg. Two causes leading to loss of DFion ROM at the AJ, both requiring manipulation at the AJ and foot, but for very different pathological reasons.


    I think/know it comes come down to the MTJ compensation resistance, stiffness, as Simon alluded to initially. I just don't see the differences being communicated effectively from my standpoint I suppose.

    I think you summed it up nicely for me Dave, thanks again!
    Cheers!
    Bruce
     
  16. David Smith

    David Smith Well-Known Member

    Donna

    Good point. would this occur when the ankle joint was too compliant ie the achilles tendon is not stiff enough. IE the foot stays dorsiflexed for too long in the stance phase. Or the talus was unusually dorsally displaced in some way or there was some osseous variation of the joint itself or there was soft tissue swelling for some reason? Or you are wearing Earth Shoes perhaps? http://www.earthshoes.co.uk/story.asp

    Dave
     
  17. For some reason this discussion keeps making me think about congenital vertical talus...
     
  18. Mart

    Mart Well-Known Member

    Bruce

    I am curious how this manifests itself in your gait exams, and what makes you decide if this causal to the problem you are dealing with rather than incidental.

    thanks


    Martin
     
  19. Bruce Williams

    Bruce Williams Well-Known Member

    Martin;

    The way that I approach my gait exams and the construction of the prescription of my orthotic devices derives from both causal and incidental findings of the F/T kinematics.

    If I perceive an early loss of heel pressure on a short limb and see kinematically a delay in the heel curve as it unloads and in the FF curve as it loads I need to make some decisions. Initially I may add a heel lift to see how that affects things. If that does the trick so be it. If not then I may need to address the AJ ROM thru manipulation to eliminate the delay in the heel unloading. If that does it, fine, if not then I need to address the FF loading in a number of ways.

    That is just a sample of how I do it. I'm not sure if that answers your question or not.
    Bruce
     
  20. Mart

    Mart Well-Known Member

    Hi Bruce

    Thanks for your reply.

    I am often ambivalent about how much I can reasonably conclude from my gait data. I was chatting to another contributor privately today about this and get the impression that an in depth look at some examples may be quite helpful to some of us.

    If you will allow me to indulge myself a bit, I saw a case today which I think may be quite illustrative and relevant to the topic of ankle stiffness and it’s effects on gait and role in chronic musculo-skeletal strain in the foot.

    I am very conscious of my tendency to try and fit the data to my theoretical preconceptions when I review gait data, anyone else have this problem? So assuming I’m not alone in this rather than presenting a detailed out of the box case history, I will present some data first to avoid this bias.

    Here’s a couple of 3 box force/time curves.

    One from someone with mild chronic foot pain, a measured ankle lunge value of approximately 20 degs. Other has lunge of 37 degs no pain.

    BTW 3 box is pressure sensor users jargon for a graph with 3 force/time curves from the same step, one line representing total force under foot, another with mask of heel area and 3rd with mask of forefoot excluding digits.

    image 1.jpg

    image 2.jpg

    Anyone wish to predict which is which from this data alone?

    I’ll reveal this tomorrow and also give a synopsis of what I think can be reasonably deduced from this data alone.

    Cheers

    Martin


    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  21. Bruce Williams

    Bruce Williams Well-Known Member

    Martin;
    I would say that the second graph represents the pt w/ the chronic foot pain and the decreased AJ rom. My reasoning for that is the fact that there is huge delay in the unloading of the heel or RF curve and a huge delay in the loading of the FF curve as well. Also the FF loads very early in the second graph, often a sign of flat foot landing adn/or early transition to the FF in a pt with AJ equinus.

    I'm guessing that these curves were from a Mat and not in-shoe?

    I hope I am correct, but it will not be the first or last time I have been wrong if I am not! :rolleyes:

    Cheers.
    Bruce
     
  22. David Smith

    David Smith Well-Known Member

    Mart

    What was the weight of each subject?

    Dave
     
  23. David Smith

    David Smith Well-Known Member

    Mart

    I'm probably setting myself up here but my interpretation of the presented data is this-

    The first set indicates a definite heel- toe foot strike. The first peak at 0seconds indicates a normal drop back heel strike at the end of swing phase. The second peak of heel strike is steep indicating perhaps not too much pronation. The high but early forefoot peak might indicate a cavus foot with forefoot valgus and equinus ankle. This is indicated by the early, steep gradient and high magnitude forefoot peak, which is behind the 3rd total force peak at the propulsive stage. This may indicate a functional equinus probably due to a FncHL . The forefoot force curve does not include the toes so therefore the addition force in the total force peak, and after the fore foot peak, must come from there.


    The second indicates a flat foot foot strike. the lack of drop back heel strike peak suggests a sliding approach to foot placement. The high total force a the first peak anf the low heel force peak indicates that much more than just the heel is in contact with the ground from heel strike to early stance. Heel lift occurs slightly later than the firstr example (assuming the same scale) but total time of stance is very similar at 700ms, however it appears that the first example is 690ms and the second 720ms this may be significant but we do not know the height, weight and leg lengths of each subject. I would assume that 2 is much heavier than 1 but then again 1 may be taking shorter steps so then his vertical force peak will be lower.

    So in summary

    1 has the equinus and functional HL probably due to low 1st mpj / valgus f/foot and compliant 1st ray. I say this one has 20dg lunge Painful foot

    2 Is a larger person with more pronation and compliant midfoot but not particularly affected by FncHL. 37dg lunge Non painful foot



    Cheers Dave
     
  24. Mart

    Mart Well-Known Member

    image 850 83kgs
    image 851 85kgs


    more later!
     
  25. Mart

    Mart Well-Known Member

    Bruce

    You correctly identified the high ankle stiffness foot (#851). I am curious to be sure I understand your reasoning though.

    Here's my understanding;

    because of high ankle stiffness the heel unloads earlier, interesting though the timing of heel off is pretty much the same for both individuals. I do not understand why you say that there is a huge delay in the unloading of the heel, I see the opposite of this.

    The ankle stiffness is sufficient to inhibit ability of ankle dorsiflexors to create a normal "1st Rocker" therefore forefoot contact is almost instantaneous, early progression into 2nd rocker means that forefoot force/time integral is larger than normal although peak forces for segments are quite similar their summed forces are quite different. Not sure why you say there is huge delay in forefoot loading when it appears early (which you also say??).

    Yes they are FMat data - no influence of foot-wear to confuse matters.


    I have just got home from a long meeting and too late to continue now but will add some more data and comments for discussion in next day or two.


    good to engage you in some discussion on this, I know that you have a lot thought and experience behind you using this technology.

    cheers

    Martin


    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  26. Mart

    Mart Well-Known Member


    Hi Dave

    Good for you sticking your neck out even though things are a bit different.

    Firstly I did a rushed job of editing the images and carelessly clipped the first part of the graphs which I think confused you a bit, sorry about that.

    I think that you were spot on with your interpretation of the higher peak force in 851 than 850 for the initial drop in COM (1st hump). Subject weights were essentially the same but I suspect 851 was walking faster. I cannot check because 850 was me, I did a quick stroll over the mat just to give a "normal ankle flexibility" comparison and did not record any kinematics as I did for 851. Crappy experiment really . . . anyhow . . . . ..

    Please comment on my interpretation of 851 in last post to Bruce - does this seem reasonable?

    I am adding a couple data of the patient (851) with high ankle stiffness and would like to comment on these later, any comments from you or Bruce on these additional displays?

    2 box 1.jpg

    2 box 2.jpg

    3box plus 2box.jpg

    forefoot COP trajectory.jpg

    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  27. David Smith

    David Smith Well-Known Member

    Hi Mart and Bruce

    Just in your own time what do you make of this odd scan of F/T curves?

    [​IMG]

    Cheers Dave
     
    Last edited: Sep 18, 2008
  28. David Smith

    David Smith Well-Known Member

    Oh its a lady of 60yrs old 62kg and 160cm tall
    Red left & green right = total force
    blu = heel
    black = forefoot
    pimk = midfoot
    orange = hallux
    green 1st mpj

    Dave
     
    Last edited: Sep 18, 2008
  29. Mart

    Mart Well-Known Member

    Dave

    I'd want to know if these were isolated steps or averaged over many and see synchronised kinematic data before making too many assumptions on these data.

    With such low HC force and loss of 2nd total FTC "hump", I'd estimate she has appropulsive gait (short step length + transfers wt to contralateral leg @ around HO). Also suggestion of right foot large amount of mid tarsal joint dorsiflexion or structural misalignment of midfoot.

    cheers


    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  30. drdebrule

    drdebrule Active Member

    Bruce,

    Consider leaving talar equinus out of your lectures because it is confusing. There is already enough confusion on ankle equinus and what we are really measuring (Kirby lecture PFOLA
    last year).

    As for the F-scan Mat analysis on this post. I find the comments are an intersting tangent, but I will still advise you to leave talar equinus out of your lectures. If it helps you personally to think of a talar equinus paradigm when considering treatments for patients, please continue to do so.

    Thanks!

    Michael B. DeBrule, DPM
    Marshall, MN
     
  31. Bruce Williams

    Bruce Williams Well-Known Member

    Martin;
    when I say delay I mean this in respect to the flattening of the curve at both the heel and FF in this patient as compared to the other one. The graph section of the heel may have encompass the same time frame, but the forces are less and prolonged over the similar time frame - hence a delay in the curves.
    Same for the FF curve, and even more so in your example.

    When I look at the curves I look for plateaus or flattened areas as opposed to nice smooth transitions. Flattened or delayed areas represent constant force over a prolonged time frame w/in the curve and this means stoppage of motion.

    So, in that pt, the decreased force over time, but with little overall unloading motion equals an ankle joint equinus and leads to early FF loading, represented by the FF curve starting so early. Then as the AJ reaches end ROM it lifts but the FF DF's causing a prolonged delay in the loading of teh FF curve, ie FnHL.
    Midfoot pain due to MTJ compensation loading forces.

    In this patient I would address the AJ rom w/ manipulaion, re-test. then address the FnHL w/ a cuout adn re-test. Then consider a soft or hard heel lift as necessary. I might address the LLD first depending on the physical exam.

    We see the same things, you just focus on different parameters than I do I think.

    Cheers
    Bruce
     
  32. Bruce Williams

    Bruce Williams Well-Known Member

    Dave;
    I would say that upper right curve has a delay in FF loading and heel unloading. I think the midfoot is delayed as well. The foot probablly pronates more if you want to think in those terms.

    Lower left foot shows delay in unloading of heel but less problems in loading of the FF curves adn less delay in the midfoot I think.

    Probably a stable midfoot adn AJE left due to LLD left foot.
    Right shows FnHL midfoot delays and AJE or Talar Equinus like this thread started out on in the first place! :dizzy:

    Let me know if that is correct.
    Cheers
    Bruce
     
  33. Bruce Williams

    Bruce Williams Well-Known Member

    Martin;
    I don't understand what the pink and green jagged curves represent?
    Otherwise theis is the foot with AJE, midfoot pain and FnHL as before I think.
    Bruce
     
  34. David Smith

    David Smith Well-Known Member

    Spot on Martin, (Gold star for you) Huge amount of pronation and f/foot adduction, navicular hits the ground and forefoot dorsiflexes about the midfoot. Short step early heel lift, apropulsive gait, tight achilles / equinus ankle. So this would be a good example to fit in with Bruces explaination of talar equinus. IE the ankle is equinus but the midfoot allows more dorsiflexion and saggital plane progression is maintained to some degree.

    This lady (a physiotherapist) had metatarsalgia 2nd MPJ and knee pain with the compensation of hyperextending knees that again allowed continued saggital plane progression.

    I advised rocker type shoes for the walking / hiking that she enjoys. She has bought MBT's and finds them very useful in facillitating her walking and reducing pain.

    Unfortunately for me she didn't go for the orthoses that I also recommended. :empathy:

    I do think that mid foot dorsiflexion stiffness is a more easily imagined concept since it can apply all along the foot at any point of interest. The more compliant the midfoot the more dorsiflexion is available during gait. The implications of pathology here are obvious of course. That's just me tho and it's just horses for courses at the end of the day.

    All the best Dave
     
  35. Mart

    Mart Well-Known Member

    Bruce.

    It strikes me that already with just 3 of us trying to comunicate our ideas we are running into issues of language, I am unaware that there has been any attempt to standardise reporting of this kind of gait data . . . perhaps with the evolution of the technology this needs some developement.

    Athough I think the gait data is relevent to your original post I agree with Michael B. DeBrule that this is some what tangential and will create a new thread to more accurately reflect what we are discussing, but will keep it specific to concidering and midfoot issues.



    new thread;

    Ankle and midfoot function: interpreting clinical gait data



    cheers

    Martin
     
  36. Mart

    Mart Well-Known Member

    I think this gets to the crux of what I understand Bruce started the thread about.

    It raises a couple of questions in my mind.

    Is the midfoot compliance primarily inherant in the foot structure/type or aquired because of chronic structural overload (in this case elevated ankle stiffness) and irreversable changes in associated ligamnetous integrity and joint architecture?

    If the underlying complaint of the patient is attributed to effects of elevated ankle stiffness then what's in our therapeutic tool box and how to evaluate effects other than patient feedback on presenting symptoms.

    I am unaware if the gait measures that we have been considering here have ever been validated and currently I look for other supporting evidence before applying too much weight to the evidence I interpret from my gait data.


    Bruce has mentioned manipulation, I assume that he is talking about superior tibiofibular joint. I am keen to learn when this is used vs attempting reduction in posterior group contractures with stretching exercise regimen for soleus and gastocnemius.

    Incorporation of a heel ramp seems logically appropriate at least a short term measure.

    more on the new thread later

    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  37. Bruce Williams

    Bruce Williams Well-Known Member

    Martin and Dave;

    I will concede Talar Equinus does not work at this point. In the future I will talk about loss of AJ Dfion, ie AJ DFion Stiffness, and stable vs unstable Midfoot compensation, ie MTJ Dfion Stiffness. We still have to respect the rest of the podiatric community that has not transitioned along w/ most re: the discussions in the Arena.

    I consider this thread closed unless someone else has more they wish to talk about.

    Thanks everyone!
    Bruce
     
  38. Colleagues:

    I agree with you all that terminology needs to standardized and properly defined in order to optimize our communication with each other. Here are the terms that I have used over the past several years since I have been lecturing on these subjects. These definitions are new and unpublished elsewhere.

    Ankle joint dorsiflexion stiffness: The load vs. deformation characteristics of the joints of the foot and ankle as measured in respect from the plantar aspect of the foot relative to the tibia in the dorsiflexion direction. Preferably measured in Newtons/degree (i.e. force/angle) or Newton-meter/degree (i.e. moment/angle) with forefoot loading force centered on the plantar metatarsal heads.

    Forefoot dorsiflexion stiffness: The load vs. deformation charactestics of the forefoot relative to the rearfoot. May be measured using reference of lateral and/or plantar aspect of the calcaneus relative to the lateral and/or plantar aspect of the medial or lateral forefoot. Preferably measured in Newtons/degree (i.e. force/angle) or Newton-meter/degree (i.e. moment/angle) with forefoot loading force centered on the plantar metatarsal heads.

    Of course, the terms "ankle joint plantarflexion stiffness" and "forefoot plantarflexion stiffness" would be used to describe the same load vs deformation characteristics of these two joints, but in the plantarflexion direction.
     
  39. Atlas

    Atlas Well-Known Member

    Agreed.

    I would add though that ankle dorsiflexion limitation needs to be considered in terms of anterior block versus posterior stretch.



    Sorry Kevin, but this is old-school podiatric over-complicated hyperbole that further removes one from understanding the ankle, assessing it, and treating it.

    Measure a lunge. Most podiatrists will start to raise NCSP versus Resting etc. This is icing, not cake. Measure the same lunge with the foot strapped in a low-dye technique. Yes you are altering the "rest of the joints of the foot distal to the talus", but you are not significantly changing the lunge (bar some slight skin drag between tape and posterior heel).


    Surely, a competent musculoskeletal practitioner can assess the mostly sagittal plane movement of a gross joint such as the ankle (cake), whilst considering only minimally the rest of the foot joints (icing).

    Time to come out of the dark ages, and look at the ankle joint dorsiflexion/plantarflexion on its own....just for 5 seconds. Less podiatric mumbo-jumbo and more understanding of one of the most important joints in the lower-limb.

    Sounds harsh, but if you want to understand the ankle joint, you can't think like a podiatrist. That was the first bit of advice I gave a pod colleague, and he has never looked back.

    By-the-way, I am not recommending thinking like a physio either; because most of them erroneously think that the panacea for the ankle is evertor strength, a wobble-board, and proprioception exercises combined with core stability. More icing! No wonder the world is getting tooth-decay and cholesterol.



    Ron
    Physiotherapist (Masters) & Podiatrist
     
    Last edited: Sep 23, 2008
  40. Ron:

    Looks like someone has a little problem with their podiatric degree and the intellectual capabilities of their podiatric colleagues......;)
     
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