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Foot Orthoses and Peroneal latency or stretch reflex

Discussion in 'Biomechanics, Sports and Foot orthoses' started by nevparker, Jul 18, 2011.

  1. nevparker

    nevparker Member


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    I've been trying to link peroneal stretch reflex or latency and the effect of a pronated foot on it.

    To clarify further I was dicussing the benefits of anti-pronatory foot orthoses in patients with ankle instability with an orthopaedic surgeon and he asked if I had any knowledge of evidence for this. Since then I have read these threads on the forum:

    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=60229
    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=41761
    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=22890
    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=28522

    (sorry, but I don't know how to insert more direct links into the forum and advice would be helpful)

    I think I am tending to agree with Jeff from the final thread page 2 (28522) where the instability is not caused by deficient peroneal tendons due to weakness or tendinitis, laterally located STJ axis. Rather, that the everted rearfoot position causes slackness and lag in the peroneus longus when called upon to protect against lateral ankle sprain.

    I also agree with Luke's opinion from thread 60229. "the most obvious reason for increased peronal activity with orthoses use, would be due to the increased ankle/rearfoot inversion moment". But do we know if fitting orthoses with increased ankle/rearfoot inversion moment is beneficial and why?

    Is anyone aware of published articles related to the effects of foot orthoses on improving the peroneal strecth reflex and the potential benefits as a treatment for ankle instability?

    Also any ideas or further thoughts on the mechanism of repeated ankle inversion instability in a foot without a laterally deviated STJ axis.

    Thanks :dizzy:

    Neville
     
  2. nevparker

    nevparker Member

    No takers?
     
  3. Nev , maybe reword the question OR topic a little.

    Ie whats your argument - Are you suggesting that a "anti" pronation device helps reduce lateral ankle sprains by making the Peroneal Ankle reflex more effective by taking up the slack in the PL, PB tendons ?




    Here is some reading which some find interesting re Peroneal stretch reflex and ankle braces - Peroneus longus stretch reflex amplitude increases after
    ankle brace application
     
  4. nevparker

    nevparker Member

    Mike,

    Thanks for your reply. I am essentially asking that question and was thinking about the causative factor of lag/latency of the peroneal strech reflex and the effect of the pronated foot on it.

    Ergo "Can/Does a foot functioning in a pronated position cause/lead to latency in the peroneal strech reflex over time?"

    Therefore "is it acceptable to treat a functional ankle instability with an "anti" pronatory device?

    I only have references for the following and have not managed to access any work that looks at the effect of foot orthoses or foot pronation.

    1: Baur H, Hirschmüller A, Müller S, Mayer F. Neuromuscular Activity of thePeroneal Muscle after Foot Orthoses Therapy in Runners. Med Sci Sports Exerc. 2011 Jan 12. [Epub ahead of print] PubMed PMID: 21233779.

    2: Menacho Mde O, Pereira HM, Oliveira BI, Chagas LM, Toyohara MT, Cardoso JR. The peroneus reaction time during sudden inversion test: systematic review. J Electromyogr Kinesiol. 2010 Aug;20(4):559-65. Epub 2010 Jan 18. Review. PubMed PMID: 20083415.

    3: Fernandes N, Allison GT, Hopper D. Peroneal latency in normal and injured ankles at varying angles of perturbation. Clin Orthop Relat Res. 2000 Jun;(375):193-201. PubMed PMID: 10853169.


    Thanks
     
  5. efuller

    efuller MVP


    In 1981? Talliard wrote a paper describing sinus tarsi syndrome. He noted that there was decreased EMG activity of the peroneal muscles in individuals with sinus tarsi syndrome. Talliard also noted that 2/3rds of patients with sinus tarsi syndrome noted ankle instability on uneven terrain. I think there was another paper published soon after that showed that people with sinus tarsi syndrome had an increased reaction time, or latency, before activation of the peroneals when exposed to a sudden inversion movement. Talliard's paper was good in describing the condition and noting the change in peroneal activity. However, in my opinion, the explanation of those observations was bad.

    My explanation of those observations is that a subtar joint that is maximally everted will have high compression forces in the sinus tarsi. This may lead to the pain that is seen with sinus tarsi syndrome. If high compression is caused by eversion, further eversion moments from the peroneal muscles will hurt more and the brain inhibits activation of the peroneal muscles. This inhibition is what I'm theorizing is the cause of the ankle instability on uneven terrain. On flat ground the ground will usually cause the STJ to pronate, so it is less of a problem on flat surfaces.

    An orthosis that attempts to increase supination moment would decrease the compression force in the floor of the sinus tarsi and may allow the peroneals to be active more normally. So, paradoxically, you may see less inversion instability with an orthotic that attempts to cause supination of the STJ in patients with sinus tarsi pain.

    Eric
     
  6. Dananberg

    Dananberg Active Member

    Here is a slightly different take. Excessive pronation is often associated with ankle equinus. Ankle equinus can be related to loss of fibula translation.(*) With a restricted fibula, an arthrogenic inhibition can occur within the peroneus longus muscle, as its origin is the proximal fibula. I have seen this effect countless times, and once the fibula and ankle are manipulated, strength is restored to the peroneous longus and the previous loss of posterior tibial antagonist is returned. It has a very pronounced effect on the ability to resist an inversion type ankle sprain.

    * Dananberg, HJ, Shearstone, J, Guiliano, M “Manipulation Method for the Treatment of Ankle Equinus, “ Journal of the American Podiatric Medical Association, 90:8 September, 2000 pp 385-389

    Howard
     
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