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Functional hallux limitus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by lalsam, Jan 30, 2006.

  1. lalsam

    lalsam Welcome New Poster

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    This is a thread for Mr Payne. Dear Mr Payne I am looking for information on functional hallux limitus, could you help me with any information to this.
    thank you lorraine
    2nd year podiatry student in the UK :)
  2. Craig Payne

    Craig Payne Moderator

    There are plenty of others that can help, not just me. A simple lit review should turn up lots of papers.

    Here are a few to start with:
    HJ Dananberg
    Gait style as an etiology to chronic postural pain. Part I. Functional hallux limitus
    J Am Podiatr Med Assoc 1993 83: 433-441

    Craig Payne, Vivienne Chuter, and Kathryn Miller
    Sensitivity and Specificity of the Functional Hallux Limitus Test to Predict Foot Function
    J Am Podiatr Med Assoc 2002 92: 269-271
  3. markjohconley

    markjohconley Well-Known Member

    dear craig

    ....is this the "dear craig" column?.......nice one (no surprise)........while you're at it craig, any advice on paying off my mortgage more quickly and remedies for hair loss??
  4. Dear Craig:

    My Chevy broke down on the way to work, my dog done got run over, and my bunions sure are a achin'. Wats a fella to do?? Write another country-western song?? ;)

    Johnny "Folsom Prison Blues" Kirby
  5. Craig Payne

    Craig Payne Moderator

    Actually, while we on this topic .... as we get more into our research on windlass function there are a number of considerations to do with functional hallux limitus that we re-evaluating. It is possible that functional hallux limitus is a disorder of windlass function - maybe related to the timing of windlass onset with MPJ dorsiflexion; and/or the force needed to establish the windlass mechanism (which varies at different angles of MPJ dorsiflexion; and/or some sort of disruption of the loading of the windlass (could be from distal or proximal influences).
  6. musmed

    musmed Active Member

    Dear Craig

    I noticed this section on hallucis limitis. All the data shows it is very commn but there is nothing much on treatment.

    As far as I am concerned H. lim. is a classic example of fascial dysfunction.

    I say this because using fascial correction techniques and some alterations by me, I have been a ble to restore full function to the great toe within 5-10 minutes.

    It is a technique that needs to be shown/demonstrated not written about.

    Basically it is a method of motion restoration using motion barrier restrictions in all 12 motions of a joint. Finding these restrictions and then seeing if this restriction can be overcome by changing the motion technique being used.

    For example: if abduction and compression hits a motion barier, one then tries distraction and internal rotation or whatever lets it release.

    In August 05 I performed this technique on a poddy who was in great pain from the condition. She was to have surgery the following week of the workshop.

    In 10 minutes I was able to give her full ROM to her right toe. This ROM was better than her left and was painfree.

    I will be demonstrating this and other techniques in Perth in March.
    Paul Conneely
  7. DaFlip

    DaFlip Active Member

    can anyone else hear the self promotion here $$$$$$$.
    but small tip dude, 'poddy' probably does not endear you to your advertising audience.

    rather than make this a sales technique for your courses let's hear about the 12 motions of a joint. as a small favour could you please outline individually the 12 degrees of motion a joint?

    DaFlip :mad:
  8. musmed

    musmed Active Member

    Dear DaFlip

    How appropriate!

    The twelve motions are:
    without distraction or compression
    1-4: flexion;extension;internal rotation and external rotation
    5-8 with joint compression
    9-12 with joint distraction
    These are the normal motions

    One then looks for abnormal motions by stressing the ligaments and repeating the above.

    If one does not do these motions one has NOT looked at a joint properly.

    Maybe you missed that lecture?


    PS. When was the last workshop that you went to cost nothing and you actually learnt something that you could apply in your daily practice?
  9. DaFlip

    DaFlip Active Member

    Oh please! My feelings may get hurt.

    What about translation. Missed that lecture hey!
    In fact for someone that is lecturing on joint restrictions this is a major miss!
    I would suggest if one does not evaluate this motion one has NOT looked at a joint properly.

    Poddy (i think i might get rid of DaFlip for a while)

  10. musmed

    musmed Active Member

    Dear DAFlip

    Translation is not a normal motion. That is why I did not include same.

    It is found with distraction when stressing joint, that is dysfunctional motion.

    Try again

  11. David Smith

    David Smith Well-Known Member

    Dear Paul

    In mechanics by convention there are 6 degrees of freedom ie rotation about the X Y Z axes and translation along the X Y Z planes but I can see the logic of your definitions. (don't know why there is only Z and X axis rotational motion in three joint positions accounted for but that's your convention) However Paul I would have thought that Translation was a common motion of a joint and that distraction or tension (of the whole joint) was rather uncommon, especially in the lower limb unless one was hanging from a tree or similar. Why do you say that translation is not a normal motion since, in my view, most joints (eg not the hip) can translate and many of those 'normally' do to some degree.
    Having written that I can see that if one translates a hinge type joint for instance then it may not be possible for it to have a normal RoM.
    Also, and this is open to all, how does one define translation of a joint? in relation to a set of Axes and planes, or in relation to the joint surfaces ie does the navicular rotate or translate over the talus head?

    Respecrtfully Dave
  12. You a right in that many of the joints of the foot and lower limb show translational accessory motion. Taking you question above re navicular and talus, I would say the answer is both. This is witnessed by the shifting of joint axes, i.e. they are non constant, this axial movement is commonly the result of translation between the bones. A nice paper by Shereff (I think) showed the varying axial positions of the 1st MTPJ as the joint is dorsiflexed. This I believe is evidence to refute Paul's contention. Accessory gliding of the 1st MTPJ is a necessary movement. However, when the axis shifts position in this way it can also lead to micro-trauma.

    BTW DaFlip I too think Paul Coneely's posting are shameless self "selling" of courses with little original thought. We had a similar problem with him doing this on the JISCMAIL list. All he appears to have done is read Kendall-woopee woo.
  13. By definition, the motion of one object relative to another object can be described as either a translation motion, a rotation motion, or a combination of both translation and rotation motions. A translation motion of an object occurs when all the points on an object move from point A to B the same distance. A rotational motion occurs when all the points on an object can be described as rotating about a set of points, describing an axis of motion.

    I don't know of a single joint in the body that has motion that can be described either as being purely translational or purely rotational. In other words, all joints in the body have motions that are most accurately described as being combinations of both rotational and translational motions (using the standard definitions above). In other words, mammalian joint structures have, designed within them, a certain amount of "slop", regardless of how accurately aligned and evenly curved the joint structures seem to be to the discerning eye.
  14. efuller

    efuller MVP

    Hi Craig,

    Could you elaborate on the theory of disorder related to timing of the Windlass. If it does not "work" at the "proper time" then this implies that there is a proper time and we know when it should work. This goes back to the idea of "normal" gait. How do we define what normal gait is and how do we define how the windlass should work. I'm sorry I don't have access to your papers right now where you define establishment of the windlass. I could elaborate on my explanations of your observations if I could remember the definition.

    The dysfunction of functional hallux limitus is lack of dorsiflexion of the 1st MTPJ when weight bearing when there is normal (>40 degrees or whatever) dorsiflexion non weight bearing. This can happen when we walk forwards, backwards and sideways. How can a "timing" approach address all of these different conditions. Now, if we want to explain why something is not moving we should look at the forces and moments acting on the parts involved. This kind of analysis can be applied to all of the above mentioned situations. See my paper on the windlass for a longer discussion of the force and moment approach. Fuller, E.A. The Windlass Mechanism Of The Foot: A Mechanical Model To Explain Pathology J Am Podiatr Med Assoc 2000 Jan; 90(1) p 35-46 In the paper I suggest a way of understanding the proximal to distal influences on the 1st MPJ.


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