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Hubscher manoeuvre

Discussion in 'Biomechanics, Sports and Foot orthoses' started by monkey rob, Jun 17, 2008.

?

Do you use Jack's Test / Hubscher manoeuvre to assess foot function?

  1. Yes

    62 vote(s)
    88.6%
  2. No

    8 vote(s)
    11.4%
  1. monkey rob

    monkey rob Member


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    Hi

    Could anyone tell me in which article Hubscher first described his manoeuvre(!)?

    Thanks

    Rob Bloxsom
     
  2. Off the top of my head I don't know, but this is an absolute beaut...
    http://www.youtube.com/watch?v=vU_BkfkjcsY
    :eek::eek::eek::cool::cool: Double cool

    I wouldn't trust this practitioner to sit the right way around on a toilet seat, let alone prescribe and dispense my orthoses for me. What's most frightening is the way the left foot actually appears worse once the orthoses is underneath the foot- BTW static Jacks test DOES NOT predict dynamic function. But the bit that had me off my chair is when she says: "yeah, they fit you alright"- cock
     
  3. Simon:

    Nice video.

    Rob:

    I think someone tried to research the Hubscher question before and never came up with the reference. I don't have a clue where this came from but maybe someday we will find the original reference.

    I do know for a fact, however, that functional hallux limitus was first mentioned in the literature by Patrick Laird, DPM who was a student of Mert Root, DPM, and a professor of biomechanics at CCPM for a few years, not by the sagittal plane facilitation crowd.
     
  4. J Orthop Sports Phys Ther. 2006 Aug ;36(8):550-6
    Weight-bearing passive dorsiflexion of the hallux in standing is not related to hallux dorsiflexion during walking.
    Jill Halstead, Anthony C Redmond
    Academic Unit of Musculoskeletal Disease, School of Medicine, University of Leeds, UK.
    STUDY DESIGN: Case control study. OBJECTIVE: To explore the validity of the assumptions underpinning the Hubscher maneuver of hallux dorsiflexion in relaxed standing, by comparing the relationship between static and dynamic first metatarsophalangeal (MTP) joint motions in groups differentiated by normal and abnormal clinical test findings. BACKGROUND: Limitation of motion at the first MTP joint during gait may be due to either structural or functional factors. Functional hallux limitus (FHL) has been proposed as a term to describe the situation in which the first MTP joint shows no limitation when non-weight bearing, but shows limited dorsiflexion during gait. One clinical test of first MTP joint limitation during standing (the Hubscher maneuver or Jack's test) has become widely used in physical therapy, orthopedic, and podiatric assessments, supposedly to assess for the presence of hallux limitations during gait. The utility of the test is based on an assumption that restriction during the static maneuver is predictive of functional limitation at this joint during gait. Despite a lack of evidence for the validity of such an assumption, the outcome of the static test is often used to infer risk of overuse injury or as an outcome for functional therapy. This paper examines the validity of the assumptions supporting this widely used static test. METHODS AND MEASURES: First-MTP-joint motion was assessed using an electromagnetic motion tracking system in cases (n = 15) demonstrating clinically limited passive hallux dorsiflexion in relaxed standing, and in 15 controls matched for age and gender and demonstrating a clinically normal Hubscher maneuver. Maximum hallux dorsiflexion was measured with the subject non-weight bearing (seated), during relaxed standing, and during normal walking. Results: Hallux dorsiflexion was similar in cases and controls when motions were measured non-weight bearing (cases mean +/- SD, 55.0 degrees +/- 11.0 degrees; controls mean + SD, 55.0 degrees +/- 10.7 degrees), confirming the absence of structural joint change. In relaxed standing, maximum dorsiflexion was 50% less in cases (mean +/- SD, 19.0 degrees +/- 8.9 degrees) than in the controls (mean +/- SD, 39.4 degrees +/- 6.1 degrees; P < .001), supporting the initial test outcome and confirming the visual test observation of static functional limitation in the case group. During gait, however, cases (mean +/- SD, 36.4 degrees +/- 9.1 degrees), and controls (mean +/- SD, 36.9 degrees +/- 7.9 degrees) demonstrated comparable maximum dorsiflexion (P = .902). There was no significant relationship between static and dynamic first MTP joint motions (r = 0.186, P = .325). CONCLUSION: The clinical test of limited passive hallux dorsiflexion in stance is a valid test only of hallux dorsiflexion available during relaxed standing. There is no association between maximum dorsiflexion observed during a static weight-bearing examination and that occurring at the same joint during walking.

    SO... what does this test really tell us?
     
  5. monkey rob

    monkey rob Member

    Ah...that's very interesting. Thanks Kevin.

    Nice vid Simon ;)

    I know the Hubscher manoeuvre/Jack test doesn't necessarily predict dynamic function, but do you see a role for it in clinical assessment? Do you use it routinely?

    Cheers

    Rob
     
  6. Like I said, what exactly does it tell you? If foot orthoses "work" by altering forces during dynamic function and the Hubscher manoeuver doesn't predict dynamic function- why would you do it? 27 to go?
     
  7. monkey rob

    monkey rob Member

    I've just come back from a 'Walking Masterclass' (!) at Plymouth Uni, and Jack's test featured heavily during a practical session...though it was admitted that there was little (any?) evidence for its use.

    PS: what does 27 to go mean?

    PPS: chris p, my pop-up blocker just stop a message from you I think. Try again now.
     
  8. You should have asked the "masters"- did they not mention the research I highlighted above?. Like I said, trust.. toilet seats etc...26 to go. You clever boy Rob, Ya'll work it out.
     
  9. Adrian Misseri

    Adrian Misseri Active Member

    G'day Rob,

    I use a modified Jack's test as part of my biomechanical assessment. Back when i was first taught it (Cheers Craig!), I was demonstrated to load up just proximal to the first MTPJ with the foot NWB, and then try to dorsiflex the hallux. If you get 5 or more degreees of dorsiflexion of the hallux before the metatarsal head plantar flexes, the functional limitus is negative, however if there's less than 5 degrees of dorsiflexion before the metatarsal head plantarflexes, then there's a functional limitus present. I use this as an indicator of saggital plane blockade, and helps is assessing where teh block is. Be aware, it's only a small part of the assessment, and shouldn't be relied solely on. But also, it only takes a moment when checking ROM so I use it.
     
  10. Mart

    Mart Well-Known Member

    Hi Simon

    I was unable to get copy of the paper you cited but am curious about methodology which I cannot glean from abstract.

    Is there any indication in the paper that GRF under 1st MTH was compared between the the different test conditions. If not, is it not then possible that the dynamic angular measurements reflect motion obtained with some form of compensatory offloading of 1st metatarsal head when restriction of ROM is encountered as proponents of sag plane facilitaion theories might suggest?

    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
     
  11. brevis

    brevis Active Member

    I have a funny feeling that video was taken at La Trobe.....Ahh, the memories
     
  12. Adrian Misseri

    Adrian Misseri Active Member

    Probably was.. Craig was doing a lot of FHL stuff when i was studing there......
     
  13. efuller

    efuller MVP

    One problem with almost any standing measurement is that there is a brain attached to the foot. If you lift the big toe up in stance, and then let go, and it stays up, and the EHL tendon is prominent, the patient is helping you perform the maneuver. The difference in how much help you get from the patient will make the test not predictive of function in gait.

    If a patient helps you less when they are standing on their orthotics, that might mean something.

    Cheers,

    Eric
     
  14. monkey rob

    monkey rob Member

    Thanks for your response Eric.

    I do this test, and I'm pretty sure that the patient isn't 'helping' me. The hallux doesn't stay up, and I look out for EHL firing. I also try and ensure that they are standing upright (no 'sway' back, or them looking down at what I'm doing.)

    As I say, I do this test because it seems to help give a visual explanation to the patient of how orthoses are effecting foot function in stance.

    I have been aware of Tony Redmond's paper for a while, and it seems this test is not predictive of hallux dorsiflexion in gait whether the patient 'helps you' or not.

    ...so why do I still do it:hammer:

    I think I might start a poll to determine how many of us are routinely using this test (even though we know maybe we shouldn't be:wacko:)

    Rob
     
  15. Lee

    Lee Active Member

    EHL is also prominent if the patient actively dorsiflexes the hallux in static stance (obviously). This has been shown to most closely approximate maximum hallux dorsiflexion during gait:

    ??
     
  16. monkey rob

    monkey rob Member

    I'm guessing no-one knows the article! :rolleyes:

    Can anyone tell me who Hubscher was?

    Ta

    Rob
     
  17. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I have tried that search before and no luck. "Jacks test" was traced to a lateral column surgical procedure by Dr Jack.

    As regards to Hubscher and dynamic function .... depends what you are measureing with the test:
    1) Total range of weightbearing at first MPJ (eg the ref that Simon cited above, that showed no relationship to dynamic function)
    2) The range of motion before you get any resistance
    3) The force needed to dorsiflex the hallux
    4) How soon after dorsiflexion does arch elevate and tibia externally rotate.

    We see differences in dynamic function with (2) and (3) using force time curves and centre of pressure progression. Have not properly looked at (4), but when you do this test, notice how many people do and do not get immediate internal tibial rotation as windlass establishes .... that has got to mean the probably function differently in the timing of events.
     
  18. markjohconley

    markjohconley Well-Known Member

    Craig, goodmorning, have just spent an hour reading over past threads after "search'ing" for the Hubscher manouvre. A particularly absorbing thread where Spooner, Asher (Kirby & Fuller) got into it. I've got to say how much I appreciate these posters contributions.
    Back to the Jack's test, I do it regularly to ascertain quantitatively "2) The range of motion before you get any resistance". I understand Mr Cluffy deserves payment if I use a wedge. How should I do this?
    I don't use it to ascertain total ROM but would like to know what are the treatment options after ascertaing "3) The force needed to dorsiflex the hallux".
    Thanks, mark c

    Once had a guinea pig we called "Hubschner" ...... vicious mongrel of a thing it was!
     
  19. Indeed mark! Moreover, how much force is too much force?

    Craig does raise some interesting points here regarding force time curves and centre of pressure progression: how well does this data predict pathology?

    Do we really have a range of motion with zero resistance as suggested by Craig's No. 2?
     
  20. Craig's post has got me thinking. What are the important variables that may influence the windlass effect observed when performing Jack's test and observing the four variables suggested by Craig that may be assessed within this test?

    Here's a half dozen off the top of my head:
    1. Elasticity of the plantar fascia.
    2. Diameter of the 1st metatarsal head.
    3. Length of hallux i.e. the "lever" and the length and resting position of other segments within the "truss"- think triangles!
    4. Coupling between joints of the medial column joints.
    5. Coupling between the STJ, ankle joints and shank.
    6. Weight of patient.

    Feel free to add to this list.:drinks
     
  21. Oh Yeah!

    And...

    7. Speed of performing the test- obviously :rolleyes: Think visco-elasticity.
    8. Stiffness of bony segments.

    Also of note within our discussion of this topic is that Jacks test exams only the first MTPJ, the windlass mechanism does not just include the 1st MTPJ

    Forgive me if I've said all this before, I don't have Mark's patience for searching through previous threads.
     
    Last edited: Jun 29, 2008
  22. Adrian Misseri

    Adrian Misseri Active Member

    9. Neurological status of patinet, specifically with regards to neurological pes cavus and/or muscle tone to intrinsic foot muscleature
    10. Patinet 'assisting' in motion i.e. patinet moving their hallux beacue teh practitioner is
    11. Quality of sesamoid articulation and sesamoid positioning

    The more you think about it, the more vairables you can come up with.....!
     
  23. markjohconley

    markjohconley Well-Known Member

    Simon, thanks for replying
    Asking the wrong dude here, oh Obi-Wan. Qualitatively there are differences in force needed to dorsiflex the hall prox phal. My query was, what does this mean re interventions? I wanted answers as I was unable to think of them.
    I didn't think Craig was suggesting zero resistance just degrees of.
    I can follow most of what you say but by g*d it gives me a nasty headhurt!
     
  24. Lawrence Bevan

    Lawrence Bevan Active Member

    12 Great that somebody is still doing these lists even though Kevin has stepped back!
    13 Anterior positioned COM?
    14 Tight/stiff gastroc/soleus ( paper somewher forgert ref showed stiff TA = stiff pl. fascia)
     
  25. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Using the device we built to quantify this test, the subject just tilting the head forward to look at what we were doing was enough to change the reading.
     
  26. Adrian Misseri

    Adrian Misseri Active Member

    Craig which machine was that? Saw a couple of your toys for measuring first ray function/windlass function when I was at uni.
     
  27. Mart

    Mart Well-Known Member

    I just wanted to add a little.

    Firstly add Flex Hal Long (FHL) to list (see below).

    My understanding (please correct me if wrong) is that the point of testing 1st metatarso-phalangeal joint range of motion with a dorsal directed GRF at 1st metatarsal head is to get a idea of possibility of 3rd Rocker dysfunction during terminal stance (heel rise with continuing ankle dorsiflexion).

    Implications for premature degeneration of dorsal margins of 1st metatarso-phalangeal joint and structural overloads secondary to compensations are well documented if unproven.

    “Jacks” test as defined and poorly executed in the video seems to be being discredited purely on the grounds of one study (Weight-bearing passive dorsiflexion of the hallux in standing is not related to hallux dorsiflexion during walking).

    Can any one tell us if this study takes into account what the GRF actually was doing under the 1st metatarsal head during the angular measurement.

    The abstract doesn’t mention this and no one seems to have picked up on this question from my earlier posting.


    This has to be crucial because, theoretically, as described in classic saggital plane facilitation theory, if the 1st metatarso-phalangeal joint range of motion is only functionally limited then the foot will likely compensate in someway to allow the range of motion to occur and wont necessarily be seen as limited if measured during gait.

    Given the large number of variables already cited which can limit hallux dorsiflexion, is the issue not less to do with the actual measured ROM (provided this is not structurally limited) but more the relative ROM for a given individual according to metatarsal position and potential for joint compression forces remodelling the dorsal margins of the joint with preloading the metatarsal head too early?


    There was a wonderful paper published last year (Contribution of the Flexor Hallucis Longus to Loading of the First Metatarsal and First Metatarsophalangeal Joint Y. M. Kirane, M.S., D. Ortho.1; James D. Michelson, M.D.2; Neil A. Sharkey, Ph.D) which used computer actuated, stance phase simulation using prepared fresh cadavers and joint force transducer implants and force plate data to measure amongst other things, 1st metatarso-phalangeal joint compression, and GRF vectors with feedback control of FHL (isometric and isotonic) activity.

    Here’s a little of the findings;


    The critical observation is that increasing the overall FHL tension by limiting its distal
    excursion leads to both higher forces in the first MTP joint and an earlier onset of dorsal angulation of the JRF vector during stance phase.

    In the sagittal plane, the JRF vector of the first MTP
    joint started to point in a dorsal direction with the onset
    of passive dorsiflexion at roughly 50% of the stance cycle.
    Similar to the pattern of increase seen in the JRF magnitude,
    the dorsal deviation of the JRF also occurred earlier in
    the stance phase, with 6-mm proximal mal-position (P6
    condition) of the FHL myotendinous junction as compared
    to the other conditions. This implies that there is earlier onset
    of dorsal compression of the first metatarsal head when the
    distal excursion of the FHL is increasingly limited. This is
    consistent with the hypothesis that stenosing tenosynovitis
    of the FHL is an etiology of hallux rigidus, since the initial
    pathological changes are seen on the dorsal aspect of the
    metatarsal head.

    My point here is that any force, be it active contractile (as in the FHL excursion experiment) or passive (positional GRF) which preloads the 1st metatarsal head in a compromised way likely has the potential to disrupt 1st metatarso-phalangeal joint function.

    I don’t use the “Jacks test as described, but do look at the 1st MPJ range of motion change with dorsiflexion of 1st ray compared to plantarflexion. I notice a variety of response to this but typically and not surprisingly see reduced ROM in those with moderate dorsal osteophytes and hallux limitus - presumably because of change in articular congruency. Theoretically this has implication for intervention be it foot orthoses design or otherwise.

    On this basis I feel we still need to consider and refine clinical tests to examine effects of preloading of 1st metatarsal head.

    Any contrarians to this point of view?

    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
     
    Last edited: Jul 1, 2008
  28. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    ........................
     

    Attached Files:

  29. markjohconley

    markjohconley Well-Known Member

    Looks excruciating!
    If it doesn't take off with the podiatry profession you could always sell it to the CIA; better than "water-boarding" for an information-eliciting technique. Mind you I'm not saying it would be a form of TORTURE!.
     
  30. David Smith

    David Smith Well-Known Member

    Rob

    I use this test regularly. Its quick and easy and is only one of hundreds of observations that make up an evaluation of the patients stance and gait.

    Assuming that the patient is not helping, which is what I ask them not to do anyway. What can we take from this test? 1st instance bare foot - observe that jacks test is difficult, second instance with orthosis - observe that jacks test is easy. Conclusion = something has changed. It can then be interpreted from these observations that the 'something that changed' was a reduction in plantarflexion moments about the 1st MPJ and 1st ray and we might assume therefore the reason for this is that there is less GRF reaction on the 1st MPJ because the rearfoot is more supinated.
    We can see that there is the possibility for the windlass action to work correctly
    and regardless of initial parameters eg stiffness, joint RoM, lever length, we can observe that something has changed in the person we are testing.

    We cannot reliably extrapolate that therefore there will be less tendency to FncHL in gait. However even tho there is research to show poor corelation between change in Jacks test and change in FncHL ( I'm assuming by the content of this thread that this must be so, but I have not read the paper yet) this is only one piece of research and even so, you still can say that you did change the forces acting thru the foot during stance via GRF and so something probably changed dynamic stance also.

    So in my opinion it is a test worth doing but the weight given to the results of this observation must be applied relative to other observations.

    Cheers Dave Smith
     
  31. David Smith

    David Smith Well-Known Member

    Simon

    In terms of change in FncHL funtion post orthotic fitting, not much really.

    This research ( I havn't been able to find the full paper yet.) does not say anything about the comparison of orthoses and no orthoses in terms of FncHL.

    It does say that there is a simillar dorsiflexion of the hallux thru gait in both groups (where n is quite small and so power reduced, P is not so significant)
    However assuming the probaility is high in the population then this experiment did not test the internal stress in the plantar fascia or the difference in this parameter between the two groups. It did not show velocity or change in gait velocity between the two groups in terms of CoM progression. It did not establish the minimum or normal dorsiflexion required for 'normal gait' in non pathological subjects. Therfore it is entirely possible that the minimum dorsiflexion required for forward progression is aroung 40dgs but the control group achieved this with lower plantar fascia tension and faster CoM velocity or less reduction in CoM velocity.
    There may have been greater lowering of the MLA or more rearfoot Pronation of the control group but we cannot tell from the experiment.
    Therefore while both groups appeared similar in the experimental measurements recorded. There may have been greater potential for pathology in the clinical case group than in the control group.

    Fitting orthoses to the clinical case group may not have changed the dynamic dorsiflexion RoM of the hallux but it may have changed the internal forces.

    Cheers Dave

    PS Why is Pod Arena so slow?
     
    Last edited: Jul 1, 2008
  32. David Smith

    David Smith Well-Known Member

    All

    I think that 'functional hallux limitus' may be a confusing term since functionally the RoM may not be limited in terms of angular deflection and yet the increased dorsiflexion stiffness of the hallux / 1st MPJ, will tend to lead to pathology and saggital plane blockage of the CoM progression.

    Dave Smith
     
  33. I think you and some others are maybe missing my point Dave. The information that can be gleaned from the Jack's test is this: a) Static passive range of 1st MTPJ dorsiflexion b) an assessment of passive dorsiflexion stiffness of the the hallux in static stance and c) how much dorsiflexion is required to initiate arch elevation and external rotation of the leg. Commonly this test is performed in a "qualitative" fashion, that is angles are "guesstimated", stiffness is "felt" and changes in the architecture of the arch of visually observed. Craig's quantitative approach is to be commended.

    We know from several research articles that passive static measures of 1st MTPJ dorsiflexion exceed those observed in normal walking. The study I posted earlier suggests that Jack's test is not useful in predicting 1st MTPJ dorsiflexion during walking. This study tells us nothing of the tests ability to predict b) and c) during gait. Nor did it set out to, nor did I say it did, hence my Socratic question to Robert. As far as I am aware, the ability of the Hubscher test to predict b) and c) has not been published yet. Nor, to the best of my knowledge has testing been performed and published to assess the tests validity in predicting the variables you listed above.

    In terms of performing the test with and without orthoses. This provides an insight into the effect the orthoses have on a), b) and c) in static unshod conditions. it tells us nothing of the effect the orthoses in situ may or may not be having on a), b) and c) during gait. Not sure why performing a validity trial like the one discussed in the paper above would be different if we used orthoses though. Interestingly, while orthoses have been shown to increase static passive 1st MTPJ dorsiflexion, orthoses have also been shown to decrease dynamic 1st MTPJ dorsiflexion so we'll have to wait and see whether this test is useful in predicting a) b) and c) during gait.
     
    Last edited: Jul 1, 2008
  34. Mart

    Mart Well-Known Member

    Mark

    please could you be kind enough to post the URL for the thread you are mentioning here. Thanks Martin
     
  35. Mart

    Mart Well-Known Member

    Yes you are right as far as my post is concerned thanks for pointing this out.

    Sorry if this has been covered elsewhere but I am wondering if the jury on FHL can only be truly satisfied by being able to observe the mechanism of articular blockage occurring in vivo. Is there remaining an issue of whether this blockage actually occurs or not; I understand it remains unresolved?

    I am somewhat fascinated by this possibility because using Ultrasound to explore those with 1st MPJ pain I have noticed how nicely the contours of the dorsal articular margins are imaged with motion to the point of being able to see impingement of thickened synovium between the joint margins with MPJ dflexion.

    With an extra set of hands to manipulate the 1st ray, I believe qualitatively, I have witnessed an alteration in the quality of motion according to ray alignment.

    Not withstanding the technical problems of maintaining probe/foot orientation to quantify these observations it strikes me as a plausible avenue to explore not only because of ability to make precise measurement but also capture and digitise motion. I am curious regarding thoughts on what this approach might have to offer.

    An idea which comes to mind is to place the weight-bearing foot into a water bath with the probe oriented sagitally dorsally to the 1st MPJ and record MPJ motion with differing thickness of platform under MTHs 2-5 and dorsal force applied to 1st ray to evaluate effect of 1st ray alignment. Whilst not demonstrating what occurs during gait, if no significant difference was seen under these conditions would this be sufficient to undermine the idea?

    Cheers Martin
     
  36. monkey rob

    monkey rob Member

    Craig,

    Was the subject on you hallux dorsiflexing machine Bilbo Baggins? :D
     
  37. markjohconley

    markjohconley Well-Known Member

    Sorry Martin, had to go "search"ing. It was the "Measuring arch height" thread from earlier this year, all the best, mark c
     
  38. Adrian Misseri

    Adrian Misseri Active Member

    Ahh Craig, I remember that one, stood on it a couple of times mysefl!
     
  39. "Yeah well that's the real trick isn't it" (Han Solo). Mark, IF the force needed to dorsiflex the hallux in static stance IS important (we don't know this- but its seems plausible), then there is likely to be a zone of optimal stiffness. This is likely to be task dependent as well as dependent upon individual variation. Moreover, it will be influenced by shoes.

    Intervention then should attempt to maintain the dorsiflexion stiffness within the zone of optimal force for that individual across as broader task range as is possible. Perhaps this might be achieved by manipulating various orthoses prescription variables e.g., rearfoot posting angle, relative stiffness of the medial aspect of the shell, kinetic wedge etc, but the current research on foot orthoses effects on 1st MTPJ dorsiflexion seem to suggest otherwise (see post below). So maybe we need to look to using another tool from the box of tricks?

    But remember, we have the problem of redundancy here- several tissues may contribute to the observed resistance at the 1st MTPJ, and ultimately it is the tissues that we are trying to maintain within their "zones of optimal stress". Different tissues may require different treatment.
     
    Last edited: Jul 2, 2008
  40. This study showed increased 1st MTPJ dorsiflexion in static stance when standing on an orthosis (hurray!):
    http://www.japmaonline.org/cgi/content/abstract/96/6/474


    Now for the boo's! :eek:
    This one showed that orthoses did not increase 1st MTPJ dorsiflexion in static stance:
    http://www.japmaonline.org/cgi/content/abstract/96/1/32

    And this one:
    http://209.85.135.104/search?q=cache:slnubO3y7fYJ:www.apodc.com.au/AJPM/Contents/Fu

    This one showed that orthoses posted medially and made from a neutral position off-weight-bearing plaster cast can alter motion in the forefoot during the propulsive period by increasing first metatarsal plantar flexion and decreasing excessive first MTP joint dorsiflexion- which is interesting in its own right -think about it!
    http://www.ncbi.nlm.nih.gov/pubmed/16396732

    This one also showed a reduction of 1st MTPJ dorsiflexion during walking when wearing orthoses:
    http://www.ncbi.nlm.nih.gov/pubmed/1920102

    This one showed that decreasing maximum ankle joint complex eversion with an orthosis did not result in any increase in first metatarsophalangeal joint dorsiflexion during gait in patients with functional first metatarsophalangeal joint limitation.
    http://www.clinbiomech.com/article/S0268-0033(05)00022-7/abstract

    This one showed that foot orthoses that incorporate a medial forefoot post do not have a consistent negative (IMO- this depends on what you are trying to achieve!) effect of reducing first MTP joint dorsiflexion during walking.
    http://cat.inist.fr/?aModele=afficheN&cpsidt=15861045

    This one showed that valgus and varus rearfoot posting in isolation reduces 1st MTPJ dorsiflexion:
    http://www.japmaonline.org/cgi/content/abstract/94/6/558

    Finally, this ones for Martin- this one showed that the kinetic wedge addition did alter 1st MTPJ pressure, but not hallux or 5th MTPJ pressure:
    http://www.asbweb.org/conferences/2003/pdfs/163.pdf

    Have a nice day y'all :cool:;):cool:
     
    Last edited: Jul 2, 2008
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