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I have reduced a platiflexed 1st met using stretch and contract technique

Discussion in 'Biomechanics, Sports and Foot orthoses' started by timharmey, Jun 4, 2011.

  1. timharmey

    timharmey Active Member

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    I was power walking with my wife when i thought , could a plantiflexed 1st met be due to peroneus longus contrature?Then i reduced my wifes plantiflexed 1st met using a contract and relax tecnique ,i.e resisted plantiflexion followed by inversion .It seemed to work and i have tried it on a few willing patients with good effect , what is it i am seeing , does it make sense .What do i do next thoughts please
  2. Get building a jig to measure 1st ray position and load/ deformation. Get ethical approval. Get a group of subjects. Get measuring their 1st ray positions and load/ deformation characteristics in both of their feet. Get one of their feet and use your technique. Get re-measuring both of their feet. Get data from lots of individuals. Get repeated data from subjects at known time intervals. Get analysing. Get writing. Get published. Get drunk. Watch "Get Carter".

    Go get 'em, Timmy.:boxing:
  3. timharmey

    timharmey Active Member

    Point taken I will watch my grammar, but what about the original idea? Is it something you have heard of before? Is it established practise?
  4. Talk me through you protocol.

    What are you doing? Inducing a post-isometric relaxation (latency period) followed by reciprocal inhibition to perform a stretch? Sounds a bit PNF (proprioceptive neuromuscular facilitation).

    See facilitated stretching McAtee and Charland: http://books.google.com/books?id=1y...&resnum=1&ved=0CCkQ6AEwAA#v=onepage&q&f=false
  5. timharmey

    timharmey Active Member

    Thanks for the reference Simon. It is basically PNF. My protocol is the patient presses their 1st MPJ into the palm of my hand, I add resistance which we do for 8seconds. I invert the foot which we repeat twice more inverting the foot more each time. I have found the plantarflexion of the 1st MPJ is reduced.
  6. I would have thought the Ground would do this most of the time anyway.

    What I would suggest is look at 1st ray stiffness. Ie the amount of force it takes to dorsiflex the 1st ray. If that has reduced you have a tangiable result.

    Just an idea.
  7. Tim:

    I was "reducing supinatus" of the forefoot before negative casting for orthoses using similar techniques back in the mid-1980s during my Biomechanics Fellowship. A sustained force which stretches the ligaments on one side of the joint axis may temporarily elongate the ligament to produce a temporary change in joint alignment. I doubt that what you are doing will produce any permanent change in structure or function of the foot.
  8. timharmey

    timharmey Active Member

    I have used this technique to reduce supinatus as well. I have had a patient return who had a plantarflexed 1st MPJ which had not reoccurred 3 months on after this treatment. My thought process is that the plantarflexed 1st MPJ is caused by peroneal contracture. This came about after I gave a talk to some physiotherapists about podiatry. On the subject of functional hallux limitus one of them said she thought this was a contracture. I thought 'what do you know' then started to ponder. I have mobilised a hallux using this technique. I realise that functional hallux limitus is a symptom and you have to treat the underlying cause. I would just like to see what other people think.
  9. Did it improve outcomes? Do you still do this?
  10. I quit doing it in the late 1980s. It didn't seem to do anything other than waste my time and my patient's time.
  11. Craig Payne

    Craig Payne Moderator

    I suspect the PNF stretch of peroneus longus can probably reduce a non-ossesous plantarflexed first ray in the same way a PNF stretch of the calf muscle can increase the ankle ROM. My concern would be how long that it would last for.

    There is a lot going on with the peroneals that we do not yet understand. Howard often talks about the neuromuscular inhibition that happens there (I not sure I full undertaken this). Perhaps the PNF stretch is having effects this way.
    Certainly worth pursuing.
  12. Dananberg

    Dananberg Active Member


    Clever thought on plantarflexed 1st ray. As Craig mentioned, I have described the effect of peroneal inhibition on dorsiflexed 1st rays....but never really thought about hyperactivity (and/or tightness) of the peroneals when the ray was plantarflexed. Thinking out of the box for a problem which can be difficult to manage with a safe and potentially effective method is to be commended. Good thinking on this topic and please keep us posted when you have the time and energy to really study this idea.

  13. timharmey

    timharmey Active Member

    Thank you!I will look in to this with a more scientific approach.I have been reticent to undertake the necessary evidence based rigour, I feel more inclined to moments of inspiration!I can see lots of problems but will seek advice. Two I can see are how is plantiflexed 1st MTPJ defined? and how do you measure its reduction?I will keep you posted
  14. Stanley

    Stanley Well-Known Member

    Do you have any references for the elasticity of the ligaments?

  15. Whiting WC, Zernicke RF: Biomechanics of Musculoskeletal Injury. 2nd Edition. Human Kinetics, Champaign, IL, 2008.

    Woo, Savio L-Y, G.A. Livesay, T.J. Runco and E.P. Young. "Structure and Function of Tendons and Ligaments", in Mow, V.C. and W.C. Hayes (eds.), Basic Orthopaedic Biomechanics, 2nd ed., Lippincott-Raven Publishers, Philadelphia, 1997, pp.209-251.

    Wright DG, Rennels DC: A study of the elastic properties of plantar fascia. JBJS, 46 (A):482-492, 1964.
  16. timharmey

    timharmey Active Member

    The mechanics is the equivalent of A level mechanics(English pre-university qualification).How many podiatrists possess such qualifications?

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