Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Stretches for Hallux Limitus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by lucycool, Jul 16, 2011.

  1. lucycool

    lucycool Active Member


    Members do not see these Ads. Sign Up.
    Hi folks,

    My pt has bilateral hallux limitus and I'm wondering what - if any- stretches people would suggest for this. He currently has about 60 degrees of motion. I have a few ideas but want to be sure I'm going down the right route!

    I have prescribed orthotics as well but would like to see if anything else can be suggested.

    Thanks,

    Lucy
     
  2. 1st question functional or structural

    Structural - no stretches

    Fuctional - as tension in the achilles tendon is linked to tension in thd plantar fascia and increased tension in the plantar fascia is the most likely the cause of a functional hallux limitus or increased dorsiflexion stiffness at the 1st MTPJ, then gastroc/sol complex stretching would be my suggestion.

    Both structional and functional - same as for functional
    Hope that helps
     
  3. lucycool

    lucycool Active Member

    Thanks - that's what I was thinking, but it helps my confidence!!
     
  4. Stanley

    Stanley Well-Known Member

    Hi Lucy,

    Try rubbing the plantar fascia on the plantar aspect of the first interspace where it attaches to the skin (actually the superficial fascia). Rub proximally for about 3 cm. approximately 10 times with moderate pressure. Check the range before and after. If you find it works, then I will tell you the theory involved.

    Regards,
    Stanley
     
  5. Ian Linane

    Ian Linane Well-Known Member

    If the limitation is more linked to soft tissue tightness then I think Stanley has a good point. It can be useful to reduce tightness in the fascia in that area by plantarflexing the forefoot, applying a soft tissue mobilisation (rub it) and then gradually take it to its full range of extension. I'm not sure you would say this is stretching the tissue as restoring its capacity to undertake load, if it has diminished.

    I have used a spray stretch technique taught me by Paul Coneelly in such situations to good effect as well. If however it is more mechanical in origin with subsequent soft tissue matters then these must be addressed.
     
  6. stevewells

    stevewells Active Member

    Why don't you tell us anyway Stanley?????
     
  7. TedJed

    TedJed Active Member

    Bearing in mind the mechanics involved (as already mentioned), we have found the following self stretching and self mobilising to be effective in contributing to increasing RoM of the 1st MtPJ by addressing related soft tissue restrictions.

    Ted.
     

    Attached Files:

  8. Stanley

    Stanley Well-Known Member

    Hi Steve,

    If it doesn't work then what's the point in telling you?
    I will give you something to think about. Why does 1/2 of the plantar fascia insert into the "skin"?

    Here is something to look at:
    http://www.anatomytrains.com/uploads/rich_media/Fascia_can_contract_in_smooth_muscle_like_manner.pdf

    This is another part of what you would need to know:

    http://www.anatomytrains.com/uploads/rich_media/Fascia_can_contract_in_smooth_muscle_like_manner.pdf

    Here is something that helps in the bigger picture:
    http://www.anatomytrains.com/uploads/rich_media/2006HistolDeepFascia.pdf

    This ties in some more stuff:
    http://www.ncbi.nlm.nih.gov/pubmed/12467083?dopt=Abstract

    This helps in our understanding when you realize that most acupuncture points are in fascia and periosteum:
    http://www.sciencedirect.com/scienc...serid=10&md5=a2db64fc45b5ae15c2a3598d7771945f

    Here is something about the output side:
    Ahluwalia S, et al Distribution of smooth muscle actin containing cells in the human meniscus J Orthop Res, July 2001; 19(4) 659-64

    This is an interesting paper that pulls some more information into the bigger theory:
    http://www.liebertonline.com/doi/abs/10.1089/acu.2009.0631

    This one helps us to understand the basis of treatment:
    http://www.ncbi.nlm.nih.gov/pubmed/16511830?dopt=AbstractPlus

    Steve, this should help you get started. If you see this works, then I will take the time to give you the basis of why it works.

    Regards,
    Stanley
     
  9. stevewells

    stevewells Active Member

     
  10. blinda

    blinda MVP

    Bad day Steve? :D
     
  11. Lab Guy

    Lab Guy Well-Known Member

    Try rubbing the plantar fascia on the plantar aspect of the first interspace where it attaches to the skin (actually the superficial fascia). Rub proximally for about 3 cm. approximately 10 times with moderate pressure. Check the range before and after. If you find it works, then I will tell you the theory involved.

    What percentage of people with plantar fibromatosis have functional hallux limitus?

    Steven
     
  12. Stanley

    Stanley Well-Known Member

    Hi Steve,

    The reality is that I find it works most of the time. As far as the spurring blocking the movement, I routinely do stress laterals of the 1st MPJ (rise up on the toes as far as possible while taking a lateral). I find in these situations, the dorsiflexion angle on the radiographs is larger than on clinical examination. This means that the soft tissue is preventing the dorsiflexion even in cases of spurring.
    As far as divulging the theory, I am sure it will result in a long discussion. Before I get involved in this I would hope that there was some familiarity with whom I discuss this with. For instance, if I were to tell you about a spade that I use for slinging **** over windmills, I would hope you would know something about ***** before I began a discussion about whether a spade could do it. At the least I would hope you would go read a little about it first, and that is why the references.
    On the other hand, I could be completely full of *******, and I might be able to explain my theory to your satisfaction and you would erroneously believe it. I would hope you would at least test this to see if it works or not.
    If it doesn’t work, then you are not going to use it. If it does work, then you will use it. In either case the theory is meaningless, unless you want to apply the concepts somewhere else. So first you should see if it works.

    Regards,
    Stanley
     
  13. Lab Guy

    Lab Guy Well-Known Member

    Stanley,

    Interesting articles that I scanned, will have to read them later. Appears that one of the causes may be that subtle energy is blocked and you are opening up those pathways/meridians so that the myofascia can relax and not be in a state of excess tension so the DF moment at the first mpj becomes greater than the PF moment, thus seeing increased DF of the first MPJ during propulsion. Interesting theory.

    Steven
     
  14. Stanley

    Stanley Well-Known Member

    Hi Steven,

    The meridians are the fascial lines in the body. It is not energy, but rather an intricate system of sensors and motor units. This system includes at least the anatomy trains, the periosteum, the fascia around the muscles (muscle spindle cells), the tendons, and the ligaments.
    If you were to design the placement of the sensors in for instance the bone, you would put it in the part that would bend the most. As an example look at GB 39 and think of where a fibula stress fracture occurs.
    This system is under tension, so it communicates with changes of tension. Acupuncture needles will drag the fascia and change the tension of the fascia resulting in a signal. Rubbing the plantar fascia at its insertion into the superficial fascia is not as subtle.
    Regards,
    Stanley
     
Loading...

Share This Page