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Tendo-Achilles stretching/ Tailors Bunion

Discussion in 'General Issues and Discussion Forum' started by Deborah Ferguson, May 11, 2013.

  1. Deborah Ferguson

    Deborah Ferguson Active Member


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    Hi All

    I would be grateful if someone could explain the rationale behind Tendo-Achilles stretching exercises in the non-surgical treatment/management of Tailors bunions. Does limited ankle joint dorsiflexion usually co-exist with this deformity or is there another reason for recommending these exercises?

    The only ref I could find was
    Baravarian, B. Key Insights On The Role of Equinus in Foot Pain. Podiatry Today. 20 (5) : 84-88.


    Thanks in advance

    Deborah
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Thats a new one for me; not heard of it before.
     
  3. Bruce Williams

    Bruce Williams Well-Known Member

    I know of no references but would say no. Tailors bunion must be associated with decreased dorsiflexion stiffness in the 5th ray just as with bunion deformity in the 1st ray. Equines can be a cause of both, but rarely without minimal stiffness, IMHO.
    Bruce
     
  4. Deborah Ferguson

    Deborah Ferguson Active Member

    Thanks for the replies.

    I have seen AT stretching recommended several times but have struggled to understand why.

    If anyone can shed any new light I woud be grateful.


    Many Thanks

    Deborah
     
  5. Bruce Williams

    Bruce Williams Well-Known Member

    Other than attempting to reduce the AJ equinus forces in the forefoot, I don't see why. It still comes down to the stiffness of the ray, but loosening up the Achilles is rarely a bad thing to do in these cases.
    My 2 cents.
    Bruce
     
  6. decreasing stiffness at the Achilles , will reduce forefoot Ground Reaction Forces , which will reduce tension in the Plantar Fascia , which will reduce dorsiflexion stiffness at the 5th MTPJ

    so makes mechanical sense
     
  7. Deborah Ferguson

    Deborah Ferguson Active Member

    D'oh I can see that now


    Many Thanks all

    D
     
  8. Bruce Williams

    Bruce Williams Well-Known Member

    Mike,

    You would prefer to increase stiffness in the 5th ray if you could via this method. That will not work for stiffness at the ray, but will potentially at the Achilles.
    Increased stiffness in the ray usually will equal a decreased likelihood of tailors bunion, IMO. There are other factors as well, like length of the metatarsal, parabola, shape of the meathead, etc.
    Bruce
     
  9. Agreed 're ,other factors

    But if plantar fascia tension is a ecological factor in Taylor's bunions ( no idea if it is) then depending on what side of the chicken or egg debate 're ray stiffness you sit, will I guess mean different approaches

    A debate already had ;)
     
  10. PodAus

    PodAus Active Member

    Maybe part of a scatter-gun approach to any foot pathology... just stretch the Achilles... :morning:
     
  11. efuller

    efuller MVP

    I'm not sure that decreased dorsiflexion stiffness is the cause of tailors' bunions. I would put the cause and high lateral forefoot loads. You could have a very flexible/ pliable/ non stiff metatarsal with very low load on it that may not develop a tailor's bunion.

    I don't know for sure, but it seems as if a tailors bunion is a frontal plane rotation of the 5th ray. If that were the case then rotational stifness would be in question over dorsiflexion stiffness.

    It does seem a bit of a reach to address the Achilles tendon for a forefoot problem. It doesn't seem like it would help much unless there was an early heel off.

    Eric
     
  12. Seems to me that since a Tailor's bunion is a transverse plane deformity of the 5th metatarsal, with the 5th ray abducting away from the 4th metatarsal to create the deformity, then stretching the Achilles tendon would have little effect on whether Tailor's bunion deformities increase or not.

    Tight Achilles tendons don't cause Tailor's bunions any more than tight Achilles tendons cause hallux abducto valgus and bunion deformities. I would think that getting the patient into more appropriate shoes that prevents adduction of the 5th digit toward the 4th digit and prevents lateral 5th metatarsal head compression forces and designing an orthosis that can offload the plantar aspect of the 5th metatarsal head effectively would be much more productive for the patient.
     
  13. Bruce Williams

    Bruce Williams Well-Known Member

    Eric,

    As I stated in another post on this there are many factors involved in this, both structural and functional. Lateral loading is certainly one of them. If the metatarsal and ray is plantarflexed or has a high stiffness I am not sure that I have seen many tailors bunions with this type of structure and function, have you? I'm not saying it can't happen, but would likely be very rare as with most bunion deformities. I think it is something to be tracked at some point.
    Bruce
     
  14. Bruce Williams

    Bruce Williams Well-Known Member

    Kevin,

    I think a tight Achilles and definitely AJE is almost always attributed to the formation of a bunion deformity. Not the only cause, but surely one of them. It is mentioned both in Root and McGlamry, in its relationship to pronation of the foot.
    Bruce
     
  15. efuller

    efuller MVP

    I don't think I have seen any plantarflexed 5th rays with taylors bunions. One reason might be that to get a tailors bunion you'd have to dorsiflex it and rotate it. True, a 5th metatarsal that is stiff in the direction of dorsiflexion is probably also stiff in frontal plane rotation.

    However, for a deformity to occur something has to push it in that direction. If there is no push then you don't get any deformity. Yes, those that can't resist the push as strongly will be more likely to develop the deformity. So, is the cause the inability to resist the push or is it the push. In terms of treatment, it is really hard to change the rotational stiffness of the metatarsal. However, we can reduce the amount of push that creates the deformity.

    On the equinus as a potential cause. For Achilles stretching to be effective there would have to be an early heel off in gait that would be changed to an average heel off in gait after the stretching. An early heel off will increase the time that the deforming force is applied to the 5th met. It's been a long time since I looked at the literature on increasing range of motion at the ankle in gait pre and post stretching. What does the literature tell us about that happening?

    Eric
     
  16. Bruce Williams

    Bruce Williams Well-Known Member

    Eric;

    regarding stretching and literature there is never much change. Howard's article on manipulation shows much better improvement. A recent article "Increasing muscle extensibility: a matter of increasing legth or modifying sensation?" is in the process of reviewing the literature on the subject. They site a theory that "an increase muscle extensibility are due to a modification of sensation only." They state later that it seems that increased lenght in stretching is transient, which I fully agree with.

    I am sure there is a CNS feedback as well if it "feels looser" or stretched. Any literature on that guys?

    bruce
     
  17. markjohconley

    markjohconley Well-Known Member

    goodaye kevin, yep still at work, would this be a typo, should it be '..prevents medial 5th metatarsal head compression forces..", mark
     
  18. alextsang

    alextsang Member

    Hi guys,
    I'm trying to understand the biomechanical factors that would lead to Tailor's bunion formation or hyperkeratosis on the lateral 5th MTP head. What factors other than footwear would lead to increase forces in the transverse plane and coronal plane at the 5th MTP joint.
    Also Kevin mentioned that decreasing the GRF under the 5th MTP will also help. How does sagital plane motion of the 5th MTP contribute to abduction adduction forces in this area.

    Thanks
     
  19. efuller

    efuller MVP

    The theory is that high plantar loads on the fifth met cause the tailors bunion and the callus sub fifth met. There are two things inherent to the foot that cause high loads on the fifth met head. One of those is lack of eversion range of motion. Also known as a partially compensated forefoot or rearfoot varus. The other one is a laterally deviated stj axis. This is the over supinator foot type. In this foot to maintain equilibrium around the subtalar joint the moment (F x distance) from the foot on the lateral side of the foot has to be equal to the moment from the medial side of the foot. If the axis is far lateral, the distance to the axis is small, so the force has to be high. One way to tell the difference between these feet is the maximum eversion height test.

    Eric
     
  20. markjohconley

    markjohconley Well-Known Member

    brought to my attention, obviously was not thinking straight, apologies
     
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