Which exercises for which presentation.

Members do not see these Ads. Sign Up.

If anyone even uses this forum anymore

I read a good post by Dr Kirby stipulating the issues around using terms like forefoot supinatus and flexible plantarflexed first ray. I appreciate the fact it is difficult to measure etc to elucidate in academia, however... we all know what it is when we see it clinically and that is all I aim to discuss here. I have been trying to consider the exercise approaches for each and wanted any feed back/advice from peoples clinical experience. In order to exist solely on a 90 degree plane these are almost the default contractures you would expect to develop unless the individual specifically takes the time to operate outside of their day to day walking biomechanics.

Forefoot supinatus: if we consider to be a soft tissue contracture of forefoot inversion due to ligament laxity and adaptive muscular/tendinous compliance/stiffness. I, like probably most, have noticed that medial wedging/skives medial to the STJ axis causes relative inversion of the calc. Over time the forefoot supinatus goes away and the individual presents with decent MLA and abduction of the hallux. As the pathology I have been treating resolves I like to remove the Orthoses and then transition the individual to heavy knee flexed heel raises with the digits dorsiflexed (as appropriate). I have noted anecdotally this is more than enough to prevent the return of the forefoot contracture overtime. I assume by stronger intrinsic and extrinsic musculature development supporting the medial arch as well as increasing compliance in the t.surae.

Flexible plantarflexed first ray: if we consider this the opposite of a forefoot supinatus in that the more lateral STJ axis requires strong activity from p/longus to maintain medial forefoot contact. Its insertion onto the 1st met/m.cuneiform causing contracture into 1st ray plantarflexion. I have again noted this contracture reduce markedly whilst treating peroneal/lateral ankle issues with lateral wedging. I was slightly more confused with exercise prescription to maintain these improvements however. I noted the latest fad with the 'tib training'. It almost invariably seemed like bollocks and a sizeable waste of time however it did get me thinking that as tib anterior is the antagonist of p/longus it would actually mobilise the 1st ray into dorsiflexion... a movement almost entirely missed in these individuals in their day to day I thought it may have some utility in these individuals. Anecdotally, I have had success in utilising heavy tib bar raises. This appears to reduce 1st ray plantarflexion if the exercises are done routinely. I would also assume this would therefore improve STJ pronation and prevent recurrence of symptomatic, 'higher arched' feet. It may also be useful in 1st and 5th met head pressure areas.

All of that is to say... I am talking to a couple of gents much smarter than me with a view to trying to gather some data on this to support the above assertions and possibly guide some cookie cutter exercise prescriptions which can be issued to patients being phased out of particular orthoses.
I would welcome any feedback on whether I am A) chasing squirrels or not on the right track B) Any reading or pointers on things to consider whilst trying to look into this.

If there's anyone left alive out there that is