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Windlass Mechanism Function and Foot Posture

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jan 18, 2017.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    INFLUENCE OF FOOT POSTURE ON THE FUNCTIONING OF THE WINDLASS MECHANISM
    Rachel Lucas, Mark Cornwall
    The Foot; Article in Press
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    They were measuring immediate vs delayed onset to the windlass in my speak ... that is not really an intact or limited windlass ... as the windlass still works, its just delayed.
     
  3. Trevor Prior

    Trevor Prior Active Member

    They also raise an important point of th etest - they note that this is currently often used to assess functional hallux limitus rather than per se windlass and perhaps the latter is a more valid use as we know this test is not reflective of dynamic 1st MTPJ motion
    (Halstead & Redmond, J Orthop Sports Phys Ther, 2006). We generally use the test as one of our evaluations for the effect of our orthoses albeit a static test.
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    There is a lot of confusion over this with several bit of conflicting advice being given. I just finished editing a video on it
     
    Last edited by a moderator: Jan 18, 2017
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Three-dimensional variations in the lower limb caused by the windlass mechanism.
    Manfredi-Márquez MJ, Tovaruela-Carrión N, Távara-Vidalón P, Domínguez-Maldonado G, Fernández-Seguín LM, Ramos-Ortega J. (2017)
    PeerJ 5:e4103 https://doi.org/10.7717/peerj.4103
     
  6. If Simon Spooner was here he might be writing something about windlass does not just occur at the 1st.
     
  7. markjohconley

    markjohconley Well-Known Member

    Trevor,
    thanks, mark
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Influence of the Windlass Mechanism on Foot Joint Coupling
    Lauren Rose Williams
    Thesis; Brigham Young University 2021
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Foot arch rigidity in walking: In vivo evidence for the contribution of metatarsophalangeal joint dorsiflexion
    Daniel J Davis, John H Challis
    PLoS One. 2022 Sep 8;17(9):e0274141
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Study of Windlass Mechanism in the Lower Limb Using Inertial Sensors
    María José Manfredi-Márquez et al
    Int. J. Environ. Res. Public Health 2023, 20(4), 3220; https://doi.org/10.3390/ijerph20043220
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Three-Dimensional Analysis of the Windlass Mechanism Using Weightbearing Computed Tomography in Healthy Volunteers
    Takumi Kihara et al
    Foot Ankle Int. 2023 Mar 24
     
  13. Dan T

    Dan T Active Member

    Can you elaborate on this
     
  14. efuller

    efuller MVP

    The medial slip of the plantar fascia goes to the first proximal phalanx. The intermediate slip goes to proximal phalanges of the 2nd 3rd and 4th toes. When you dorsiflex the lesser toes you see the intermediate slip of the plantar fascia tighten and the corresponding metatarsal plantar flex.
     
  15. Dan T

    Dan T Active Member

    Ah, got you. Still most efficient to encourage propulsion through the 1st MPJ with good windlass recruitment though? I use a hubscher test often and will sometimes laterally post the forefoot to encourage 1st MPJ propulsion (thinking Bojsen Moller). I know you opined a few weeks ago RE; lateral forefoot posting decreasing peroneus longus activity, and I therefore now wonder whether I am inadvertantly having the opposite effect by reducing late stance phase pronation.
     
  16. efuller

    efuller MVP

    I'm not sure about efficiency, but my main concern is overload. I think the ideal push off is even weight across all the metatarsal heads. If you push off only the first and second metatarsal heads, you are putting a lot of strain on the medial slip of the plantar fascia.

    I'm not a big fan of Bojsen-Moller. The high and low gear push off does not look at resistance. It's like starting a bicycle from a stop, you can't go very fast in the high gear because the resistance is too high.
    I will also use a lateral forefoot post but with different reasoning. The Kogler study showed that there is decrease in tension in the plantar fascia with a lateral post. My theory is that you prevent overload of the medial slip of the plantar fascia by distributing the load over wider area. It is interesting to see to different theories come up with the same treatment plan.

    I'm not sure what you are thinking in terms of what the peroneus longus does. I've had a paper in the works, for over 10 years on peroneus longus function. Tension in t the tendon will create different actions depending on where the STJ axis is. Only in the most lateral STJ axis position does the peroneus longus crate supination of the STJ. With a medial axis the peroneus longus causes late stance phase pronation.
     
  17. Dan T

    Dan T Active Member

    Hey Eric. Im not familiar with "The Kogler study" I will have a look.

    "I'm not sure what you are thinking in terms of what the peroneus longus does. I've had a paper in the works, for over 10 years on peroneus longus function. Tension in t the tendon will create different actions depending on where the STJ axis is. Only in the most lateral STJ axis position does the peroneus longus crate supination of the STJ. With a medial axis the peroneus longus causes late stance phase pronation"

    - I theorised that the incidence of 1st met head ulceration in patients with a laterally deviated STJ was driven by strong peroneus longus activity plantarflexing 1st met, which in combination with large amounts of tension in the medial slip of plantar fascia due to elevated medial arch/calc inversion, reduces saggital plane motion through the 1st MPJ and increases transverse plane movement as the leg externally rotates. These ulcers (almost) always present as sheer type pressure areas prior to deteriorating. I find lateral posting stops re-ulceration but over time also (entirely subjectively) seems to improve the plantarflexion of 1st ray as though the contracture is resolving.

    You mentioned that in lateral deviation peroneus longus can cause supination. Therefore will the lateral posting still be achieving the desired effect of increasing pronation by shortening the muscle belly and reducing its contribution to further supination? I tend to find things that work but then as I try to find out why I discover it is for entirely different reasons ‍♂️

    Also in medially deviated STJs with forefoot supinatus contracture, for which I would post lateral to forefoot and medial to rearfoot. Is elevating the lateral column really doing anything to transfer pressure medially/evert the forefoot. Or is the success in this treatment approach driven by reducing late stance pronation and therefore improving functionality as a whole.

    Any time frame for your paper on p.longus as I think it would go a long way to answering a lot of my confusion. Cheers
     
  18. efuller

    efuller MVP

    I agree with the idea that a laterally deviated STJ axis will tend to have increased peroneal activity and increased peroneal activity will cause foot eversion (late stance phase pronation.) and this will tend to put high loads on the first met/ medial forefoot. I usually stop theorizing at high loads cause ulcer. I would not be surprised if your observation was correct. One theory is that the lateral posting keeps pressure laterally longer and this could reduce the force time integral at the first met. When you watch people walk barefoot you can often see the fifth toe up in the air as people push off first and 2nd met. Another theory is that the lateral wedge comes from decreased peroneal activity because of the greater pronation moment from the ground, so less peroneal activity is needed.

    I don't know about shortening the muscle belly. The way that I look at it is there is a balance issue. Ideally, there is even weight across the forefoot after heel off. In some feet the ground will cause pronation and in other feet the ground will cause supination. The subconscious brain can choose to add muscle moments to alter what the foot will do. Without the brain, the laterally deviated axis foot would tend toward supination, possibly so much that the person would twist their ankle. What the valgus forefoot wedge does for the laterally deviated axis foot is two things, it shifts the center of pressure laterally to decrease pronation moment and puts the STJ in a more pronated position and this will cause internal rotation of the talus and leg and this will move the STJ axis to a more internally rotated position making it more medially deviated.

    The increased pronation moment, would create less need for peroneal activiation.

    I think it is important to focus on the problem the patient is having. Conversely, the idea of improving functionality as a whole is a bit nebulous and assumes that we know what good functionality is. The problem with this is that some guys in the 1950's and 60's were sitting around trying to decide what normal was and what good functioning should be without actually doing good research. When a patient has medial column symptoms: plantar fasciitis, functional hallux limitus, first met head overload, then you want to reduce load on the medial column. A lot of feet with medially deviated axes will have medial column symptoms and attempting to invert the rearfoot with a varus heel wedge and increasing load on the lateral forefoot with a forefoot valgus wedge can do that.

    You do have to know the exceptions to the rule. A medially deviated STJ axis foot may not have enough eversion range of motion available to get significant load on the medial forefoot in static stance. (You may see medial roll off in late stance) These feet should not have a lateral forefoot post. This is why I like the maximum eversion height measurement. If they can't lift their lateral forefoot off of the ground then you should not add a forefoot valgus wedge.

    When I get a round tuit.
     
  19. Dan T

    Dan T Active Member

    Eric.
    That's given me a good deal to think about. I'll go do some further reading.
    Appreciate you
     
  20. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Evaluation of the relationship between truss/windlass mechanisms and foot stiffness while walking
    Daiki Yamagiwa et al
    Journal of Bodywork and Movement Therapies; Volume 37, January 2024, Pages 265-270
     
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