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Windlass test

Discussion in 'Biomechanics, Sports and Foot orthoses' started by phil s, Aug 6, 2011.

  1. phil s

    phil s Active Member


    Members do not see these Ads. Sign Up.
    I'm only a soon to be second year Podiatry student, so please go easy on me!

    The Windlass test is performed with the foot plantigrade and yet the hallux only ever dorisflexes during contact period with the heel raised from the ground.

    Any thoughts?

    Feel free to correct any misuse of terminology!
     
    Last edited: Aug 6, 2011
  2. RobinP

    RobinP Well-Known Member

    Dear Phil,

    I have lots of thought about what you have said. The mechanics of the 1st MPJ are, I think, quite fascinating. But that doesn't help you

    You haven't really asked a question but I would guess what you are asking is "why do we use a test that doesn't represent what happens dynamically ie the hallux dorsiflexing in terminal stance cannot be represented by a static WB at plantigrade test"

    I hate it when people do this to me because I just want an answer but, I 'm going to ask you a question

    What is the goal of performing the Windlass test?(I presume you mean a weight bearing halux dorsiflexion test)

    A test is useless unless it tells you a valuable piece of information the will influence how you prescribe. So, when you are performing that test, what information do you expect to glean from it and how will it affect your prescription?

    There is no shortage of information on this forum regarding that test and perhaps Admin 2 will come along and place them in your lap. However, rather than me explain to you what I thikn about your original question, perhaps your investigations might answer your question or moreover tell you why the question that you ask is not really the question you should be asking.

    Happy reading

    Cryptic Robin
     
  3. phil s

    phil s Active Member

    Robin: It's just some thing I’m pondering at the moment: I guess I’m learning how to go about properly investigating things I, as yet, have a limited knowledge about. The weight bearing hallux dorsiflexion test is a functional test of a mechanical system that in reality operates in a differing way to the test? If I were to assess the sagital rom of the knee joint, I would expect the same rom to be available to the knee should it need it. I think I’m saying that there is a logical discrepancy between the test of function and the functional reality.
     
  4. RobinP

    RobinP Well-Known Member

    I think you are a million miles ahead of where I was at your stage in my training if you are pondering the questions you are. In my opinion, that is very encouraging.

    You're getting there. What does the hallux dorsiflexion test tell you?

    Why would you test the range of motion (ROM) at the knee? What does it tell you?

    Here is a bit of a list of threads that might help

    Robin
     
  5. efuller

    efuller MVP

    You have to analyze the difference between the two situations. The major difference between dorsiflexion of the MPJ in gait and static stance is the amount of weight on the forefoot. The more weight on the forefoot the more the windlass will unwind. Or stated another way, in gait there will be a higher plantar flexion moment on the hallux than in stance. If you find a foot that you can't pick the hallux up off of the ground in stance, in all probability it will have an even higher plantar flexion moment in gait. That will happen unless there is some other factor that makes hallux easier to dorsiflex. Understanding those factors is what will help you understand the windlass mechanism and the rationale for treatment of windlass related problems.

    Eric
     
  6. RobinP

    RobinP Well-Known Member

    Phil,

    Here's a starter.

    Stop thinking about the test as one of assessing a range of movement. Start thinking forces, moments, lever arms and equilibrium.

    It'll take a bit of getting your head around, but it's worth it

    Robin
     
  7. Admin2

    Admin2 Administrator Staff Member

  8. BeratDemaj

    BeratDemaj Member

    I'm reading an unpublished study that breaks down the windlass mechanism, it's real convincing too. A very smart person wrote it, but he's having difficulties to publish because it was refused by his jury and His own work is now property of the University where he was studying.

    DO NOT BELIEVE EVERYTING THEY TEACH YOUUUUUUU :) :bash:

    Cheers
     
  9. DaVinci

    DaVinci Well-Known Member

    Could that be because they were wrong or unconvincing in what they did?
     
  10. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Where can I get a copy?
     
  11. BeratDemaj

    BeratDemaj Member


    I would have to get his permission first, he's flying over upcoming weekend from south africa to promote his anti-windlass mechanism theory here in Belgium in an exclusive gathering. I'll ask him....
     
  12. DaVinci

    DaVinci Well-Known Member

    Why won't he promote it in the public domain so it can be scrutinized?
     
  13. BeratDemaj

    BeratDemaj Member

    Because the University says it's their property... He's trying to do something with lawyers, it's been 4 years now....
     
  14. BeratDemaj

    BeratDemaj Member

    Because the University says it's their property... He's trying to do something with lawyers, it's been 4 years now....
     
  15. I should like to discuss these ideas with him too. Perhaps you could invite him to join the discussion here? Surely the University cannot stop him from answering questions on an independent internet forum.
     
  16. BeratDemaj

    BeratDemaj Member


    I haven't really met the guy, from what I undertand he is not a podiatrist but a movement scientist. This all started with a healthy discussion I got in to with a doctor in sportsmedicine at work, before that I had not heard of him,and was telling about this Craig Nevin (south africa) and his work.

    I'm going to meet him this upcuming weekend he's coming to Belgium. I'll post a small report on how it went... if there is interest ofcourse.
     
  17. timharmey

    timharmey Active Member

    To go back to the original point,I have pondered this, I did Put a thread on but it was not thought to be significant , maybe it wasnt.I thought that the test would be more "like real life" If you took a stride forward on the foot not being tested , so the foot being tested was approaching toe off , make any sense ?
    Tim
     
  18. efuller

    efuller MVP

    Standing, as a stopped stride, creates a difficult balance position. Most people when they stand in that position will be using their muscles to balance and they will probably will be using them differently than they will in gait. You have to understand what other factors effect the windlass. When the windlass moves with dorsiflexion of the hallux most of the timeyou will get plantar flexion of the first ray, plantar flexion and maybe some abduction of the midtarsal joint, supination of the STJ. So, things that create moments at each of those joints will influence the difficulty of the windlass.

    If you grab someones toe and dorsiflex it, and then let go and the toe stays up in the air. The subject was using muscles to help you dorsifex the toe and move the windlass. There is a brain attached to the foot.

    Eric
     
  19. timharmey

    timharmey Active Member

    But if they have FHL then you wont be able to dorsiflex it .To test someone standing still both feet next to each other what does it prove? That is a question ? I just wonder ? It is showing what ? That there Hallux does not dorsiflex while they are standing still?Is that clincal relevant ? I am not trying to challange you I am just thinking out loud
    Tim
     
  20. phil s

    phil s Active Member

    The knee example was just an example, but I suppose it give an idea of the levels of flexion the knee can be put through during loading response? My basic understanding of hallux dorsiflexion test is: the ability of the hallux to resupinate the talus, decreased parallelism of the oblique axis of the mid tarsal joint components (rigid lever creation) and contribute to the external rotation of the limb?
     
  21. phil s

    phil s Active Member

    Seems more logical.
     
  22. Griff

    Griff Moderator

    One Axis Midtarsal Joint Model
     
  23. efuller

    efuller MVP

    see post # 5 in this thread
     
  24. Eric, I agree with the rationale you gave in post no.5. However, the static test could still give a false negative. i.e. low dorsiflexion stiffness in static stance, yet as the COM moves anteriorly during dynamic function, stiffness could be increased beyond a given threshold. I actually like the idea of performing the Jack's test / Hubscher with the non-tested limb anterior to the test limb, or even in single leg stance, to better approximate dynamic function.

    In terms of validity, Halstead and Redmond demonstrated a lack of correlation with this test and dynamic motion. But the paper had a number of limitations.

    If you are not familiar with it, here it is: http://www.ncbi.nlm.nih.gov/pubmed/16915976

    Spot the problems.... "Can you feel the force"
    http://www.youtube.com/watch?v=WEDboC4mBYk

    Worth watching, if only for the guy doing the intro, suggestions of Paul Whitehouse singing "please release me" at the start of the Fast Show, me thinks.
     
  25. efuller

    efuller MVP

    I agree there are limitations. Another explanation of an easy windlass in stance and limited dorsiflexion in stance is high pronation moment from muscles. You are more likely to see high pronation moments from muscles in lat dev STJ axis feet. So you can measure both the windlass difficulty and STJ axis position and combine those to get an improved, but still flawed predictor.

    I would think that you would run in to some of the same problems. Still worth a look though.

    Eric
     
  26. Another thing to consider re dorsiflexion stiffness testing at the MTPJ is what it this stiffness relative too.

    2 people may have the same stiffness in newtons, but one may have the means to overcome this stiffness without causing stress in relative tissue and thus injury.
     
  27. timharmey

    timharmey Active Member

    With regards #5 and once again just being honest ,I have not taken part in this to be difficult .Is not one of the differences between stance and gait the role of equinus.Would it be worthwhile to undertake testing Hallux stiffness while completing the lunge test.With regards stiffness isnt FHL to the most part an either or i.e the hallux dosiflexes or it doesnt ?
    Tim
     
  28. Correct tension in the gastroc/sol complex will lead to increased tension in the plantarfascia and therefore an increase in dorsiflexion stiffness.

    But CoP will move distally at the same time, and at a certain point will help to dorsiflex the digits due to the increased external dorsiflexion moment acting on the MTPJs.

    Also it is important to consider that increased dorsiflexion stiffness will have positive effects in creating elastic energy in the gastroc/sol complex and to a lesser extent the plantarfascia, at propulsion the stiffer digits will provide a more effective propulsion aid.

    So it comes back to timing.

    I have a feeling that dorsiflexion stiffness will be ever changing. In that it will increase, decrease and increase during gait.

    Time will tell if I'm correct or not.

    I also have a feeling the knee flexion maybe the key to controlling dorsiflexion stiffness at the MTPJs
     
  29. Good call. Or, maybe hallux dorsiflexion stiffness controls knee flexion- didn't Howard say that? Isn't it time you finished that paper?
     
  30. You know which side of the arguement I'm on re knee flexion and dorsiflexion stiffness.

    And yes just crawling out from under a large rock called life soonish I hope.
     
  31. efuller

    efuller MVP

    The test has flaws either way. I think it gives me some information, but not a lot. And the information has low reliability as there are multiple variables effecting stiffness of the MPJ. It is hard enough to make it reproducible with the feet side by side. If you want to to do the study with one foot in front of the other, you are welcome to do it. How do you decide, or how does the subject decide, how much weight to put on the foot being tested? How do you get the person to maintaine balance in that position. All problems that probably can be worked out, but I'm not sure it's worth the effort. You are welcome to prove me wrong on that.


    I think the tests should be done by students so that they can appreciate the variation across people.


    Eric
     
  32. efuller

    efuller MVP

    See the van Langelaan EJ. Acta Orthop Scand Suppl. 1983;204:1-269.
    This 1983 paper, in its literature review, completely destroyed the notion of parallelism of the axes of the bones of the midtarsal joint. 1983!!! Please show this paper to whoever taught you about parallelism of the axes. You can learn more from that paper than you will learn from the person who taught you about axes being paralell makes the foot less rigid.

    Eric
     
  33. Ben

    Ben Member

    I know this doesnt really answer the original question, but it is only ONE test of a complete assessment. Like most of the assessments Podiatrists utilise, there is always going to be limitations, but if you recognise these, and use them in combination with a full biomechanical assessment and gait analysis, then you are going to get the overall picture of what you are trying to achieve.
     
  34. Phil:

    This is an excellent question for a second year podiatry student. Good job!

    There are multiple names for this "Windlass Test" you speak of. Other commonly used names include the "Hubscher Maneuver" and "Jack's Test". All of these involve the same test: assessing the ability of the examiner to manually dorsiflex the hallux during relaxed bipedal stance while also assessing the response of the medial longitudinal arch and subtalar joint to this hallux dorsiflexion.

    Even though we have talked about this many times on Podiatry Arena, let me give you a quick summary of what I have observed over the past 3 decades of examining feet. Those feet that require normal to less manual force to dorsiflex the hallux tend to have the following in common:

    1. Adequate dorsiflexion range of motion of the 1st metatarsophalangeal joint (MPJ) in the non-weightbearing examination.

    2. Normal to lateral subtalar joint axis (STJ) spatial location during relaxed bipedal stance.

    3. Normal to high medial longitudinal arch height during relaxed bipedal stance.

    4 An intact medial band of the central component of the plantar aponeurosis.

    As John Hicks described in his 1954 paper (Hicks JH: The mechanics of the foot. II. The plantar aponeurosis and the arch. J Anatomy. 88:24-31, 1954), manual hallux dorsiflexion in a "normal foot" during relaxed bipedal stance will produce first ray plantarflexion, raising of the medial longitudinal arch, STJ supination motion and external tibial rotation.

    However, when any of the four factors above are not present, this sequence of events, of where hallux dorsiflexion causes external tibial rotation, will be less likely to occur.

    1. If the patient has a structural hallux limitus/hallux rigidus, then the internal 1st MPJ plantarflexion moment caused by a structural abnormaility within the 1st MPJ will prevent normal hallux dorsiflexion.

    2. If the STJ axis is medially deviated, then the external STJ pronation moments from ground reaction force may be so great that the STJ supination moments from manual hallux dorsiflexion force are of insufficient magnitude to allow the STJ supination motion that is necessary to plantarflex the first ray and allow hallux dorsiflexion to occur.

    3. If the medial longitudinal arch is lower than normal, then the increase in tensile force within the medial band of the central component of the plantar aponeurosis caused by manual hallux dorsiflexion force may not generate enough first ray plantarflexion moment to allow medial longitudinal arch raising and STJ supination to occur.

    4. If the medial band of the central component of the plantar aponeurosis has been ruptured or cut, then the hallux may dorsiflex freely without first ray plantarflexion and without medial arch raising since the hallux no longer is, effectively, attached to the plantar fascia.

    I have seen all of these situations occur multiple times over the years in the thousands of feet I have examined.

    Hope this helps.
     
  35. drsha

    drsha Banned

    Eric:

    This is a very telling posting in that it seems to side with my arguments and against your practices and teachings.

    1. If we use muscles differently in stance than when in gait, wouldn't your drawings and evaluations of the moments, stresses and stiffnesses that you have arrived at using contact/midstance/ toe off, etc have less clinical import when dealing with stance or any other movement other than gait (what you really mean is The Gait Cycle or heel contact gait isn't it?),
    i.e. a diabetic who is 300 pounds and has totally abnormal gait and balance and therefore spends much time sitting or in stance?
    2nd i.e. how would all your rules apply to forefoot contact walking or running or backwards movement or the act of lifting a weighted object, etc?. Using your statement, it would seem that they would be flawed when applied at any other moment than heel contact gait.

    Don't many of our patients need an orthotic for living life instead of an orthotic for gait?

    2. Your important comment that there is a brain attached to the foot mimics what I have been posting on The Arena and elsewhere for decades in that primary Newtonian Laws are overridden by that very same brain reducing or removing the power, import, reliability and clinical usefullness of all of your Newtonian based principles, theories and evidence when they are applied to living organisms with a brain in real time, clinically.

    I will be quoting your comments in my future lectures and publications as reinforcing The Foot Centering Theory of Biomechanics and thank you for having written them, in advance.

    I await your reaction and those of other tissue stressers.

    Summarily, if you remove the word gait and add the conscious and unconscious actions of a living subject into your teachings and those of others, my opinion remains that it becomes one gigantic straw man argument (Robert, correct me if I am using the wrong term).

    Dennis
     
  36. Dennis:

    I don't believe I have ever seen this "Foot Centering Theory of Biomechanics" published in a peer-reviewed journal. Please provide us a reference of something other than your website that fully explains how it obeys Newtonian mechanics and is a logical and scientific method of understanding how the foot works mechanically. Also, please tell us how this "theory" of yours obeys Newtonian mechanics more fully than does Tissue Stress Theory.
     
  37. efuller

    efuller MVP

    How does this statement side against my arguments? What exactly is your practice and teachings. How is a centring different than an arch support? Why do you bother to type a foot if you create the exact same orthosis for each foot type? (For those of you unfamiliar with our past conservations, I asked Dennis how he altered how an orthosis was made depending on the foot type. He has yet to answer that question on the arena.)


    No, they are still important as you can estimate stress on anatomical structures regardless of the position of the foot. You can also include muscle forces in those estimates of stresses.

    Dennis, why would the rules be flawed? Here's why I think the rules would still apply with forefoot contact walking. With forefoot contact walking the center of pressure will be on the forefoot. You can still calculate the moment from ground reaction force about the STJ axis when the center of pressure is on the forefoot. In some feet that moment will be higher and some lower depending on the position of the STJ axis. The principles still apply.

    Dennis, what do you mean by the brain overrides Newton's laws? When I'm saying that a brain is attached to the foot, is that the brain controls the relative amount of muscle activity. That is the moment, created by the muscles, at various joints will be different depending on the relative activation of muscles that cross those joints. This can be accounted for when examining tissue stress. A good example of this is our description of posterior tibial tendon dysfunction. Since the PT tendon and muscle have less leverage at the STJ and the ground has more leverage at the STJ the brain has to signal the posterior tibial muscle to create more force in a medially positioned STJ axis foot than in an average axis foot to produce the same motion. Those higher forces in the tendon is what causes pain and pathology in the tendon.

    Dennis, why in one foot type would you see posterior tibial tendon pathology and not in another foot type? Foot typing would be a good idea if it were helpful in explaining pathology. It might even still be helpful if it even correlated with pathology. Do foot types correlate with pathology in any instance? Have you looked?

    Dennis, I could help you out with my quotes. I just want to make sure that you understand what I said. Could you give me an example, of how you plan to use it? The one above about the brain overriding Newton's laws doesn't work. See explanation in this post above.

    Dennis, you could replace the word gait with the words weight bearing and tissue stress still applies. Now, Root, Orien and Weed and their foot typing system only looked at gait on level ground. At least they made some predictions of what they would see in gait. Have you made any predictions of what you would see, or what pathology should correlate, with your foot typing system?

    Eric
     
  38. drsha

    drsha Banned

     
  39. DaveJames

    DaveJames Active Member

    Hi All,

    It sounds like a an interesting paper and one I should read. I've tried getting a copy online without any success.

    Do any of you guys have an electronic copy that you would be willing to send over?

    Thanks in advance.

    Kind regards,

    Dave
     
  40. Dave PM me your email address Ive only got your work email and it will be yours.
     
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