Functional Hallux Rigidus and the Achilles-Calcaneus-Plantar System

Maceira, Ernesto; Monteagudo, Manuel

doi:10.1016/j.fcl.2014.08.006

Cited by 32 publications

(39 citation statements)

References 30 publications

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“…In this sense, the triceps surae has to counteract the dorsiflexor moments at the ankle arising from the ground reaction forces in an analogous way to what the plantar fascia does in the MT joint. This supports the existence of a mechanical relationship between the gastrocnemius-soleus complex and plantar fascia, also known as the Achilles-calcaneus-plantar system (Kirby 2002;Kirby 2008;Maceira & Monteagudo 2014;Pascual Huerta 2014). Conversely, the MP joint is only subjected to a very low DF moment during the propulsive phase, with a DF motion of approximately 30º, counteracted by the plantar muscles and the passive structures of the joint.…”

Section: Discussionsupporting

confidence: 53%

3D characterisation of the dynamics of foot joints of adults during walking. Gait pattern identification

Sanchis-Sales

Sancho-Bru

Roda-Sales

et al. 2017

Computer Methods in Biomechanics and Biomedical Engineering

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A detailed description of the kinematics and kinetics of the ankle, midtarsal and metatarsophalangeal joints of the feet of a healthy adult male population during barefoot walking is provided. Plots of the angles and moments in each plane during the stance phase are reported, along with the mean and standard deviation values of 87 different parameters that characterise the 3D dynamics of the foot joints. These parameters were used to check for similarities between subjects through a hierarchical analysis that allowed three different gait patterns to be identified, most of the differences corresponding to the frontal and transverse planes.

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Section: Discussionsupporting

confidence: 53%

3D characterisation of the dynamics of foot joints of adults during walking. Gait pattern identification

Sanchis-Sales

Sancho-Bru

Roda-Sales

et al. 2017

Computer Methods in Biomechanics and Biomedical Engineering

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“…Biomechanical theories about functional hallux limitus claim that both the elevation of the head of the first metatarsal and the increase in tension in the plantar aponeurosis may alter the joint dynamics in the first MTPJ. Owing to the ground reaction forces that are exerted on the first metatarsal head during midstance and propulsion phases, dorsiflexion of the first ray occurs in some patients, which can lead to blockage of the first MTPJ [13]. In our radiological univariate analysis, an increased dorsiflexion of first metatarsal declination was observed in patients who had previously developed hallux reulceration, which should support this theory.…”

Section: Discussionsupporting

confidence: 68%

“…Foot examination in a non-weight-bearing position can be normal, but dorsiflexion of the first MTPJ can be blocked during gait, which means that this risk factor may remain unrecognized. This condition whereby range of motion is reduced when the forefoot is loaded is referred to as functional hallux limitus [13].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Diabetic Foot Reulceration beneath the Hallux

Molines-Barroso

Lázaro‐Martínez

Montesinos

et al. 2019

Journal of Diabetes Research

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Aims To evaluate the factors that predict reulceration beneath the hallux in people with a history of diabetic foot ulceration. Methods A prospective study conducted between January 2012 and December 2014 was performed in a diabetic foot unit to assess the risk factors associated with hallux reulceration. Sixty patients with diabetic neuropathy and a history of previous ulcer were consecutively included. Sociodemographic factors and comorbidities plus the biomechanical and radiographic factors were obtained. Follow-up on participants was conducted every month, and they wore offloading therapeutic footwear and custom-made insoles. Hallux reulceration during the follow-up period was assessed as the main outcome measure in the study. Results Patients were followed up during 29 (14.2-64.4) months. Twenty-nine patients (52%) developed a new ulceration: 9 patients (31%) in the hallux and 20 (69%) in other locations. Functional hallux limitus (p = 0.005, 95% CI (2.097–73.128), HR 12.384) and increased body mass index (p = 0.044, 95% CI (1.003-1.272), HR 1.129) were associated with the hallux ulceration-free survival time in the multivariate Cox model. Conclusions Obesity and the presence of functional hallux limitus increase the probability of developing hallux reulceration in patients with diabetic neuropathy and a history of ulcers.

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“…There has been an increasing amount of literature in the last several decades suggesting a link between equinus and many foot and ankle conditions ( 1 , 3 – 53 ). Despite this association, little if any evidence concentrating on a mechanism of how the tight calf might actually produce problems in the foot and ankle ( 3 , 4 , 11 , 15 , 18 , 31 , 32 , 44 , 54 – 56 ).…”

Section: Introductionmentioning

confidence: 99%

The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle

Amis

2016

Front. Surg.

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We are currently in the process of discovering that many, if not the majority, of the non-traumatic acquired adult foot and ankle problems are caused by a singular etiology: non-neuromuscular equinus or the isolated gastrocnemius contracture. There is no question that this biomechanical association exists and in time much more will be uncovered. There are three basic questions that must be answered: why would our calves tighten as we normally age, how does a tight calf, or equinus, actually cause problems remotely in the foot and ankle, and how do the forces produced by equinus cause so many seemingly unrelated pathologies in the foot and ankle? The purpose of this paper is to address the second question: how does a tight calf mechanically cause problems remotely in the foot and ankle? There has been little evidence in the literature addressing the biomechanical mechanisms by which equinus creates damaging forces upon the foot and ankle, and as a result, a precise, convincing mechanism is still lacking. Thus, the mere concept that equinus has anything to do with foot pathology is generally unknown or disregarded. The split second effect, described here, defines exactly how the silent equinus contracture creates incremental and significant damage and injury to the human foot and ankle resulting in a wide variety of pathological conditions. The split second effect is a dissenting theory based on 30 years of clinical and academic orthopedic foot and ankle experience, keen clinical observation along the way, and review of the developing literature, culminating in examination of many hours of slow motion video of normal and abnormal human gait. To my knowledge, no one has ever described the mechanism in detail this precise.

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Functional Hallux Rigidus and the Achilles-Calcaneus-Plantar System

Cited by 32 publications

References 30 publications

3D characterisation of the dynamics of foot joints of adults during walking. Gait pattern identification

3D characterisation of the dynamics of foot joints of adults during walking. Gait pattern identification

Predictors of Diabetic Foot Reulceration beneath the Hallux

The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle

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