When the Windlass is lost.
Here, this case again (hallux amputation), when the Windlass is lost or at the very least, impaired, what holds up the arch?
Without the winding of the plantar fascia through hallux dorsiflexion (toe extension) and without the FHL (flexor hallucis longus) we lose major engineering advantages to lift/support the arch and control pronation variables.
So what is left ?
Tibialis posterior, tibialis anterior, peroneus longus, mostly, are what is left. So when these guys are suffering (ie, tendinopathy etc) it could be due to the other previously mentioned engineering marvels being impaired.
It is a team effort to keep the foot healthy and functioning without expressible pathology.
*note the heavy flexion attempts of the 2nd toe, the next soldier in line, no surprise there.
Now you should realize why you see this 2nd toe over-flexion attempts when even an existing, yet incompetent, hallux is present.
This slide is part of a new presentation, one we will be doing a WEBEX on that you can all join in on, and it will be a new presentation for our onlineCE Wednesday night seminars.
Now, go read this dudes blog, inspirational journey through big toe cancer. Thanks for sharing your story Kevin, and your case photos. (PS: presentation is almost done, so i will be in touch soon so we can go over it and collaborate).
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