A year ago we produced this short video (link) on how to bring back the EHB (extensor hallucis Brevis muscle). Well, it continues to do its magic on a regular basis. Here is a patient’s foot with clear demonstration of unassisted success of isolated engagement of the EHB while simultaneous release of the EHL (ext. Hallucis long us) while engaging the FHL (flexor hallucis long us). This patient could not isolate any of the long or short hallux muscles on his own. “I can’t find it, my brain doesn’t know what it is supposed to do or how to do it ! (paraphrased) But after just 24 hours consisting of a few sessions of the exercise here is the result in the photo above. Success ! And here were his comments:
Doc, you were right - the brain is an amazingly plastic thing!
I’ll keep working on it, but happy to see such quick progress!
The client’s problem was some medial mid-rear foot pain from the resultant excessive increased pronation because of a forefoot varus. Well, it is a bit more complicated than that to be precise. There was some true clinical ankle and rearfoot instability because of a lifetime of ankle sprains as well as some highly suspect lower syndesmosis hypermobility from probable distal anterior tib-femoral ligamentous attenuation/tears but the main point is that these were clinically manifesting themselves because of the apparent forefoot varus and the resultant pronatory foot mechanics to get the 1st metatarsal head (medial tripod) to the ground; a typical phenomenon . Here is the kicker, he did not have a fixed forefoot varus, it was a mirage, it was functional. What he had was an inability to descend the first metatarsal (plantarflex the Metatarsal) / medial tripod of the foot. He could not do this because he could not separate ankle dorsiflexion and hallux dorsiflexion. There was essentially no hallux dorsiflexion at all because he could not descend the 1st MET (head). So, we knew it was time to break out the nuclear EBH exercise in the video above ! Big problems require big guns !
The rest is history. We fully expect to see a virtual disappearance of the “so called” forefoot varus (because it was never present in the first place).
“If you have never seen the beast, you will not recognize it when you see it.”-unknown
The Gait Guys
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