About 8 years ago (?) I was in my Muscle Activation Class (MAT) here in Chicago and somewhere during the course of the class the topic came up about problems with the big toe. This really nice fella spoke up about a major injury to his thumb (the photo is not of him but here is a link to this fella’s story) and how doctors then proceeded to amputate his big toe to replace the thumb.
Gosh, with my brain knowing all that it does about gait as well as hand function, thoughts began to swim in every direction. What would I do if I were presented with the same scenario? Without my thumb my work as a manual medicine physician would definitely be changed. But, heck, my gait would forever be changed too! I would be sentenced to a life of never ending gait compensations that could never be treated. My mind swirled around impaired hip extension and gluteal dysfunction, not to mention:
foot tripod incompetence
pronation and supination dysfunction guaranteed
virtually guaranteed hammer toe formation
metatarsal stress impacts
inappropriate loads on the medial column stabilizers such as the tibialis posterior now that the medial foot tripod was impaired let along the new absence of the long and short toe flexors that often provide compensatory activity to help an insufficient medial tripod.
impaired ipsilateral and contralateral arm swing
impaired shoulder function
core and hip impairments and asymmetry
the list goes on and on……. perhaps for hours ! We could do a whole 1-2 hour lecture just on the gait compensations and the subsequent motor impairment patterns that would ensue.
Seeing this photo and reading this fella’s story brought my mind back to the swirling thoughts I had while sitting in that lecture hall that day. And now some 8+ years later i am still brought to the same uncertain conclusion. Would I go for the switcheroo ? The transplant isn’t guaranteed successful, if it was that might sway things a little. But the gait impairments are guaranteed.
What would you do ?
We hope you ( and us here at The Gait Guys) never are confronted with this most difficult presentation. However, in just a few years, with the advent of 3D printers the anxiety of this issue is likely going to become a non-issue.
Just some food for thought today. Or maybe we should have said “Foot for thought.”
Shawn and Ivo
The Gait Guys
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