Hallux amputation. What would you expect to present in this case ?

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The stuff we get/see.
Hallux amputation.
What would you expect to present in this case ?
We will dive into this one next week, but here are some cursory things to consider:

It is the right foot.
-Without the hallux, we cannot wind up the windlass and shorten the distance between the first metatarsal and heel, thus the arch will splay (more permanently over time we suspect) and we cannot optimize the arch height.
This will promote more internal spin on that limb because of more midfoot pronation and poor medial foot tripod stabilization.
- more internal limb spin means more internal hip spin, and more demand (which might not be met at the glute level) and thus loads that are supposed to be buffered with hip stabilization, will be transferred into the low back, and or into the medial knee. Look for more quad protective tone if they cannot get it from the glutes. Troubles arise when we try to control the hip from quadriceps strategies, it is poorly postured to do so, but people do it everyday, *hint: most cyclists and distance runners to a large degree)
- anterior pelvis posturing on the right, perhaps challenging durability of the lower abdominals, hence suspect QL increased protective tone, possible low back tightness or pain depending on duration of activities
- there is so much more, we are just wetting your appetite here on this one.
see you next week on this one gang !

Ivo and i are in the studio for another podcast this afternoon, hope you got to #137 this week ! lots more goodies to come !

cheers, shawn and ivo

Photo permission by patient

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When the Windlass is lost.

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).
https://www.theagecoach.com/

#gait, #gaitanalysis, #gaitproblems, #thegaitguys, #gaitcompensations, #halluxamputation, #windlassmechanism, #halluxdorsiflexion, #pronation, #FHB, #FHL, #hammertoes, #theagecoach

Podcast #140: Running, hallux amputation, building deeper gait concepts.

Topics:

hallux amputation, achilles tendon, achilles tendinopathy, rehab achilles, bursae, marathons, vapourfly, shoes, shoe fit, gait, gait problems, gait correction, gait retraining, running, foot strike, heel strike, midfoot strike, rearfoot strike, heel strike, loading responses, gait rehab, muscle strength, isotonics

Links to find the podcast:

Look for us on iTunes, Google Play, Podbean, PlayerFM and more.

Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com

doctorallen.co

summitchiroandrehab.com

shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:

iTunes page:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Direct download URL: http://traffic.libsyn.com/thegaitguys/pod_140real_-_10618_9.18_AM.mp3


Permalink URL: http://thegaitguys.libsyn.com/podcast-140-running-hallux-amputation-building-running-concepts


Libsyn Directory URL:http://directory.libsyn.com/episode/index/id/7135745


Topics and links:


The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound. Nuri L, et al. J Exp Biol. 2017.

https://www.ncbi.nlm.nih.gov/m/pubmed/28620014/

Good tip to decrease loading and help decrease injury risk in runners: See study by Chan et al.:
http://journals.sagepub.com/doi/abs/10.1177/0363546517736277?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

Vapourfly shoe
https://www.nytimes.com/interactive/2018/07/18/upshot/nike-vaporfly-shoe-strava.html

Men’s marathon:
https://twitter.com/chrisbramah/status/1019481750039343104/photo/1


fun facts:

Foot strike patterns of the World Championships Marathon:
Women’s race:
73% rearfoot, 24% midfoot, 3% forefoot
Men’s race:
67% rearfoot, 30% midfoot, 3% forefoot
pic.twitter.com/iWRzjImQBZ
https://www.iaaf.org/about-iaaf/documents/research#biomechanical-research-projects

Foot structure and stiffness is critical
https://www.nature.com/articles/srep29870

Tendons can change
Progressive calf strength training led to increased achilles stiffness @ 4 weeks & increased tendon cross sectional area @ 8 weeks
https://link.springer.com/article/10.1007/s00421-018-3904-1

Bursae can thicken painlessly as a normal adaption to activity... just like skin calluses!
https://www.ncbi.nlm.nih.gov/pubmed/24907190

Between 63-72% of participants were wearing incorrectly sized footwear. review of the literature here from @LTPodiatry team:
https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z

How Neuroscientists Explain the Mind-Clearing Magic of Running -- from the Science of Us
https://www.huffingtonpost.com/science-of-us/how-neuroscientists-expla_b_9787466.html

Hallux amputation: Part 1 . What is next for this person ?

Screen Shot 2018-08-03 at 12.52.22 PM.png

The stuff we get/see.
Hallux amputation.
What would you expect to present in this case ?
We will dive into this one next week, but here are some cursory things to consider:

It is the right foot.
-Without the hallux, we cannot wind up the windlass and shorten the distance between the first metatarsal and heel, thus the arch will splay (more permanently over time we suspect) and we cannot optimize the arch height.
This will promote more internal spin on that limb because of more midfoot pronation and poor medial foot tripod stabilization.
- more internal limb spin means more internal hip spin, and more demand (which might not be met at the glute level) and thus loads that are supposed to be buffered with hip stabilization, will be transferred into the low back, and or into the medial knee. Look for more quad protective tone if they cannot get it from the glutes. Troubles arise when we try to control the hip from quadriceps strategies, it is poorly postured to do so, but people do it everyday, *hint: most cyclists and distance runners to a large degree)
- anterior pelvis posturing on the right, perhaps challenging durability of the lower abdominals, hence suspect QL increased protective tone, possible low back tightness or pain depending on duration of activities

Screen Shot 2018-08-03 at 12.52.29 PM.png


- there is so much more, we are just wetting your appetite here on this one.
see you next week on this one gang !

Screen Shot 2018-08-03 at 12.52.13 PM.png

Ivo and i are in the studio for another podcast this afternoon, hope you got to #137 this week ! lots more goodies to come !

cheers, shawn and ivo

Photo permission by patient