The banana hallux. When the big toe curls upward

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Note: over-extension of the hallux and over-flexion of the 2nd toe. How can they both be so different at rest ? read on

This is common, but not commonly addressed. And, it can become a cause of symptoms.
Note how curled up into extension the hallux appears. This is just a representation of hyperextension of the distal phalange at the IP joint (interphalangeal joint).
This often occurs in hallux limitus/rigidus, where there is insufficient extension through the 1st MTP joint (metatarsophalangeal joint). In that condition, they client attempts to toe off, needing extension (dorsiflexion) at that joint, and they do not have it, so the extension can be found through arch collapse (1st metatarsal dorsiflexion) or through extension at the IP joint. Over time, form follows function and you will often see this presentation.

However, we do not need to see impaired ROM function at the 1st MTP joint, as in this case. This foot had full 1st MTP ROMs.
In this case, this toe represented massive imbalance between the long and short flexors and extensors. Specifically, increased use and strength in the EHL (extensor hallucis longus) and weakness and unawareness of how to even engage the short extensor (EHB).
Similarly, the pairing met the one we always see with this, that being weak and even difficulty of awareness to engage the FHL (flexor hallucis longus) and over-activity of the FHB (short flexor-flexor hallucis brevis).
There pairings: weak: EHB and FHL & overactive: EHL and FHB over time will result in this presentation.

In gait, you will note poor compentence and purchase of the hallux on the ground and thus a sharing of that load through overflexion hammering of the 2nd digit through increased FDL activity (note the great evidence of this with the thick obvious callus at the tip of the 2nd toe).
These clients can also often have pain at the plantar aspect of the Metatarsal head because of sesamoid imbalanced loading (sesamoiditis) as well as frank pain at the MTP joint dorsally or plantarward. One will often note a medial pinch callus on these feet medial to the metatarsal head, from a rotational spin toe off. Hallux valgus and bunion formation are also not uncommmon at all in this incompetent hallux presentation.
PS: the solution is so much more complex and involved than just towel-scrunches and marble pick up games. I mean, come on, we can do better that this team !
This requires some serious reteaching of how to use the foot, arch, tripod, windlass and foot-ground engagement skills.

Shawn and Ivo, the gait guys

#gait, #gaitproblems, #gaitcompensatins, #gaitanalysis, #bunions, #halluxvalgus, #sesamoiditis, #turftoe, #halluxlimitus, #pinchcallus, #bananatoe, #metatarsalgia, #thegaitguys, #hammertoe

Podcast 44: New knee ligaments and Ankle Rocker

The newly discovered knee ligament, ankle rocker, hammer toes, yoga, joint flexibility and more ! Download Podcast # 44 today !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-44-new-knee-ligaments-and-ankle-rocker

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

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D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience:
New ligament discovered in the human knee
http://www.sciencedaily.com/releases/2013/11/131105081352.htm
3. Brain and Motion
‘Anklebot’ Helps Determine Ankle Stiffness
8. Blog reader:
richies77 asked a questionHi, Incredible source of information. I have severe arthritis in the 2nd toe of my left foot. I have very little dorsiflexion and this has caused my hip flexor to become chronically, extremely tight. This has twisted my entire spine and made me pretty much disabled. I’ve been offered orthotics and perhaps rocker shoes but do you think surgery is the only way to bring back correct balance to my spine? Does anything else actually work? Thank you!
9. In the News:
Yoga and the Brain:
11. another blog reader:
What should I start doing for early cerebellar atrophy symptoms? I’m 6'5 195 and an athlete
 
12. CADENCE and BAREFOOT

Doing Squats, Lunges as well as Walking and Running using the Big Toe Ineffectively.

This is an important video.
Here in the initial frames you should see that this fella is using his big toe muscles incorrectly.  There is a long flexor and short flexor of the big toe, just like there is a long and short extensor muscle.
You should clearly see that the big toe sort of curls upwards in the early frames before he is coached to correct in the later frames. In these early frames his medial tripod stabilizing strategy is to use the short toe flexor (FHB - flexor halucis brevis) and more long toe extensor (EHL- extensor hallucis longus). This is what is giving the upward curl presentation. The problem with this strategy is that it is ineffective and uneconomical. It does not help to engage the medial tripod of the foot (ie. keep the big toe knuckle, the metatarsal head, down and purchased well on the ground) nor does it effectively assist the arch posturing of the foot.

You can see at the 17 second mark, with our coaching, he begins to learn and teach himself about the differing uses of the long and short hallux flexors. You can see him over correct from too much short flexor (FHB) into too much long flexor (FHL) where he claws the toe into the ground. You can then see in subsequent frames that he begins to play with the relationship to find a balance between the two. Then, you see that he loses the purchase of the medial tripod at 21 seconds where you see our hand enter the picture and queue the metatarsal head/knuckle down. When done correctly a double arch will form, one in the longitudinal arch of the foot and a second one just under the big toe. This big toe arch should be subtle but visible. If the client collapses this “toe arch” as we call it, they are driving the toe down with abundant short flexor (FHB). This can be easily seen on a pedograph mapping or foot scan represented by too much ink or pressure mapping at the proximal toe and little to no pressure distally through the pad of the big toe. These folks will struggle with adequate anchoring and purchase of the medial tripod (the 1st metatarsal head) and will challenge the longitudinal arch of the foot and thus the tibialis posterior as well as other structures. They can pronate too much and challenge the ankle mortise dorsiflexion range.  Rear foot eversion can become abundant as well. 

Balance of the long and short flexors of the big toe in concert with the long and short extensors. Too much short flexor usually couples with too much long toe extensor (hence the upward curl of the toe as we saw in the early video frames). Too much long flexor couples with too much short extensor, forming a claw-hammer toe presentation. There is a science to this. Balance must be achieved.  Just running barefoot or in minimalism does not guarantee a stronger foot or better form. It may in fact get you a more strength in a bad pattern (as you saw in the first few seconds of the video) which leads to injury  and it may get you stronger into many bad running and walking forms, both at the foot and higher up into your body.

There is more to this game than shoes and random exercises. This is a specific science, if you care to look beyond the basics that allow alot of injuries.  This is how detailed our game is with our athletes and patients, because it is the way the game should be played.

The devil is in the details
Shawn and Ivo………Uber gait geeks.