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).

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