Barefoot Science, Foot Function & Fascial Lines Series

Local Reflexive Stabilization & Movement Efficiency

Screen Shot 2016-04-25 at 12.24.22 AMWhether we consciously realize it or not we all want to move better, feel stronger and stay pain-free.   We all seek the ability to do the activities we love – whether that be going for a long walk with a loved one or competing in an obstacle race.

It is my mission to help professionals and patients alike achieve what I call movement longevity by better understanding the concepts of movement efficiency and local reflexive stabilization.

What does it mean to be efficient?

To be efficient means to effectively use energy.   When we think about bipedal locomotion the energy that we need to get from Point A to Point B is found from the ground we walk on.

Bipedal locomotion or walking is considered a series of falls with each foot contact (foot fall) providing the energy needed to take the successive step.   As our foot contacts the ground we are encountering 1 – 1.5x our body weight in impact forces. These impact forces are converted from potential energy to elastic energy, providing a recoil effect to bring the swing leg forward.

forceWhen we look at the force peak curve of a walking gait cycle what’s quite fascinating and perhaps under appreciated is that even though our body brings in 1 – 1.5x our body weight in energy (heel contact) we actually release 2 – 2.5x our body weight when we push off (forefoot propulsion)!

What this means is that our body is somehow is able to double the energy that it is provided with!   How is this possible?   And why is this even important?

Understanding Fascial Elasticity

The concept I described above is referred to as the catapult effect and truly is the meaning of movement efficiency.   To move efficiently does not meant to just take in energy and release it with little loss of energy.   It actually means to take in energy and double it!

This ability to double potential energy allows a basketball player to slam-dunk a ball or a triple jump jump 50+ feet.  This catapult effect lies within our connective tissue – namely our myofascia.

To effectively understand the catapult effect and the oading response during bipedal locomotion one must first understand what’s referred to as the Muscle Tuning Theory .   This theory was researched and developed by Dr Benno Nigg out of the University of Calgary Canada.

What the Muscle Tuning Theory demonstrates is that in order to effectively damp the impact forces encountered during initial contact we must have sufficient foot and ankle stiffness.   We must contact the ground with enough foot and ankle isometric contractions to allow the rapid loading of impact forces (potential energy) into our connective tissue.

Because our foot and ankle muscles are firing isometrically during the loading response what actually allows the joint movements of deceleration (ankle dorsiflexion, STJ eversion, tibial internal rotation) is the elasticity of our connective tissue (fascia / tendons).

normal-foot-pronation-at-midstance-sample_view
This fascial loading is dependent on the degree of elasticity or rubber band effect in our connective tissue.   However simply having fascial elasticity is not enough.  In order to effectively load our fascia with potential energy we must first achieve sufficient fascial tension.

Fascial Tension = Stability

If I were to say that to have fascial elasticity we must first have fascial tension – this may seem contradictory.   How can our fascia be both elastic and stiff at the same time!

What if I were to word it another way.   In order to effectively load impact forces (potential energy) we must be STABLE!   Let me take it even further with this statement – Stability is the foundation through which power, force and resistance is generated.

In other words to move efficiently and transfer energy we must have sufficient stability.   In the words of Dr Perry Nickelston I think that deserves a BOOM!

This above statement is what I try to achieve in all of my patients.   To help my patients become pain-free I know I must teach them to achieve proper stability.   But not only do we need proper stability – we need deep joint stability.   And not only do we need deep joint stability – we need fast deep joint stability.

This is what I refer to as Local Reflexive Stabilization.   Local – referring to our local stabilizing muscles and reflexive meaning fast or subconscious.

Understanding Local Reflexive Stabilization 

The concept of local vs. global stabilizers was first introduced by Dr Vladamir Janda and then later expanded upon by Shirley Sahrmann.

Screen Shot 2016-04-25 at 12.05.53 AMThe  following image demonstrates some of the biggest differences between local and global stabilizers.   What’s fascinating is that when we consider the Deep Front Fascial Line we can see it is formed by all the local stabilizers.   The foundational concept in EBFA’s Barefoot Training Specialist Certification is to train stiffness and reflexive sequencing between the foot and core.

By intelligently tapping into our local stabilization system we will find ourselves with enhanced stability – and therefore better be able to load impact forces during dynamic movements.

Because it is so easy to slide out of local stabilization and into global stabilization the below 3 exercises should be used as a daily reset or activation for the local reflexive stabilization needed for bipedal locomotion.

3 Way to Enhance Local Reflexive Stabilization

Step 1 – Diaphragmatic Breathing

Step 2 – End Range Expiration (with pelvic floor activation if possible)

Step 3 – Diaphragmatic Breathing / End Range Expiration & Short Foot

To learn more about EBFA’s education and our Barefoot Training Specialist Certification please visit http://www.ebfafitness.com

As always – stay #barefootstrong!

Dr Emily 

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Barefoot Biomechanics, Barefoot Science

From Primal to Bipedal : Why we must lock in our rolling and crawling with foot to core sequencing

Rolling and crawling are currently some of the hottest trends in fitness and corrective exercise programming.   From Animal Flow to Original, health and fitness professionals are exploring the power of primal movement patterning for correcting movement dysfunction and achieving optimal function.

We actually happened to just do a webinar on this exact topic with Stop Chasing Pain’s Dr Perry Nickelston which we encourage you to catch the archived version on the EBFA YouTube Channel HERE!

baby-development-web

Babies Sitting, Crawling, and Walking

Why rolling and crawling are such powerful stabilization techniques is that they bring us back to our neurodevelopmental origins.   Back when we were first introducing our nervous system to the demands of movement – millions of neuromuscular pathways were being developed.

These neurological pathways soon become the joint stability and coordination needed to sit upright, resist gravity and ultimately put one foot in front of the other.

What movement specialists are starting to realize is that by bringing it back down to the ground and reducing the demands of gravity, clients and patients are better able to restore stabilization patterns.

Test Your Primal Stability 

One example of crawling stability is the quadruped position.  In Animal Flow they call this position The Beast.

animal-flow-fitness_1394828697

Begin on your hands and knees with your shoulders directly over your wrists, hips over knees, neutral spine and feet flexed.

After creating proper alignment on these 6 points of contacts, engage the deep abdominals and lift the knees 1 cm off of the ground.   Immediately you should start to feel all your stabilizers engage.

Richard Scrivener of Animal Flow recommends holding this 4 point Beast for 45 seconds to test stability.

From Primal to Bipedal 

Despite the current popularity in rolling and crawling I think that it is important for movement specialists to remember that we are still bipedal animals and that simply training primal patterns is not enough to restore the demands of bipedal locomotion.

One of the biggest differences between primal movements and bipedal movements is the degree of impact forces encountered with every step that we take.   When walking each time our foot contacts the ground we are encountering 1 -1.5 x our body weight in impact forces that are entered at a rate of < 50 milliseconds.

To effectively and efficiently load these impacts forces over and over (sometimes over 10,000 times a day!) requires fast and accurate stability.

Now although we were training stability in our primal patterning that stability was not at the rate nor was it specific to the demands of bipedal foot contact.

Foot to Core Sequencing 

This is where foot to core sequencing comes into our programming.

walking-barefoot-298x232I refer the foot to core sequencing we use in the Barefoot Training Specialist® Certification as the critical step in locking in stability.

Why do we want to lock in our stability with foot to core sequencing?

Here are a couple powerful reasons:

  1.  The foot is the only contact point between the body and the ground which means this complex structure is the neurological gateway between impact forces and stabilization.
  2. Fascial sequencing exists via the Deep Front Line connecting the plantar foot with the deep hip and pelvic floor.   Studies have shown that by training the foot to core sequencing you can begin to establish feed forward, pre-activation sequences to enable faster foot to core stability
  3. Thousands of small nerve proprioceptors on the bottom of the foot detect the vibrations of impact forces making the bare foot the gateway to understanding how hard we are striking the ground and how quickly our foot to core sequencing needs to occur

Training Foot to Core Sequencing

The simplest exercise to train foot to core sequencing is via an exercise called short foot.  For those who follow my work probably new I was going to say this!

A few tips with cueing and integrating short foot.

  1.  Start with pelvic floor activation and identification if the client or patient is unfamiliar with how to engage these muscles.   Video on pelvic floor activation is HERE
  2. Stand up and find short foot.  In those clients familiar with short foot immediately begin to cue that they start with the pelvic floor engagement then add in short foot The video on how to do short foot is HERE
  3. Begin to coordinate the breathe with short foot / pelvic floor sequencing ensuring that the engagement happens on the exhalation.   I prefer the breathe to be relaxed and not forced exhalation but natural deep breathing that involves the entire thoracic cavity with lateral ribcage expansion.
  4. Begin to integrate foot to core sequencing in single leg exercises such as those listed HERE

Want to learn more about the benefits of foot to core sequencing and the Barefoot Training Specialist Certification please visit http://www.ebfafitness.com

Finally – as always – stay barefoot strong!

Dr Emily

 

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Barefoot Science, Foot Function & Fascial Lines Series

Myofascial Energy Transfer & Movement Efficiency

When we walk, run, jump or do any dynamic movement there is a fascinating interaction that occurs between the body and the ground.  This interaction may only take a mere milliseconds but it provides the energy source needed for efficient human movement.

Upon ground contact the body encounters impacts forces which are detected by the plantar foot (and sometimes palmar hand) and quickly converted into potential energy.

What happens next is critical to how effectively you take your next step.  Even before your foot contacts the ground the nervous system is preparing for impact.  This preparation is achieved through what’s called stiffness.

Stiffness is a requirement for movement efficiency

The stiffer your foot & ankle are upon contact the quicker you will be able to load and
unload the potential energy contained within these impact forces.   In fact research has shown that it is foot and ankle stiffness that actually translates to running speed.   A 2002 study by Brett et al. found that sprinters who could generate the greatest stiffness had the fastest acceleration.

So how do we create this stiffness needed upon foot contact?

The answer lies within the integrated relationship between our muscles and fascia.

Myofascial Tensioning = Stiffness

picAll of our muscles contain a deep interconnected myofascial web that is continuous with the surrounding tendons and ligaments.  This myofascial web runs from around the muscle as a whole (epimysium) to around the muscle fascicles (perimysium) and finally around the individual muscle fibers (endomysium).

Each of these individual facial layers have muscle fibers inserting onto them making their relationship dynamic – as well as one that is necessary for movement efficiency.

The way our body creates stiffness is through isometric contractions.  Isometric contracts create tension through this myofascial web – especially through the perimysium.    Why the perimysium is important to stiffness and energy transfer is that studies have shown that it is this layer of facia that contains the highest concentration of myofibroblasts.  Myofibroblasts are the cells that contain the contractile potential for elastic energy transfer.

This process of isometric contraction leading to fascial tension is what Dr Nigg refers to as the Muscle Tuning Theory and what EBFA refers to as fascial tensioning.

Fascial Training Beyond Foam Rolling

The health and fitness industries have done a great job at bringing myofascial or trigger point release to the forefront however we cannot stop there.   Our fascia requires attention beyond simply foam rolling.

To achieve optimal movement efficiency our fascia needs to be trained to create tension or stiffness – a stiffness that must actually be pre-activated before our foot contacts the ground.   In addition our fascia needs to be elastic or have a rubber band effect to it.   This can be trained through rhythmic movements such as tai chi, gyrotonics or many of the exercises we do in the BARE® Workout.

To explore the concept of fascial tensioning a little bit more please check out the video HERE

I also encourage you to check out EBFA’s Barefoot Training Specialist® Certification!

http://www.ebfafitness.com

Stay #barefootstrong!

Dr Emily

 

References:

Brett et al.   Leg strength and stiffness as ability factors in 100m sprint running, J Sports Med Phys Fitness. 42(3): 274 – 281. (2002)

Schliep, et al. Active fascial contractility, Structural Integration 2006

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Foot Function & Fascial Lines Series

The Future of Proprioceptive Training | Small Nerve Stimulation

UnknownWhen you hear the words “proprioceptive training” what comes to mind?

If you do a Google image search for these two words you will get hundreds of pictures demonstrating balance exercises on unstable surfaces.   Despite the popularity of these unstable surfaces how effective are they for improving balance or proprioception?

Surprisingly, not as good as their manufacturers would like us to believe.

In this article I challenge you to question the effectiveness of unstable surfaces in improving joint stability and if perhaps there is a more effective technique for improving proprioceptive awareness.

What is proprioception?

Often confused with kinesthetic awareness, proprioception is our internal messaging which drives our movements.   For example proprioceptors within our joint capsule provide the nervous system information on joint position which is used to control our movements.

Meanwhile kinesthetic awareness refers to our ability to navigate space and an awareness of how we move.   One such example would be if you are doing a box jump. To know how high to jump as to not clip the foot requires kinesthetic awareness.

Rate of Nervous System Responses

When it comes to controlling movements our nervous system plays a role in how fast the stimuli or sensory information comes into the central nervous system – as well as how quickly the motor response is sent back down to the peripheral nervous system.

We will see that the limiting facto in controlling movement is sensory input. This means that the faster the nervous system can sense the stimuli, the faster and more precise our movements will be.

The Peripheral Nervous System (PNS)

Unknown

Since it is our peripheral nerves which respond to the stimuli, understanding how this system is broken down is important to creating the most effective programming.

The PNS can be broken down into sensory nerves and motor nerves.   If we look at the tibial nerve (the nerve that supplies the skin / muscles of the plantar foot) 3x as many branches off of this nerve are sensory vs. motor. Of these sensory nerves 4x as many branches are small nerves vs. large nerve.

Nerve size matters when it comes to rate at which the nerves respond to stimuli.   Research has demonstrated that small nerves create a faster response when detecting inversion ankle moments.   In addition research has shown that these small nerves which are found primarily on the plantar skin play an important role in quiet stance.

The Future of Proprioception Training 

As we consider the future of proprioceptive training we want to remember that response time is very important to the precision of movements.   Many of the unstable surfaces we associate with proprioceptive training are actually examples of large nerve (or slower) proprioceptive training.

Therefore if we consider time we must think small nerve stimulation for faster proprioceptive responses.   To create small nerve proprioceptive programming we must know what tissue contains small nerves and what are the most effective ways to stimulate these small nerves.

Small Nerve Proprioceptive Rich Tissue

For anyone who has ever taken one of my workshops knows that the palms of the hands and the soles of the feet are rich in small nerve proprioceptors.   This is one of the greatest reasons why barefoot training is so important for all individuals.

Interestingly there is an even more dense small nerve proprioceptive tissue.   Can you guess what it is?

Your fascia!

Screen Shot 2015-09-28 at 9.09.49 PMFascia is a highly proprioceptive rich tissue with current research demonstrating that many of the sensory nerves found in fascia are small nerve and free nerve endings.   This is quite fascinating as it feeds into the speed at which are fascia is able to help control and stabilize for movement.

Another interesting fact about fascia is that it has 10x as many sensory nerves when compared to our muscles.   This means that when we exercise and move we are actually “feeling our fascia” – not “feeling our muscles”.

The baseline tone of our fascia actually allows us to better perceive movements and what is referred to as joint position sense.

Small Nerve Barefoot Fascial Training

This is the foundation to all barefoot movements taught through the EBFA Certifications.     By integrating the barefoot stimulation with foot to core fascial tensioning we are able to more effectively train and rehab our clients.   I believe that fascial tensioning is the future of proprioceptive training!

Want to learn more about our education programs and the science of barefoot stimulation please visit www.ebfafitness.com

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Barefoot Science, Foot Function & Fascial Lines Series

Compartment Pressure | The Secret to Preventing Impact Injuries?

imagesUpon haring the words “compartment pressure” – what comes to mind?

A majority of us may think of exertional compartment syndrome in runners or possibly compressive garments.

Today’s blog is going to explore how our body – particularly the foot and lower leg – uses compartment pressure to efficiently transfer forces. After researching the concepts I am about to discuss with you, my approach to overuse injuries and my Podiatry practice as a whole has changed!   It’s as if I look at injuries through a different lens.

Foundational Concepts

Before we delve deeper into the concept of compartment pressure, we must first review a few key points which lay the foundation to impact and movement efficiency.

I decided to do it in a step-wise fashion to make it easier to understand.

Step 1 – Encounter Impact Forces

With every step we take our body encounters impact forces ranging from 1 – 1.5x our body weight (walking) to 3 – 4x our body weight (running)

These impact forces are designed to provide the kinetic energy to walk, run, dance etc.

Step 2 – Perception of Impact Forcestuningfork

Our body perceives these impact forces as vibrations – vibrations which are initially detected through the skin on the bottom of the foot.   All vibrations (like a tuning fork) is set to different frequencies with walking impact forces being 15 – 20 Hz)

Step 3 – Damp / Load Impact Forces

As impact forces enter the body our soft tissue (muscles) respond to stop or damp the entering vibrations by contracting isometrically.   The concept of loading through isometrics is a new concept so let me give you an analogy to better understand this.

If you imagine a tuning fork vibrating upon impact it will vibrate at a certain frequency. To stop the vibrating tuning fork one must either touch it or put it against something.   Putting pressure against the tuning fork is analogous to the isometric contractions of our lower leg upon impact.

Step 4 – Elastic Energy Stored in Fascia / Tendons

As the muscles contract isometrically the fascia and tendon fibers slide thus allowing the joint range of motion needed for ankle dorsiflexion and STJ eversion.   As the joints flex elastic energy is being stored in the fascia and tendons.

As we shift from late midstance to push-off the fascia and tendons release this stored energy swinging the leg forward into swing phase.

So where does compartment pressure come in?   And what even is a compartment?

UnknownA compartment is a group of muscles that are surrounded by a sleeve of fascia.  Muscles within a specific compartment are often innervated by the same nerve and supplied with the same artery.

In our lower leg we have 4 compartments:  anterior, lateral, superficial posterior and deep posterior.   In our foot we have 9 compartments!

As our muscles contract (especially isometrically) compartment pressure and stiffness begins to increase.  The degree of pressure or stiffness is dependent on the rate at which the muscle fibers contract as well as the number of fibers recruited.

How does this affect the loading response? 

Well all compartments respond to vibrations of different frequencies.  Walking impact force frequency is 15 – 20 Hz which is also the frequency at which the lower leg muscles contract.

The goal upon foot contact – regardless of the movement – is to match the stiffness in the compartments to that of the incoming impact forces.  Any delay in creating stiffness or compartment pressure can result in an increased risk of injury.

I’ve begun to look at overuse injuries – particularly running injuries – with this concept and a clear association exists between delayed or inadequate compartment pressure on foot contact.

How can you begin to apply this concept to prevent impact injuries? 

  1.  Train the foot to detect impact forces faster and more accurately through barefoot training
  2. Condition the lower leg and foot to better create stiffness and compartment pressure through barefoot landing techniques
  3. Control training surfaces knowing that all surfaces vibrate differently with natural surfaces such as wood being the best
  4. Utilize compression sleeves to assist in damping vibrations

To learn more about impact forces and preventing injuries please visit http://www.ebfafitness.com and check out one of our Certifications

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Foot Function & Fascial Lines Series

Great Toe Mobility : The Linchpin to Movement Longevity | (Part 3 – Correctives & Client Programming)

Over the past couple days we have been reviewing the anatomy and functional assessment for great toe mobility.   Again I am very happy by the positive response and interest by so many professionals in this topic.   It shows this increasing awareness to the importance of the foot and foot function which makes me so proud!

In Part 3 of 3 of this blog series we will begin to explore the most appropriate programming for these clients and when is surgery really the best option.

I do want to emphasize that the biggest take-away from this blog series should be that great toe mobility is not just a local issue but is globally interconnected to rear foot, core and hip stability.   As we know – everything is integrated!

Structural Limitations in Hallux Dorsiflexion

UnknownHallux Limitus / Rigidus

One of the most important causes for limited hallux dorsiflexion is structural and progressive – arthritis     Often associated with older age great toe arthritis is actually quite common among runners, dancers, athletes or any client who has an unstable foot (over-pronation).

This loss of joint mobility is structural and cannot be corrected with functional training.   Great toe arthritis can be managed or slowed down with correctives but it cannot be reversed.  

To the left is an X-ray of a patient with structure changes to the great toe joint.   Joint space narrowing and spurring or osteophytes can be appreciated both of which greatly reduce the range of motion.

If we look at the lateral X-ray we can see that osteophyte development can become quite Unknownimpressive dorsally – it’s no wonder these clients have no dorsiflexion.

I must emphasize that in these clients doing aggressive manual joint mobilization can fracture these osteophytes leading to bigger issues than they started with.

You must always know the health of the joint before you start manually manipulating a great toe joint.

So what can you do with this client?

Surgery is always an option with the ideal procedure (which of course depends on the health of the joint) is a decompression-type procedure with removal of the osteophytes.   I personally try to avoid joint fusion at all costs if possible but sometimes the condition of the joint requires fusion.

met-head-rockerIf surgery is not an option or desired by the client then I often recommend using a rocker forefoot bar or shoe.

A forefoot rocker is a graphite bar that allows the client to dorsiflex over the shoe improves function and can eliminate pain.  This type of shoe allows the client to achive proper hip extension and propulsion despite having less than 30 degrees DF.  (Think Sketcher Shape-Up shoes).

Functional Limitations in Hallux Dorsiflexion

This is the area where most of you will be able to hep your clients improve their great toe mobility.   Functional means it is driven by a loss of stability elsewehere in the foot (or body).

This type of limitation in hallux dorsiflexion will generally demonstrate good mobility open chain but then lose that range of motion as soon as they enter a closed chain environment.

Where we want to first look for instability would be the first ray.

Loss of first ray stability typically presents in those patients with decreased medial arch, excessive STJ eversion or inversion, navicular drop and under-active glutes.   For the sake of the article not all of these issues will be covered however in all EBFA Certification workshops we cover each in detail.   To find a workshop near you click – HERE

Excessive STJ Eversion 

In Part 2 we briefly demonstrated how STJ eversion can cause 1st ray instability.   To review – this unstable STJ position puts the peroneus longus tendon on slack causing a delay in or insufficient plantarflexion of the 1st metatarsal head realative to the base of the proxmiaml phalynx.   (If you have not read Part 1 – please click HERE)Post Tib Exercise

In this client our goal is to improve STJ positning through posterior tibialis strengthening, short foot activation and glute strengthening.   One of my favorite exercises for this client is the ball between heels exercise (see picture on right).

Excessive STJ Inversion

For the client who has limited hallux dorsiflexion due to an inverted STJ and dorsiflexed 1st metatarsal our goal is to increase foot mobility and neutralize the STJ.

Supinated_1For this client we want to mobilize the platnar foot, tibialis anterior and deep hip rotations.

Combination Structural & Functional Limited Dorsiflexion

Hallux Valgus

Similar to hallux limitus, the client with bunions often presents with joint space narrowing and coral spurring which can begin to block hallux dorsiflexion.

With bunions structure is not the only contributor to limited joint mobility.   Bunion formation is also greatly associated with foot type – specifically eversion / over-pronation and generalized foot instability.

For this client we must consider both structural limitations (need X-ray) as well as our ability to slow the format1426198925_Bunion-Bootie-Before-Afterion of the bunion through corrective exercises.

In addition to the foot and hip strengthieng exercises mentioned above for the STJ eversion, we also want to include a medial stretch to the great toe with either tape or a Bunion Bootie (www.bunionbootie.com).

This medial pull will mildly stretch the adductor hallucis muscle as well as position the abductor hallucis for better intrinsic activation.

Final Key Tips & Pearls

A few additional paddings and modifications to inserts and shoes which may benefit your client include:

– Reverse Morton’s Extension

– Cluffy Wedge

– LA Pad & Varus Posting

Finally my last tips of advice:

– Please know why you are doing what you are doing.   I am seeing too much of cluffy wedge for everyone! and l don’t think everyone fully understands who and when this is the most appropriate.

– Remember sometimes it’s best to refer out.

– When in doubt get a copy of your client’s X-rays

To continue exploring this topic I encourage you to check out our upcoming FREE educational webinar on Wednesday August 19th at 9pm EST.   All webinars are recorded so if you cannot tune in live you will be sent the recorded version!    Sign up HERE

And finally – as always – remember to say #barefootstrong!

Dr Emily 

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Foot Function & Fascial Lines Series

Great Toe Mobility : The Linchpin to Movement Longevity | (Part 2 – Functional Assessment)

I am very happy to see the overwhelming response to yesterday’s Part 1 of 3 blog posts in our Great Toe Mobility series.

Based on the responses it seems like many of you are already considering the great toe and it’s mobility during your assessments – great job!  In today’s post we are going to review some of the most functional assessment techniques for the great toe as to ensure that we are all accurately and effectively assessing hallux dorsiflexion.

If you recall in Part 1 we emphasized the interconnection between great toe mobility, 1st ray stability and STJ position.   Remember this interconnection as we go through the below assessment techniques.   If you have not read Part 1 I highly recommend you reading it before proceeding to Part 2 – even if you think you know your great toe mobility.   Part 1 is HERE

Open Chain vs. Closed Chain Assessment  

When considering hallux dorsiflexion we always want to do both an open chain and a closed chain assessment.   Reason being that in the open chain assessment we are getting an idea of the joint integrity and are able to rule out any crepitus or arthritic changes that may be present in the joint.   Meanwhile in the closed chain assessment we are now factoring in functional stability of the foot to see if it allows maximum hallux dorsiflexion.  One should not be done without the other.

Step 1 – General 1st MPJ Appearance 

Morton's ToeAlways start by looking at the 1st MPJ non-weight bearing.

Do you see a bunion?   Depending on the size of the bunion this can greatly effect the integrity of the joint as well as alter push-off position.

Do you see spurring dorsally?   In the presence of arthritis and altered joint function, the body starts to create spurs or osteophytes along the dorsal aspect of the joint.

These are easiest seen on X-ray but you can often see them or palpate them along the dorsal joint line.   Depending on the degree of osteophytes they can begin to limit hallux dorsiflexion during push-off.

Step 2 – Joint IntegrityIMG_6745

Next you want to assess the health of the joint to determine if any arthritic changes are present.   By moving the toe up and down you are not only assessing mobility but are more so looking for the presence of crepitus or bone on bone.

In this step you also want to determine if there is limited dorsiflexion open-chain.   If there is a limitation in open chain dorsiflexion – you will surely see a limitation on closed chain!

Step 3 – Load the 1st Metatarsal

In Step 2 we are simply looking for joint integrity but not getting an accurate representation of functional hallux dorsiflexion.

If you look at the picture on the right you will see that as I am dorsiflexing thIMG_6748e hallux the 1st metatarsal head plantar flexes greatly.    This degree of plantar flexion is not possible when standing on the ground as it would be blocked by the ground when we walk.   This means that Step 2 assessment doesn’t really translate to closed chain dorsiflexion.
To get a more accurate representation of closed chain mobility you want to load the 1st metatarsal head like I am doing in the picture to the left.   This mimics the ground when closed chain.    Now dorsiflex the hallux and determine your mobility.

IMG_6750

Step 4 – Heel Rise Assessment

Next we want to have our client stand up and begin to compare the above findings with closed chain function.    The first assessment we want to look at is a heel rise.

Not only is this a great assessment for determining the foot’s ability to lock and become a rigid lever – but it also allows us to look at the client’s forefoot lever.

When coming up to a heel rise you are looking for the height the client is able to lift – as well as the ability to stay even across all 5 metatarsal heads of MPJs.

On the picture above I’d like to see this client stay a little more medial on the hallux during her heel rise.   This assessment finding will be compared to the gait assessment and walking push-off position below.

Step 5 – Walking Push-Off Position 

Walking push-off position and hallux dorsiflexion is probably the most important assessment you can do for the greIMG_6757at toe.   If a client has great hallux dorsiflexion in all other assessments but then doesn’t push-off properly – all other assessments are irrelevant.

Remember our goal is to optimize function – not just seeing if our client’s pass static assessments.

When walking we need a minimum of 30 degrees of hallux dorsiflexion.   If there is less than 30 degrees dorsiflexion – or the dorsiflexion isn’t occurring at the right time during the gait cycle – then compensation results.    The most common compensation is that we will see our client’s begin to assume what is called a low gear push-off position.

A low gear push-off position looks like the image to the right and is associated with an unlocked and unstable foot.   If you recall during push-off we need maximum foot rigidity to allow power output.   In Part 3 of 3 of this blog series we will be focusing on the low gear push-off.

Step 6 – Finger Under Toe / STJ Assessment 

I’m sure I could come up with a more technical name for this assessment but I think the “finger under the toe” is easiest to remember!   In this assessment I like to demonstrate to clients and professionals the impact that the STJ has on 1st ray stability and hallux dorsiflexion.

In the above client we saw through the different assessments that she had good dorsiflexion open chain with good joint integrity (no crepitus).    When we had her stand up though and do a heel rise we begin to see a deviation off of the body weight away from the hallux.   In addition during gait she assumed a low gear push-off position – all indicating a compromise in functional hallux dorsiflexion.

The next assessment we want to do as to determine if the limitation in hallux dorsiflexion is driven by a lack of 1st ray stability would be the finger under the toe test.    IMG_6753

Have the client stand with the feet in a relaxed calcaneal position.   In the case of our above client you can see that she is mildly pronating or in an unlocked position.   Remember that we ideally want to assess STJ position from behind – not anteriorly like in the picture to the right.

IMG_6755When the client is in this unlocked, relaxed position we then want to assess the hallux dorsiflexion by trying to put our finger under the great toe.   Advise the client to stay relaxed and to not fight or assist you in any way.

In the picture to the left you can see I can barely get my finger under her big toe.   This is an insufficient amount of hallux dorsiflexion.   We should be able to get the entire finger under the toe.

What you want to do next is put the foot in a neutral position.   This neutral STJ position will shift the 1st ray into a stable position and engages theIMG_6752 peroneus longus or spiral line which we learned in Part 1.

From here you want to re-assess the hallux dorsiflexion with the finger under the toe test.

IMG_6754 You can see in the picture to the left that stabilizing the STJ and 1st ray led to a large improvement in hallux dorsiflexion.

This assessment begins to guide my approach to this client.

My focus must go back to STJ stability and function if I ever want to optimize her hallux dorsiflexion during closed chain movements.

In Part 3 we will begin to explore the most effective programming to improve client hallux dorsiflexion.   Please remember that the above assessment techniques are designed to get your thinking.   They are not intended to be a be all end all to diagnosis of great toe dysfunction.    A complete great toe assessment would also include images such as X-rays so that we can get a true perspective on joint health.

To prepare for tomorrow’s Part 3 of 3 blog post you may view a recent video I created where I begin to discuss high gear vs low gear push-off positions seen below – as well as sign up for a FREE educational webinar I am doing on Weds August 19th at 9pm EST available – HERE

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