Curly toes?

-We have all seen them. We like them, we hate them, we despise them, we scratch our heads.

-The question becomes why?

-it’s pretty obvious from the picture that there is dominance of the flexor muscles and not enough intrinsic strength in the extensor muscles. Look at the prominence of the extensor tendon‘s and posturing of the toes.

– Flexor dominance occurs essentially because of too much activity in the central nervous system, particularly the lower brainstem, over activating the flexors and shutting down (reciprocally inhibiting) the extensors.

-This doesn’t necessarily mean that it is a neurological problem however the nervous system is what’s driving the bus here. Extensor tone is largely regulated by the cerebellum and vestibular system with the flexor tone being regulated by the cortex as well as lower, sub cortical systems.

– The cerebellum and vestibular system get the majority of their input from joint and muscle And joint mechanoreceptors as well as the vestibular apparatus. Their output is predominantly to axial extensor muscles as well as muscles which would be directly affected, from a gravitational standpoint, from those systems as well.

– When we don’t have enough afferent information traveling in from these systems, the flexor systems have a tendency to predominate. Think about protective posture’s and DNS work.

Driving the extensors and working on posture/balance/coordination and perhaps long, sustained stretching of the flexor musculature can help to end the bane of curly toes. 

–so let’s go ahead and make those feet, lower extremity, lower kinetic chain muscles and joints and core more competent and help these folks out.

#curlytoes #flexordominance #toeproblem #toeproblems #footproblem #footproblems 

What's wrong with the big toe on the right?

So this is what happens when you don’t wear the right shoes as a kid…

This woman came into the office with lower back pain. Do you notice anything peculiar about her feet?

She said that when she was young she was told by the doctor she was “dink toed” and given special shoes (on a sidenote, she has bilateral external tibial torsion and no evidence of forefoot adductus) . The shoes evidently (according to the doctor) were too tight and caused the deformity that you see here. She stated that the shoes were extremely painful while wearing them and then for quite a while when she stopped. This is always been her “problem foot“ with limited toe dorsiflexion and ankle dorsiflexion on that side.

Notice how the distal phalanx of the Halex is stunted and it’s with is increased. Dorsiflexion at the MTP is limited with respect to the other side and dorsiflexion flexion at the IP is limited as well. It appears that the growth plate was damaged resulting in a hypo plastic digit which, due to insufficient length, transfers a lot of weight during terminal stance and preceding ( at the end of her gait cycle, preparing for propulsion) to the second metatarsal head where she gets moderate discomfort.

We can increase the motion of the first ray with mobilization and exercise but unfortunately we are not able to lengthen her digit.

Growth plates are fragile things and what we do to children early on can have a profound impact upon their adult life.
footproblem #toeproblem #hallux #halluxdeformity #bigtoe #gait #gaitanalysis #footexam