The Gait Guys

October 19, 2015 October 19, 2015/ The Gait Guys

Dr Ivo, talking about some of the finer points on the “Toe Waving” exercise

September 07, 2012 September 07, 2012/ The Gait Guys

The Toe Waving Exercise, Part 2

In part one of this series, we talked about the importance of the short flexors of the toes (FDB or flexor digitorum brevis) in forming and maintaining the foot tripod. In this installment, we discuss another important muscle used in this exercise, the extensor digitorum longus (EDL).

We have shown you time and time again, dominance of the long flexors in gait, which cause biomechanical imbalances. We remember that through reciprocal inhibition, the log flexors will reciprocally inhibit the long extensors, so increased activity in the former, means decreased activity and activation in the latter.

The balanced activity of the long flexors and long extensors helps to create harmony during gait. Working the long extensors with this exercise (along with others, like tripod standing, toes up walking and the shuffle gait exercises) helps one to achieve this balance.

The Gait Guys; promoting foot and gait competency every day here, on Youtube, Facebook, Twitter, and in our offices and yours.

all material copyright 2012 The Homunculus Group/The Gait Guys. All rights reserved. If you rip off our stuff, you will never have an adequate foot tripod and will have gait problems for the remainder of your days.

September 04, 2012 September 04, 2012/ The Gait Guys

The Mighty Extensor Digitorum Longus (EDL): a pedograph case.

We have long been promoting appropriate function of the long extensors of the toes (predominantly the EDL, but also the Extensor hallucis longus) here, in our practices, our lectures, on Youtube, in our book……You get the idea. Lets tale a closer look at this muscle (picture left above)

The EDL has a proximal attachment in the lower leg up at the condyle of the tibia, proximal fibula, the interosseus membrane, and the connective tissues between the muscles. It travels down the leg, under the extensor retinaculum and attach to the base of the distal phalanges of toes 2-4. These muscles act from initial contact (to help eccentrically lower the foot to the ground), loading response (to continue to lower the foot slow or attenuate pronation), midstance and terminal stance (to provide compression of the metatarsal phalangeal and interphalangeal joints, and to offset the long flexors (which are often overactive, due to flexor dominance)).

What does it look like when the long extensors don’t work so well? Have a look at the pedograph on the right. what do we see? First we notice the lack of printing under the head of the 1st metatarsal and increased printing of the second metatrsal head. Looks like this individual has an uncompensated forefoot varus (cannot get the head of the 1st metatarsal to the ground, and thus a weak medial tripod). Next we see increased printing of the distal phalanges of digits 2-4. Looks like the long flexors are dominant, which means the long extensors are inhibited. What about the lack of printing of the 5th toe? I thought the flexors were overactive? They are, but due to the forfoot varus, the foot is tipped to the inside and the 5th barely contacts the ground!

How do you fix this?

Help make a better foot tripod using the toe wave, tripod standing and extensor hallucis brevis exercises. Make sure the articulations are mobile with joint mobilization, manipulation and massage. Make sure the knee and hip are functioning appropriately. Give the client lots of homework and put them in footwear that will allow the foot to function better (a less rigid, less ramp delta shoe). As a last resort, if they cannot make an adequate tripod (because of lack of motivation or anatomical constraints), use a foot leveling orthotic.

Ivo and Shawn. Two guys, making a difference, every day.

August 31, 2012 August 31, 2012/ The Gait Guys

The Toe Waving Exercise: Part 1

Welcome to Friday, Folks. A little exercise here for you today that we use all the time.

There are at least 3 muscles important in forming and maintaining the foot tripod. The short flexors of the lesser digits (Flexor Digitorum Brevis or FDB) are one of the important component sfor creating and maintaining the foot tripod (the tripod between the head of the 1st metatarsal, head of 5th metatarsal and center of calcaneus).

It arises by a narrow tendon from the medial process of the calcaneal tuberosity the plantar aponeurosis, and from the connective tissue between it and the adjacent muscles. As it passes forward, and divides into four tendons, one for each of the four lesser toes which divide into 2 slips ( to allow the long flexor tendons to pass through), unite and divides a second time, inserting into the sides of the second phalanx.

Because the axes of the tendons passe anterior to the metatarsal phaalngeal joint (MTP), they also provide an upward (or dorsal) movement of the MTP joint complex, moving it posterior (or dorsal) with respect to the 1st metatarsal heal (thus functionally moving the 1st met head “down”). This is a boon for people with a forefoot varus, as it can help create more mobility of the 1st ray, as well as help descend the head of 1st ray to form the medial tripod (and assist the peroneus longus in anchoring the base of the big toe). It also helps the lumbricals to promote flexion of the toes at the MTP, rather than the distal interphalangeal joint.

In this brief video, Dr Ivo explains the exercise to a patient (Thank you N, for allowing us to use this footage).

The Toe Wave: try it. Use it with your patients. Spread the tripod. We know you want to….

Ivo and Shawn