Addressing big toe mobility. A fundamental feature of the foot, often missed in
our assessments is first toe mobility. Specifically the metatarsophalangeal joint.
The first MTP joint should be able to extend as much as 65 degrees, but many people
lack full range of motion due to osteoarthritis or injury. During the stance phase of gait,
our toes dorsiflex to help raise the arch and provide greater shock absorption.
As the arch flattens, the toes, plantar fascia, and associated muscles eccentrically contract
via the windlass mechanism, shown here. This action helps spring the person forward with
greater propulsion during push off. However, it only works when there’s big-toe mobility.
So in this demonstration we're going to begin by bracing the
metatarsal bones with my right hand, my left hand is going to come in and come on top and
bring it into plantar flexion first. Checking the amount of plantar flexion.
Distracting and bringing it into dorsal flexion for extension. Checking for any kind of grinding
sound, pain provocation or just lack of range of motion. So here we go. Opposite foot. Got
to make sure that you maintain that brace with your right hand so you get an accurate reading.
After we do dorsal flexion, plantar flexion, we're going to side bend and rotate at the same time. A
little bit of rotation in there, side bending, checking for grinding sound, pain provocation,
and/or range of motion loss. Now I'm translating. Notice how it goes back and forth with the
counterforce between the two hands. Coming back over to the left foot, grasping metatarsal
joint there and back and forth, back and forth. Side bending first, side bending, rotating,
a little bit of distraction and then translation. This really implicates osteoarthritis,
that maneuver there. Now I'm just going to check for joint play between the metatarsals. It's a
good idea just to go through here and see if you have any restrictions and joint play. I'm going
to come over in the final thing I'm going to do is AP joint glide. Anterior Posterior joint
glide of all the metatarsals. Notice how I've got my palm around all of them, so it's up and back,
up and back. It's like translation, but it's forward and back. AP joint glide. Very important.
Now let's assess for metatarsal movement on the cuneiforms. At the tarso-metatarsal joint line.
So notice how I'm just side bending and rotating a little bit, grasping the cuneiforms,
the distal cuneiforms, proximal metatarsals, and just putting a twisting force through there,
rotating, translating, whatever you want to do through there. Just a movement back-and-forth
to see if there is mobility between the metatarsals and the distal cuneiform bones.
We're going to look at the Cubiod on the outside, now. And the Navicular on the inside. It's very
important for those joints to be moving because of the arches. We want to make sure we have a
lateral and a medial arch, so here we go. I'm bracing at the Navicular bone and Cuboid
and translating, rotating, and side bending to try to check for mobility.
Now for Moton's Neuroma, we mentioned that earlier. If the metatarsals are
squashing the little nerves in there, between the toes, we can get irritation,
inflammation, and pain on the - usually on top of the foot. So, all you do is just squeezing force
on top and if there's pain reported primarily on the top, that's a Morton Neuroma problem.