‘Functionele Hallux Limitus Test’ Les4 : De Voorvoet : Sagittal plane fascilitation of motion. ‘Functionele Hallux Limitus Test’

Functionele hallux Limitus Wat je moet weten of opzoeken Achtergrond Wat is het (niet)? Uitganghouding patiënt Uitgangshouding therapeut Parameters Hoe waarde toekennen? Interpretatie Compensatie ‘sagitaal blok’ Literatuur

Wat je moet weten of opzoeken Achtergrond van Sagittal Plane Fascilitation of motion. Wat is betrouwbaarheid? Wat is validiteit? MTP 1: Soort gewricht? ROM? Beweging?

Sagittal plane fascilitation of motion Principles this theory is based on: The foot must be able to resist forces that are applied to it. This must co-ordinate with the power input which is required to move the body forward over the foot. The foot has its 3 autosupportive mechanisms - Dananberg, H.: Functional Hallux Limitus and its effect on normal ambulation. Current Podiatric Medicine 34, pp.1-16, 1985. - Dananberg, H.: Functional Hallux Limitus and its relationship to Gait Efficiency. JAPMA Vol.76, November, 1986. - Dananberg, H.: Gait Style as an Etiology to chronic Postural Pain, part 1 functional hallux limitus. JAPMA Vol.83, Augustus, 1993.

Sagittal plane fascilitation of motion Autosupport 1: Hicks (1954): Windlass Mechanism - Dananberg, H.: Chronic Low-Back Pain and its Response to custom-Made Foot Orthoses. JAPMA Vol.89, maart, 1999. - Dananberg, H.: Gait Style as an Etiology to Chronic Postural Pain, Part II , postural compensatory process. JAPMA Vol.83, November, 199.

Plantaire fascia spant aan Voetboog komt omhoog Tibia gaat exo roteren Calcaneum gaat inverteren Autosupport : Hicks et al. (1954)

Sagittal plane fascilitation of motion Autosupport 2: Bösjen-Mollor (1979): close packing of calcaneocuboid joint high gear/low gear push off - Lee, W.E.: Podiatric Biomechanics: An Historical appraisal and Discussion of the Root Model as a Clinical System of Approach in the Present Context of Theoretical Uncertainty. Clinics in podiatric Medicine and Surgery 18 (4), pp. 555-685, October 2001. - - Bojsen-Moller F.: Calcaneocuboid joint and stability of the longitudinal arch of the foot at high and low gear push off. Journal of Anatomy 129(1), pp.165-176., 1979. - Payne, CB.: Sagittal Plane Facilitation of the foot. Australasian Journal of Podiatric Medicine 31, pp. 7-11, 1997.

Sagittal plane fascilitation of motion Autosupport 3: Locked Wedge Effect Posterior Tibial muscle and Peroneus Longus keep the base together. The shape of the bones in the midfoot are more or less trapezium shaped. In function it will support itself…

Sagittal plane fascilitation of motion Autosupport 3: Locked Wedge Effect Posterior Tibial muscle and Peroneus Longus keep the base together.

Uitgangshouding patiënt Onbelast Belast

Uitgangshouding Therapeut Zittend, voor de voet van de patiënt Knielend voor de voet van de patiënt

Differentiaal diagnose : Hallux Rigidus = structureel Hallux Limitus = structureel Functionele Hallux Limitus = functioneel

RX : Hallux Rigidus = géén mobiliteit

Parameters Extensie mogelijkheid, open kinetische keten. Extensie mogelijkheid mét en zonder weerstand van de therapeut. Extensie mogelijkheid mét en zonder weerstand van de GRK

Interpretatie Positive functional hallux limitus test A: A load is applied to the first metatarsal head to simulate ground reaction force. B: As dorsi flexion of the toe is attempted, there is a jamming at the first metatarso phalangeal joint.

Interpretatie Negative functional hallux limitus test A: Plantar flexion of the first metatarsal. B: Stability of the arch is achieved through the windlass mechanism once dorsiflexion of the first MTP joint is achieved

Compensaties voor ‘sagitaal blok’ Veranderde hiellift Vertraagd (Mid foot brake/collaps) Afwezig gedurende ‘single support phase’ Verticale Toe Off Geïnverteerd stappatroon Geabduceerd stappatroon Flexie compensatie van het lichaam

Clinical pearls clinical pearl : een korte, straightforward, stukje klinisch advies By Mark Russel

Clinical pearls clinical pearl : een korte, straightforward, stukje klinisch advies By 1ste podo 

Clinical pearls clinical pearl : een korte, straightforward, stukje klinisch advies By 1ste podo 

Literatuur Dananberg HJ. Gait style as an etiology to chronic postural pain. Part 1. Functional hallux limitus. J Am Podiatr Med Assoc 1993;83(8):433-441 Payne C, Chuter V, Miller K. Sensitivity and specificity of the functional hallux limitus test to predict foot function. J Am Podiatr Med Assoc 2002;92(5):269-271 Dananberg HJ. Sagittal plane biomechanics. In: Subotnick SI, ed. Sports Medicine of the Lower Extremity. New York: Churchill Livingstone;1999:137-156 Van Gheluwe B, Dananberg HJ, Hagman F, Vanstaen K. Effects of hallux limitus on plantar foot pressure and foot kinematics during walking. J Am Podiatr Med Assoc 2006;96(5):428-436 http://www.vasylimedical.com/pdf/VasyliMedical%20Functional%20Hallux%20Limitus_PF.pdf