The afferent information collected by your feet is critical to the overall balance and motion of your body. Without this important information making its way unimpeded to your brain due to improper functioning of the joints within your feet, a whole number of issues can arise. Poor posture, inability to balance or walk properly (especially over irregular surfaces), subluxations of joints going up the kinetic chain from the foot to the knee and low back, and chronic degeneration of the spine and knees are some of the effects.
Jonathan Hooker
Techniques within chiropractic often have an above-down philosophy, although there are also some that have a bottom-up philosophy when it comes to analyzing and correcting subluxation. Typically, the bottom-up philosophies start from the sacrum as opposed to the feet. The exclusion of extremities when assessing the body for subluxation can be a critical omission when analyzing your patients, depending on what it is they need. Oftentimes you can get by without assessing the lower extremities, but for those critical patients who have problems in their feet, recurring subluxations that do not seem to resolve further up in the body or stabilize could be corrected by addressing the feet, knees, and femoro-acetabular joints.
Bunions, knee pain, and low back pain are common when the Windlass mechanism is not functioning and the foot is not working properly (1). If the foot is not able to appropriately shorten and proper extension of the big toe does not occur, the individual’s gait tends to alter such that the foot flairs outward so the individual rolls over the inside of the foot. Also, plantar fasciitis can develop from the plantar fascia being chronically stretched, leading to a lot of pain and further complicating the case and care.
Vallotton et al. describe the importance of preserving the motion of the foot and the proposed mechanism behind functional hallux limitus/rigidus (FHL) as a “tenodesis effect” on the flexor hallucis longus tendon at the retrotalar pulley (1). The tenodesis effect is where the tendon becomes fixated, preventing the proper extension of the hallux and leading to FHL, and ultimately dysfunction of the windlass mechanism. They suggest a maneuver called the “Hoover cord maneuver,” where you hold the foot by the heel and forefoot, distract inferiorly, then gently sway the foot in a valgus and varus motion listening for an associated “popping” sound. They note that this maneuver recovers the hallux extension, restoring the Windlass mechanism in the foot. I find this an interesting approach to remedying FHL, especially how similar it is to what chiropractors do to restore the Windlass mechanism function when it is diminished or lost.
Santilli et al. demonstrated the reduced activation time of the peroneus longus muscle during the stance phase of the gait cycle after an ankle injury causing ankle instability (2). This follows directly what we find when there is an antalgic behavior due to an inactivation of a muscle or muscles when a bone is out of place, often as a result of some form of trauma. In this paper, they do not attribute the muscle inactivation to a particular cause, only that ankle instability exists, leaving chiropractors with a good place to contribute to the literature in regard to antalgic behavior.
The importance of a properly functioning joint is paramount to minimize antalgic behavior due to muscle inactivation and malalignment of the bones. Vallotton et al. and Santilli et al. (1,2), as well as others (3,4) have illustrated the effects of these deficiencies, making it clear why they should be treated. Strongly consider this when analyzing your patients, especially if they are not improving after a week or three!
This article first appeared in the February 2020 issue of Lifelines, the Life West student magazine.
References
- Vallotton J, Echeverri S, Dobbelaere-Nicolas V. Functional hallux limitus or rigidus caused by a tenodesis effect at the retrotalar pulley: Description of the functional stretch test and the simple hoover cord maneuver that releases this tenodesis. J Am Podiatr Med Assoc. 2010;100(3):220–9.
- Santilli V, Frascarelli MA, Paoloni M, Frascarelli F, Camerota F, De Natale L, et al. Peroneus longus muscle activation pattern during gait cycle in athletes affected by functional ankle instability: A surface electromyographic study. Am J Sports Med. 2005 Aug;33(8):1183–7.
- Ergen E, Ulkar B. Proprioception and Ankle Injuries in Soccer. Vol. 27, Clinics in Sports Medicine. 2008. p. 195–217.
- Hertel J. Sensorimotor Deficits with Ankle Sprains and Chronic Ankle Instability. Vol. 27, Clinics in Sports Medicine. 2008. p. 353–70.