At 20:54 17/02/01 EST, you wrote:
>Is the ruptured fascia caused by Windlass dysfunction?
Chicken or egg?
Taylor + Stainsby used MRI on 12 consecutive DM's with claw toes and
sensory neuropathy and a control group ... all the DM's had a ruptured
plantar fascia, so I suspect that this is part of the so called 'intrinsic
mius foot'. I was sitting next to Peter Cavanagh at the conference when
Stainsby presented this and his other ideas on foot function (Leeds
plantar pressure mtg) and we nearly fell off our chairs wondering who this
crankpot was ... after considering his work, ideas and thinking about it,
it certainly is innovative thinking on the pathogenesis of a whole range of
foot pathology and lead us to reveiw his ideas in the AJPM paper.
Stainsby's new book is called 'The Foot: A New Approach in Structure &
Function' and is due out this month ... apparently.
We used Jack's test in the midfoot charcot's and a neuroathic control
group. None of the Charcot's repsonded to Jack's test. Subsequent
ultrasounds confirmed either no plantar fascia or 10 times thicker than
normal (very dysfunctional). I still remeber the shock that we and the
radiologist had on the first patient ... the posterior part of the plantar
fascia was there, but from the midfoot forward, it was non-existant!!!!! -
we could not find it!!!! ...again - the chicken or the egg? this work is
about to be published in Diabetic Medicine.
Based on this work, I would suggest that all DM's with sensory neuropathy
should have Jack's test regularly performed on them as a screening measure
to pick up those at increased risk for Charcot's and, at the very least,
bang them into foot orthoses (or even casts) to prevent Charcot's (if that
is possible).
>Has anybody linked ruptured fascia (and windlass) to foot ulceration?
No
>I would say from my experience that the main perception in the UK diabetes
>foot world from journals and conferences is that foot ulceration is caused by
>neuropathy + deformity + trauma
Yes it probably does, but what caused the deformity - what about dynamic
function??? Was it not Einstein (or somebody else who is famous) that said
something like ... "to be a good scientist you have to think for at least
1/2 an hour a day differently to everyone else" ...
>Windlasses are not something that get aired.
should do - windlass needs first MPJ dorsifexion, but DM's have LJM of
first MPJ. Windlass also needs some sort of structural integrity of
collagen etc in plantar fascia, but in DM its affected by glycation - this
is probably why Stainsby and us found so many with ruptures in the DM's.
> Biomechanics in diabetes simply does not get promoted other than by
>people such as Peter Cavenagh.
I had paper in JAPMA two years ago on biomechanics in DM foot
>So, a well fitting shoe with a total contact insole and maybe a rocker sole
>is the perceived goal by most of the diabetic foot world. How does this tie
>in with windlass theories?
PERFECTLY. Cavanagh's group showed that rocker sole reduced pressure under
first MPJ (hence its effeectiveness), BUT increased pressure under the
lateral side of the forefoot.... my explanation is that as the rocker sole
prevented first MPJ dorsiflexion and hence windlass establishment. This
prevented the first met head from taking its full share of weight (hence
the pressure reduction) ... this pressure has to go somewhere, so it went
to the lateral side of the foot (hence the pressure increase under the
lateral side of the foot reported by Cavanagh's group with the use of
rocker soles)
We are currently writing up a paper that found exactly the same plantar
pressure pattern in new running shoes (ie the initial stiffness of the
running shoe prevented windlass from working due to restricted motion of
first MPJ from stiff sole - we found increased lateral pressure with the
new shoe compared to the same shoe at one or so months after the sole was
less stiff and assume that MPJ working better after the shoe became more
flexible) ... at least that my theory.
Kind Regards
CP
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Craig Payne email: [log in to unmask]
Department of Podiatry phone: (+61)(3) 9479 5820
School of Human Biosciences fax: (+61)(3) 9479 5784
Faculty of Health Sciences mobile: (+61)(0419) 103327
LaTrobe University
Bundoora, Vic 3083
http://www.health.latrobe.edu.au/Schools/POD/home.html
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