Ralph;
You wrote;
> During static loading as you describe you may find a limit in the range of
hallux dorsiflexion but this has no relationship to the position in active
gait.
How does this static measure have no relationship to the positioin in active
gait? The foot during midstance will be in the exact same position as in
static stance, though the moments and foreces on the foot in general, and
the 1st ray specifically may be very different from patient to patient.
I agree with Craig that patients not only vary with the available ROM on
the FnHL test, but also on the amount of force needed to overcome any
tendency to the 1st mpj locking up.
I feel it is also important to realize that often the 1st mpj, as you
described, will not extend until the knee begins to flex, and the
contralateral limb has made contact, and more often than not move towards
midstance. This is much different than we have generally been taught re:
the gait cycle. This is an observation easily made w/ video.
Static measurements are useful to pick up pathomechanical tendencies.
They are not absolute. Finally, Re: Gareth's idea of a shoe for measurement
of the available motion, consider the use of in-shoe pressure devices, such
as F-scan. You may not be able to calculate actual changes in kinematic
motions, but you can objectively substantiate changes in kinetic changes of
the postion and timing of the CoP and other pressure variables.
Sincerely;
Bruce Williams, D.P.M.
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