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  1. #1
    Join Date
    Dec 2015
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    Wilton Street Glasgow
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    Windlass mechanisms - plural - and diabetes

    These are extracts from a thread I have posted on Podiatry Arena . Any comments welcome .

    Post 1

    So during the gait cycle the windlass mechanism is engaged and reversed twice . Going from heel strike to heel strike we have windlass , reverse windlass , windlass and then reverse windlass at toe off . Yes ?


    Post 2

    So in this short clip we have windlass ,reverse windlass ,windlass ,reverse windlass ?

    Haile Gebrselassie slowmotion left barefoot - YouTube

    ▶ 1:04
    https://www.youtube.com/watch?v=Tek2JuRcO_w
    6 Oct 2014 - Uploaded by Light Feet Running / Le Guide du Crawl Moderne
    20kms de Paris 2017 : au ralenti, le passage de coureurs à 15km/h (4'/km) - Duration: 8:18. Light Feet Running ...


    Gerrard Farrell

    Glasgow



    Post 3

    So with regard to the above , the toe extensors contribute to arch stiffness during early stance by dorsiflexing the hallux and lesser toes and tensioning the plantar fascia . As stance progresses and ground reaction forces build , it seems likely that the prestrike , dorsiflexed position of the hallux/lesser toes will allow the plantar fascia and plantar intrinsics to load over a greater period of time reducing the stresses to which these tissues are subjected and so reducing the chances of plantar fasciitis developing .
    Question .Can the first of the two windlass cycles during gait be significantly inhibited by footwear ?



    Post 4



    So the extensors contribute to foot stiffness .

    In the case of a foot with intrinsic foot muscle atrophy caused by diabetic neuropathy , the foot likely becomes a less effective lever during gait , especially during late stance . Thus the musculo/neural/skeletal system may , through the information received by proprioception inputs , slowly adapt to the changing capabilities of the foot by causing gait to be altered in such a way as to reduce the work load of the forefoot during toe off . Hence a high stepping gait or a shuffling gait may develop .

    However , I believe it is plausible that intrinsic muscle atrophy may also , in part , be compensated for by increased activity of the external toe EXTENSORS . Increased use of the toe EXTENSORS would tension the plantar fascia during midstance and late stance giving a more rigid lever and more proximal plantar pressures during these phases of stance .

    Using the extensors in this way may lead to permanent extension of the proximal phalanges of the hallux and lesser toes , giving rise to cocked /claw toes . The fat pad under the met heads would migrate distally giving rise to pressure problems and ,over time the entire forefoot may start to curve upwards .

    A cavus foot would also likely develop as the plantar fascia is tensioned by the extrinsic toe EXTENSORS to compensate for reduced plantar intrinsic input .

    Could all of this be greatly helped by a podiatrist led ,conservative approach to the intrinsic foot muscles using an appropriately prescribed and supervised progressive resistance exercise program ?

    Back to Dr Karen Mickle and her trial . "Evaluating a foot strengthening exercise program to improve foot function and foot health in older adults with diabetes"

    What do you think ?

    Regards
    Gerry


    Gerrard Farrell

    Last edited by Gerrard Farrell; 04-12-2018 at 02:10 PM. Reason: EXTENSORS in capitals . not flexors . typo

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