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  1. #1
    Join Date
    Dec 2015
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    Wilton Street Glasgow
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    64

    Footwear as a cause of pathology

    During gait we have two windlass phases ,the initial windlass phase and the second windlass phase . Generally speaking , shoes are designed not to interfere with the second windlass phase but I believe that most do interfere with the " initial windlass phase of gait " . This interference may lead to a number of pathologies including shin splints and plantar fasciitis and ,in my opinion , these conditions may well persist for as long as the footwear is used .

    Recap on initial windlass phase of gait - ( for fuller explanation of " initial windlass phase of gait " see link 1 )

    The initial windlass phase of gait (IWPG) occurs during the swing phase of gait and during weight acceptance . The mechanism involves the dorsiflexion of the toes before foot strike , which winds the plantar fascia around the MTFJ s and then passive plantar fexion of the toes ,against the eccentrically contracting toe dorsiflexors during weight acceptance ,and the progressive " paying out" of the wound plantar fascia , rather like line being pulled off a fishing reel against the drag . This mechanism allows the forces generated during weight acceptance to be spread over a significantly longer time period than would otherwise be the case ,thus protecting the plantar tissues of the foot from damaging levels of peak force .


    Shin splints -

    Shoes which inhibit the dorsiflexion of the toes by the toe extensors , during the swing phase of gait , can cause these muscles to have to work harder than would otherwise be the case leading to overuse and shin splints .



    Plantar fasciitis - ( from posts of mine in Pod arena )

    My understanding is that clogs are a common choice of footwear amongst nurses . I believe that shoes which require that the toes be pressed down against the sole of the shoe to hold the heel in place during the swing phase of gait , may habituate suppression of the initial windlass phase of gait ,causing unnecessary stresses on the plantar foot structures during gait , leading perhaps to plantar fasciitis .

    Consider a nurse , male or female , getting home from a hard day around the hospital , performed wearing a clog type shoe with no heel restraint . The nurse's feet and legs are sore and they are glad to get in and put on their slippers ........which have no heel restraint!

    . The feet are again obliged to planter flex the toes during the swing phase of gait to keep the slippers on , which in my opinion should not be encouraged as it suppresses the initial windlass phase of gait .

    Ok , its a day off and our nurse goes for a run . No initial windlass phase , strain on the plantar fascia giving plantar pain , and 40 years of struggle begin .
    And over all those years , in the corner of the room , sit the clogs , the backless slippers , and the restrictive running shoes .


    Link 1

    Windlass mechanisms - plural - and diabetes - Biomch-L

    https://biomch-l.isbweb.org/threads/31054-Windlass-mechanisms-plural-and-diabetes


    2 Mar 2018 - 8 posts - ‎1 author
    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



    Gerrard Farrell

    Glasgow


    Last edited by Gerrard Farrell; 06-25-2018 at 04:10 AM.

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