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Monday, August 11, 2008

Functional hallux limitus 

I am privileged with the honour of being invited to speak at many conferences. Most recently was at the Podiatric Surgeons conference. When I agreed to speak, I did not think to much about about the topic until I was back from another conference, then I had a OMG why did I agree to talk about that moment ? What the hell am I going to say?

One reason I enjoy speaking at conferences is that it forces me to organise my thoughts and "put them on the line", so I thought I would try and take our traditional understanding of first MPJ dysfunction (ie hallux rigidus; structural and functional hallux limitus) and the windlass dysfunctions (ie no windlass; delayed windlass; high force to establish; disruption during loading) and reconceptualise them in the framework of the mechanical engineering terms of 'stiffness'.

While going through the dot points, I got struck by something: All functional hallux limitus really is, is a temporary increase in the dorsiflexion stiffness of the first MPJ ! It got the thought processes going. (I have written about it here: Reconceptualising Functional Hallux Limitus)

Traditionally we have considered FnHL as being present or absent, when in reality it probably exists on a continuum. If we conceptualise it as a temporary increase in first MPJ stiffness, it then opens the possibility of grading functional hallux limitus (ie a low temporary increase in first MPJ stiffness to a high temporary increase in first MPJ stiffness). Maybe we can measure this !

Should we reconceptualise FnHL as a temporary increase in first MPJ stiffness? What say you?

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