Transcript Sagittal Plane Fascilitation of motion

Les4 : De Voorvoet : Sagittal plane
fascilitation of motion.
‘Functionele Hallux Limitus Test’
Functionele hallux Limitus
Wat je moet weten of opzoeken
Achtergrond
Wat is het (niet)?
Uitganghouding patiënt
Uitgangshouding therapeut
Parameters
Hoe waarde toekennen?
Interpretatie
Compensatie ‘sagitaal blok’
Literatuur
Wat je moet weten of opzoeken
 Achtergrond van Sagittal Plane Fascilitation of
motion.
 Wat is betrouwbaarheid?
 Wat is validiteit?
 MTP 1: Soort gewricht? ROM? Beweging?
Sagittal plane fascilitation of motion
Principles this theory is based on:
 The foot must be able to resist forces that are applied
to it.
 This must co-ordinate with the power input which is
required to move the body forward over the foot.
 The foot has its 3 autosupportive mechanisms
- Dananberg,
- Dananberg,
- Dananberg,
H.: Functional
H.: Gait
H.:Style
Functional
Hallux
as an
Limitus
Etiology
Hallux
and
Limitus
toits
chronic
effect
andPostural
on
itsnormal
relationship
Pain,
ambulation.
part
to 1Gait
functional hallux limitus. JAPMA
Current
Efficiency.
Vol.83,
Podiatric
Augustus,
JAPMA
Medicine
1993.
Vol.76,34,
November,
pp.1-16, 1986.
1985.
Sagittal plane fascilitation of motion
Autosupport 1:
Hicks (1954): Windlass Mechanism
- Dananberg,
H.: H.:
GaitChronic
Style asLow-Back
an Etiology
Chronic
Postural to
Pain,
Part II , postural
- Dananberg,
Paintoand
its Response
custom-Made
Foot
compensatory process.
JAPMA
Vol.83,
November,
199.
Orthoses.
JAPMA
Vol.89,
maart, 1999.
 Plantaire fascia spant aan
 Voetboog komt omhoog
 Tibia gaat exo roteren
 Calcaneum gaat inverteren
Autosupport : Hicks et al. (1954)
Sagittal plane fascilitation of motion
Autosupport 2:
Bösjen-Mollor (1979):
- close packing of calcaneocuboid joint
- high gear/low gear push off
- Lee, W.E.: Podiatric Biomechanics: An Historical appraisal and Discussion of the Root Model as a
- - Bojsen-Moller
F.:
Calcaneocuboid
joint andofstability
of the
longitudinal
arch ofofthe
foot at
- Payne,
CB.:
Sagittal
Plane
the
foot.
Australasian
Journal
Clinical
System
of Approach
in the Facilitation
Present Context
of Theoretical
Uncertainty.
Clinics inPodiatric
podiatric
high and low gear push
off. Journal of Anatomy
129(1),31,
pp.165-176.,
1979.
pp.October
7-11, 1997.
Medicine and Surgery 18Medicine
(4), pp. 555-685,
2001.
Sagittal plane fascilitation of motion
Autosupport 3: Locked Wedge Effect
 Posterior Tibial muscle and Peroneus Longus keep the base
together.
 The shape of the bones in the midfoot are more or less
trapezium shaped.
 In function it will support itself…
Sagittal plane fascilitation of motion
Autosupport 3: Locked Wedge Effect
 Posterior Tibial muscle and Peroneus Longus keep the base
together.
Uitgangshouding patiënt
Onbelast
Belast
Uitgangshouding Therapeut
 Zittend, voor de voet van de patiënt
 Knielend voor de voet van de patiënt
Differentiaal diagnose :
Hallux Rigidus = structureel
Hallux Limitus = structureel
Functionele Hallux Limitus = functioneel
RX : Hallux Rigidus = géén mobiliteit
Parameters
 Extensie mogelijkheid, open kinetische keten.
 Extensie mogelijkheid mét en zonder weerstand
van de therapeut.
 Extensie mogelijkheid mét en zonder weerstand
van de GRK
Interpretatie
Positive functional hallux limitus test
 A: A load is applied to the first
metatarsal head to simulate ground
reaction force.
 B: As dorsi flexion of the toe is
attempted, there is a jamming at
the first metatarso phalangeal joint.
Interpretatie
Negative functional hallux limitus test
 A: Plantar flexion of the first
metatarsal.
 B: Stability of the arch is achieved
through the windlass mechanism
once dorsiflexion of the first MTP
joint is achieved
Compensaties voor ‘sagitaal blok’
1. Veranderde hiellift
 Vertraagd (Mid foot brake/collaps)
 Afwezig gedurende ‘single support phase’
2.
3.
4.
5.
Verticale Toe Off
Geïnverteerd stappatroon
Geabduceerd stappatroon
Flexie compensatie
van het lichaam
Clinical pearls
clinical pearl : een korte, straightforward, stukje klinisch advies
By Mark Russel
Clinical pearls
clinical pearl : een korte, straightforward, stukje klinisch advies
By 1ste podo 
Clinical pearls
clinical pearl : een korte, straightforward, stukje klinisch advies
By 1ste podo 
Literatuur
 Dananberg HJ. Gait style as an etiology to chronic postural pain. Part 1. Functional
hallux limitus. J Am Podiatr Med Assoc 1993;83(8):433-441
 Payne C, Chuter V, Miller K. Sensitivity and specificity of the functional hallux limitus
test to predict foot function. J Am Podiatr Med Assoc 2002;92(5):269-271
 Dananberg HJ. Sagittal plane biomechanics. In: Subotnick SI, ed. Sports Medicine of
the Lower Extremity. New York: Churchill Livingstone;1999:137-156
 Van Gheluwe B, Dananberg HJ, Hagman F, Vanstaen K. Effects of hallux limitus on
plantar foot pressure and foot kinematics during walking. J Am Podiatr Med Assoc
2006;96(5):428-436
 http://www.vasylimedical.com/pdf/VasyliMedical%20Functional%20Hallux%20Limitu
s_PF.pdf