Materiały źródłowe

• #1 Understanding the nature and mechanism of foot pain

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2631512/

  Currently, the nature and mechanism underlying many types of foot pain is not clearly understood. […] A deeper understanding of pain is needed to identify the nature and mechanism of foot pain, its diagnosis and how best to target clinical intervention. […] Currently, the aetiological mechanisms underlying some types of tissue injury within the foot are not clearly understood. […] Tissue damage in the foot may occur via chemical, mechanical or thermal stimulation associated with direct trauma, musculoskeletal overload, infection, or systemic or proximal pathology (e.g. nerve entrapment, diabetic neuropathy). […] Many common types of foot pain such as tendonitis, stress fracture, corns and callus are routinely attributed, in part or full, to mechanical stress. […] While mechanical stress (broadly defined as force applied to tissue) is a normal component of foot function, tissue damage occurs when the maximum stress threshold of the tissue is exceeded.

• #2 Understanding the nature and mechanism of foot pain | Journal of Foot and Ankle Research | Full Text

  https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-2-1

  Currently, the nature and mechanism underlying many types of foot pain is not clearly understood. […] Currently, the aetiological mechanisms underlying some types of tissue injury within the foot are not clearly understood. As a result, interventions targeting foot pain in clinical trials often lack specific targets. […] A deeper understanding of pain is needed to identify the nature and mechanism of foot pain, its diagnosis and how best to target clinical intervention. […] Physiological foot pain is experienced as an acute response to injury (or potential injury) following healthy functioning of both the peripheral and central nervous systems. […] Pathological foot pain is experienced following nociceptive pathology; involving dysfunction of either or both of the peripheral or central nervous systems.

• #3 Understanding the nature and mechanism of foot pain

  https://nova.newcastle.edu.au/vital/access/manager/Repository;jsessionid=06A1EA71FB02B669FE87530A8008292B/uon:7599?view=list&f0=sm_date%3A%222009%22&f1=sm_type%3A%22journal+article%22&sort=ss_dateNormalized+asc%2Csort_ss_title+asc

  Approximately one-quarter of the population are affected by foot pain at any given time. […] Currently, the nature and mechanism underlying many types of foot pain is not clearly understood. […] A deeper understanding of foot pain is needed to identify causal pathways, classify diagnoses, quantify severity, evaluate long term implications and better target clinical intervention.

• #4 Understanding the nature and mechanism of foot pain

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2631512/

  Physiological foot pain is experienced as an acute response to injury (or potential injury) following healthy functioning of both the peripheral and central nervous systems. […] Pathological foot pain is experienced following nociceptive pathology; involving dysfunction of either or both of the peripheral or central nervous systems. […] Neuropathic foot pain is pain instigated by a primary dysfunction, lesion or transitory perturbation in the peripheral or central nervous systems. […] Inflammation produces characteristic changes within the nervous system. […] Chronic foot pain does not typically share the sharp spatial localisation typical of acute foot pain.

• #5 Understanding the nature and mechanism of foot pain | Journal of Foot and Ankle Research | Full Text

  https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-2-1

  Neuropathic foot pain is pain instigated by a primary dysfunction, lesion or transitory perturbation in the peripheral or central nervous systems. […] Inflammation produces characteristic changes within the nervous system. […] Chronic foot pain does not typically share the sharp spatial localisation typical of acute foot pain. Chronic foot pain is characteristically diffuse, spreads beyond the original site of injury, exhibits a non-linear relationship between nociception and pain intensity, and involves adaptive changes at various levels of the nervous system.

• #6 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/1236962-overview

  Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. […] As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads. Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues. […] Hammertoe deformity causes metatarsalgia because the top of the shoe pushes the toe down, depressing the metatarsal head. The toes also share some weight bearing. Hallux valgus may create abnormal foot biomechanics. […] Athletes who participate in high-impact sports that involve the lower extremities commonly present with forefoot injuries, including metatarsalgia.

• #7

  https://trauma.zaslavsky.com.ua/index.php/journal/article/view/799

  Metatarsalgia is the term for pain in the forefoot. This is a set of symptoms corresponding to a wide range of diseases. Central metatarsalgia arises from structural and functional changes that lead to excessive pressure in the area of metatarsal heads. […] Using combined osteotomy techniques as well as taking into account structural and functional pathologic changes of the forefoot and repair of metatarsophalangeal joint ligaments will ensure the most successful development of surgical treatment techniques for central metatarsalgia.

• #8 Metatarsalgia: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/1236962-overview

  Body weight is transferred to the foot by gravity. This transfer of force is increased to the forefoot during the mid-stance and push-off phases of walking and running. In the forefoot region, the first and second metatarsal heads receive the greatest amount of this energy transfer. […] Athletes who take part in high-impact sports that involve running or jumping are at high risk of forefoot injuries. […] Freiberg avascular necrosis can occur from a congenital, traumatic, or vascular etiology. An athletic injury is unlikely to be the sole cause of avascular necrosis; however, mechanical stress to the forefoot from high-impact sports may precipitate a previous predisposition to this condition.

• #9 Muscle strength and foot pressure vary depending on the type of foot pain | Scientific Reports

  https://www.nature.com/articles/s41598-024-56490-8

  This study compared muscle strength and foot pressure among patients with metatarsalgia, patients with plantar fasciitis, and healthy controls. […] The strengths of the plantar flexor and hip muscles were measured using isokinetic and handheld dynamometers, respectively. […] Compared with the healthy control group, plantar flexor strength was significantly reduced in the affected feet of the metatarsalgia and plantar fasciitis groups; however, hip strength was significantly decreased only in the affected feet of the metatarsalgia group. […] Plantar flexor and hip strength were significantly lower in the metatarsalgia group than in the plantar fasciitis group. […] The PTI was lower in the forefeet of the affected feet in the metatarsalgia and plantar fasciitis groups. […] Foot AI was significantly reduced only in the metatarsalgia group.

• #10 Muscle strength and foot pressure vary depending on the type of foot pain | Scientific Reports

  https://www.nature.com/articles/s41598-024-56490-8

  These results suggest the need to consider the evaluation of muscle strength and foot pressure in both feet for the diagnosis and treatment of foot pain. […] Our findings showed the weakest plantar flexor and hip muscle strength in patients with metatarsalgia. […] Metatarsalgia was also associated with low forefoot pressure. […] Furthermore, patients with metatarsalgia and plantar fasciitis had high pressures in the rearfoot of both feet. […] The plantar fasciitis group in this study showed significantly reduced plantar flexor strength compared with that in the healthy control group. […] However, the reasons why the plantar flexor and hip muscle strength decreased more in the metatarsalgia group than in the plantar fasciitis and control groups are not known. […] One possible explanation may involve compensatory strategies to reduce forefoot pain.

• #11 Muscle strength and foot pressure vary depending on the type of foot pain | Scientific Reports

  https://www.nature.com/articles/s41598-024-56490-8

  Our findings also showed decreased forefoot-PTI in patients with metatarsalgia compared with the plantar fasciitis and healthy control groups, indicating a lack of sufficient foot adaptation for forward propulsion during walking. […] However, further studies are needed to clarify whether plantar flexor and hip muscle weaknesses are the cause or result of metatarsalgia. […] Our results showed that metatarsalgia was associated with cavus foot posture and differed from healthy controls. […] Taken together, the results of this study and those of previous studies may explain the higher plantar pressure on the rearfoot in patients with metatarsalgia and plantar fasciitis. […] Our results suggest that muscle strength and foot pressure should be evaluated in both feet for the diagnosis and treatment of foot pain.

• #12 Metatarsalgia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/metatarsalgia/symptoms-causes/syc-20354790

  Metatarsalgia (met-uh-tahr-SAL-juh) is a condition in which the ball of the foot becomes painful and irritated. Metatarsalgia results from activities that involve running and jumping. Other causes include feet that aren’t formed correctly and shoes that are too tight or too loose. […] Too much pressure on the forefoot can cause pain and redness, called inflammation, in the long bones in the front of the feet, just below the toes, called metatarsals. […] Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including: […] Hard training or activity. Distance runners are at risk of metatarsalgia. This is mainly because the front of the foot takes in a lot of force when a person runs. But anyone who does a high-impact sport is at risk. This is especially true if shoes fit poorly or are worn down.

• #13 Metatarsalgia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/metatarsalgia/symptoms-causes/syc-20354790

  Certain foot shapes. A high arch can put extra pressure on the metatarsals. So can having a second toe that’s longer than the big toe. This causes more weight than usual to be shifted to the second metatarsal head. […] Toes that have different shapes. Wearing too-small shoes or high heels can cause feet and toes to change shape. A downward-curling toe, called a hammertoe, can cause metatarsalgia. So can swollen, painful bumps at the base of the big toes, called bunions. […] Excess weight. Most of a body’s weight goes to the forefoot while moving. So extra pounds mean more pressure on the metatarsals. Losing weight might reduce or get rid of symptoms. […] High heels or poorly fitting shoes. High heels are a common cause of metatarsalgia. Wearing high heels puts extra weight on the front of the foot. Shoes with a narrow toe box or athletic shoes that don’t have enough support and padding also can be part of the problem.

• #14 Metatarsalgia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/metatarsalgia/symptoms-causes/syc-20354790

  Stress fractures. Small breaks in the metatarsals or toe bones can be painful and change the way you put weight on your foot. […] Morton’s neuroma. This noncancerous growth of fibrous tissue around a nerve usually occurs between the third and fourth metatarsal heads. It causes symptoms that are like those of metatarsalgia. The growth can stress the metatarsal.

• #15 Turf Toe – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507810/

  Bowers initially described the term turf toe in 1976 as a sprain of the plantar capsule ligament of the great toe metatarsophalangeal (MTP) joint. It occurs secondary to forceful hyperextension of the first MTP joint. Injury to the plantar plate of the great toe leads to pain with push-off and reduced agility. […] The first MTP is a ginglymi arthrodial joint, which functions as a hinge and a sliding joint. The shallow articulation between the convex metatarsal head and the concave base of the proximal phalanx articular surface results in little bony stability. Therefore, it relies on the complex attachments of the capsule, ligaments, and musculotendinous structures surrounding the joint. The plantar plate is the strongest stabilizer of the first MTP joint and is composed of a thickening of the joint capsule. It attaches to the transverse head of the adductor hallucis, the flexor tendon sheath, and the deep, transverse intermetatarsal ligament. The classification system is composed of the degree of injury to the plantar plate:

• #16

  https://www.orthobullets.com/foot-and-ankle/7011/turf-toe

  Turf Toe is a hyperextension injury to the plantar plate and sesamoid complex of the big toe metatarsophalangeal joint that most commonly occurs in contact athletic sports. […] Diagnosis is made clinically with the inability to hyperextend the hallux MTP joint without significant pain and the inability to push off with the big toe. A vertical Lachman test will show greater laxity compared to the contralateral side. […] Pathophysiology mechanism of injury: forefoot is fixed to the ground, hallux MTP joint positioned in hyper-extension, axial load is applied to the heel, combination of force and joint positioning causes attenuation or tearing of the plantar capsular-ligamentous complex. […] Tear to capsular-ligamentous-seasmoid complex occurs off the proximal phalanx, not the metatarsal. […] Mechanism of injury consistent with hyper-extension and axial loading of hallux MTP.

• #17 Turf Toe | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/turf-toe/

  Turf toe or first metatarsal-phalangeal (MTP) joint sprain is an injury to the joint capsule and ligaments that connect the big toe to the rest of the foot, causing pain at the ball of the foot. The severity of the injury depends upon the degree of damage that occurs to the ligaments and joint capsule. Injury can range from a mild stretch to a complete tear. […] Turf toe occurs when the big toe gets bent too far upward (hyperextension) or downward (hyperflexion). This can occur with jamming the big toe, pushing off a hard surface, or pushing off repeatedly from the ball of the foot when running or jumping. […] As artificial turf became popular in the 1960s, the incidence of MTP joint injuries also increased. This is because artificial turf provides poor traction, increasing the chances of hyperextension injury to the big toe, which is why the injury is called turf toe.

• #18 Turf toe: Mechanism of injury and treatment options | Dr Geier

  https://drdavidgeier.com/turf-toe-injury-treatment/

  Turf toe is a slang term for a hyperextension injury to the metatarsophalangeal joint of the hallux, or the ball of the foot on the great toe. […] An athlete commonly suffers the injury when he absorbs an axial load to the back of his ankle when the ankle is plantarflexed (pointing toward the ground) with the toes dorsiflexed or extended (pointing toward the head). The force to the back of the ankle with the great toe extended injures the capsule and ligaments underneath the metatarsophalangeal joint. The severity of the injury can range from a sprain of this soft tissue to a partial or complete rupture of the capsule, ligaments, and other tissue supporting this joint. […] For severe cases of turf toe, where the capsule and ligaments on the bottom of this joint have been disrupted, especially in high-level athletes, surgical repair is occasionally attempted.

• #19 Turf Toe: Symptoms, Treatment and Prevention

  https://guilfordortho.com/turf-toe-symptoms-treatment-and-prevention/

  In most turf toe injuries the mechanism involves an athletes foot being planted, his heel raised up off the ground, and his 1st MTP joint hyperdorsiflexed upwards. This is accompanied by a downward force applied through the 1st MTP that results in injury to the capsule. […] Injury to the capsuloligamentous structures of the 1st MTP may also occur with valgus, varus, or hyperflexion forces to the joint although these are not considered true turf toe. […] Each mechanism of injury affects different structures of the joint and an accurate diagnosis is crucial in proper treatment of the injury.

• #20 Turf Toe – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507810/

  Turf toe is most commonly sustained due to forceful hyperextension of the first MTP joint. Turf toe can occur during many sports, such as basketball, soccer, and gymnastics. Still, it is most commonly described in football, and the prevalence is far greater in athletes who play on an artificial field since it is more rigid than a natural grass field. This injury was prevalent in the past astroturf (short-pile) fields because it had a much less compliant surface and placed more strain on the players’ feet. Modern (high-pile) turf behaves in a way more similar to natural turf, and the prevalence of the injury has decreased.

• #21 Turf Toe | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/turf-toe/

  Dancers and gymnasts that repeatedly stand on their toes in relev can also experience turf toe due to chronic stretch and strain to the MTP joint ligaments and capsule. […] Turf toe is diagnosed based on your mechanism of injury and physicians examination of your foot. […] An MRI may be performed to confirm the diagnosis or determine the extent of the injury. […] Surgery may be recommended for turf toe if symptoms do not improve after several months of rest and physical therapy, if joint range of motion is severely limited, or if there are associated injuries such as a capsular avulsion fracture.

• #22 Painful Legs and Moving Toes

  https://www.mdpi.com/2673-8392/2/1/20

  Painful Legs and Moving Toes syndrome (PLMT) is a rare neurological movement disorder characterized by involuntary and irregular movements of one or more toes, often together, with moderate to severe diffuse pain at the foot and leg. […] The etiology of PLMT is still unclear; therefore, the main symptoms of PLMT, including pain in limbs as well as involuntary movements of toes, can be treated only symptomatically, and the outcomes are often unsatisfactory. […] Central or peripheral nerve injuries have been assumed to be the possible causes of irregular involuntary movements, often accompanied by chronic pain; however, its etiology is unknown in most cases. […] The management of PLMT is very difficult because of its rare prevalence and obscure pathogenesis, and there have been no clear guidelines for the treatment of PLMT.

• #23 Painful Legs and Moving Toes

  https://www.mdpi.com/2673-8392/2/1/20

  Until now, the etiology and pathogenesis of PLMT has been poorly known; however, it could come from neuropathic changes or traumatic injuries in the peripheral nervous system. […] Its possible causes have been discussed in case/case series reports, including neuropathological conditions in peripheral and/or central nerves, e.g., post traumatic peripheral nerve injury, focal nerve injury, polyneuropathy, or injuries of the spinal cord. […] With the relief of or decrease in clinical symptoms after sympathetic ganglion block in some cases, it was assumed that that pathologically induced impulses from afferent fibers of an injured nerve into the sympathetic nervous system abnormally activated neurons in the anterior horn of spinal cord, resulting in involuntary movements of toes. […] Generally, the pain pathway consists of activating nociceptors or converting to neural signals or stimuli directly at the nerve injury site (transduction), transferring from peripheral neurons to central neurons in the dorsal horn of the spinal cord, brain stem, and thalamus (conduction and transmission), inhibition in the spinal cord and activation of descending inhibitory tracts (modulation), and projection to the somatosensory cortex, enabling the perception of pain.

• #24 Painful Legs and Moving Toes

  https://www.mdpi.com/2673-8392/2/1/20

  Nerve plexus injury, radiculopathy, polyneuropathy (large fiber and/or small fiber), and posttraumatic peripheral nerve injuries were more common in cases, even though their exact participation in developing PLMT are not clear. […] PLMT could mostly begin with peripheral causes and be associated later with subsequent changes in CNS. […] In several cases, central lesions, e.g., stroke, morbus Parkinson, encephalopathy, spinal cord injury, cervical myelitis and Morbus Wilson were identified and assumed to be associated with the development of PLMT, but the association with its development and these diseases was unclear. […] In one recent report including eight cases with clinically identified PLMT, the brain single photon emission computed tomography (SPECT) showed the hypoperfusion to the frontal and occipital cortices, thalamus, and cerebellum, as well as hyperperfusion to the anterior cingulate gyrus and parietal cortices (primary and secondary sensory cortices) on both sides, which are related to pain, as compared to controls.

• #25 Painful Legs and Moving Toes Syndrome: Case Report and Review

  https://www.mdpi.com/2035-8377/16/6/102

  Painful legs and moving toes (PLMT) syndrome is a rare movement disorder characterized by discomfort and defuse pain sensation in the lower extremities and involuntary irregular movements of single or multiple toes. […] The etiopathogenesis in unclear as most of the cases are due to peripheral nervous system (PNS) disorders such as spinal cord compression, peripheral neuropathy, radiculopathy, and history of trauma. […] However, it is hypothesized that a crucial part in the development of this syndrome is played by functional alterations in the afferentation of the nociceptive impulses, spinal cord interneurons, sympathetic nervous system, and subsequent reorganizations of the central nervous system (CNS) at the spinal cord level or higher levels. […] After numerous clinical observations it was assumed that the involuntary toe movements are due to abnormally activated neurons in the anterior horn of the spinal cord due to the constant pathological firing of impulses from afferent fibers of an injured nerve of the sympathetic nervous system.

• #26 Painful Legs and Moving Toes Syndrome: Case Report and Review

  https://www.mdpi.com/2035-8377/16/6/102

  The theory that the sympathetic neuronal signals could provoke pain and unvoluntary movements by activating a so-called “impulse generator” at the injured location of affected limbs was proven by improvement of the symptoms in a case-series treated with sympathectomy. […] In general, there is an activation of the nociceptors at the site of the nerve injury (transduction), transferring the neuronal signals from peripheral neurons to central ones in the dorsal horn of the spinal cord, brain stem, and the thalamus (conduction and transmission). […] Spinal cord interneurons may partially transmit abnormal neural signals from the afferent sensory structures to segmental or multisegmental efferent motor pathways, which may reproduce simple or more complex abnormal involuntary movements. […] Chronic primary pain, such as neuroplastic pain, can be part of the pathogenesis of chronic pain over time, due to central pain modulating disturbances, including three major mechanisms: increased excitability of ascending and descending facilitatory tracts, reduced inhibition of descending anti-nociceptive tracts, and psychogenic conditions.

• #27 Painful Legs and Moving Toes Syndrome: Case Report and Review

  https://www.mdpi.com/2035-8377/16/6/102

  Frequent ectopic impulses to the posterior root, which are spontaneously produced at the injured peripheral nerve, could lead to pain and involuntary movements via the abnormal re-networking of local spinal circuits. […] A trigger point may arise as a result of several subthreshold sensory stimuli when the sum of their potentials exceeds a particular threshold. […] Afferent impulses may cause aberrant interneuron simulation in response to above-threshold stimulation, which can manifest clinically as movement amplification.

• #28 WINDLASS MECHANISM OF THE FOOT | ACE Physical Therapy and Sports Medicine Institute

  https://ace-pt.org/ace-physical-therapy-and-sports-medicine-institute-windlass-mechanism-of-the-foot/

  The plantar fascia is a thick, leather-like band of connective tissue that spans the bottom or plantar surface of the foot. The band attaches to the heal bone (calcaneus) and stretches across the mid-tarsal bones to the ends of the metatarsals. The plantar fascia inserts into the flexor tendons of the toes. When the toes are moved into a dorsiflexed position (movement toward the shin bone) the plantar fascia is wrapped around the metatarsal heads. The Great toe or Big toe is the primary site of this occurrence. This wrapping is referred to as the windlass mechanism of the foot. The term is taken from the sailing world because the winch mechanism wraps the rope around a drum to move the sail. […] The windlass mechanism in the foot enables the foot to support the body weight and move it through space. When the foot transition from mid-stance to toe off, the toes move from a plantar flexed or neutral position to a dorsiflexed position. The dorsiflexion of the toes produces the windlass mechanism utilizing the plantar fascia. The wrapping of the plantar fascia around the metatarsal heads pulls the calcaneus towards the toes. The mid tarsal arches raise up off the ground and the foot transitions from a supple, pronated position to rigid, supinated position. The rigidity of the foot is needed to become a lever that is capable of propelling someone as they walk.

• #29

  https://docpods.com.au/pages/foot-pain-info__the-windlass-mechanism-in-the-foot-and-foot-pain?srsltid=AfmBOopXGv2TqVDDlA-Cq_O5FOfxMl_5S1dYFzGfcodNY__n0TiTsi7G

  John Hicks (1954) was the first to describe this mechanism in the foot. […] The bending of the toes leads to winding of the plantar fascia around the metatarsal heads, as explained above. […] The absence of the windlass mechanism has been proven to play a role in many foot and lower limb injuries.

• #30 Anatomy 101: The windlass mechanism & great toe extension — Rayner & Smale

  https://www.raynersmale.com/blog/2017/9/5/anatomy-101-the-windlass-mechanism-great-toe-extension

  The windlass mechanism refers to the function of the anatomy on the base of the foot, specifically the plantar aponeurosis, sesamoid bones, plantar pads and the attachment of these structures under the MTPJ. […] The outcome of these bones moving closer together in distance is a rising of the metatarsals forming the apex of the triangle and resulting in the MLA rising. […] When the foot reaches foot-flat or mid-stance, the tension in the plantar aponeurosis reduces and the foot is able to shock-absorb and adapt to the terrain through midfoot supination or pronation depending on the demand. […] As first MTPJ extension increases, the height of the MLA should also increase. […] Both of these behaviours were different to the normal pattern. […] Both scenarios result in an ineffective windlass mechanism.

• #31 WINDLASS MECHANISM OF THE FOOT | ACE Physical Therapy and Sports Medicine Institute

  https://ace-pt.org/ace-physical-therapy-and-sports-medicine-institute-windlass-mechanism-of-the-foot/

  If there is damage to the plantar fascia or the anatomy of the foot does not allow the windlass mechanism to function, the energy needed to walk rises significantly. Many times the person will walk with a limp due to the lack of push off power. The foot and ankle are more unstable and are susceptible to injuries. […] The ability of the foot and ankle to support and move ones body through space is partially dependent upon the windlass mechanism of the plantar fascia. A healthy plantar fascia enables the foot and ankle to move someone through space without pain and without excessive energy expenditure.

• #32

  https://biomch-l.isbweb.org/forum/isb-forums/footwear-biomechanics-group/31602-footwear-as-a-cause-of-pathology

  During gait we have two windlass phases, the initial windlass phase and the second windlass phase. […] 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. […] 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 flexion 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.

• #33

  https://biomch-l.isbweb.org/forum/isb-forums/footwear-biomechanics-group/31602-footwear-as-a-cause-of-pathology

  A properly functioning „initial windlass mechanism phase” will likely reduce the rate of loading of the plantar tissues and therefore the cumulative stresses to which the plantar fascia is subjected, thus reducing the risk of plantar fasciitis. […] It seems to me then, that methods of loading the plantar fascia less rapidly during weight shifting and thus reducing strain in the fascia would be of benefit to workers who stand all day even if they do not actually take many recognized steps.

• #34 Big Toe Kink in the Kinetic Chain – Erik Dalton Blog

  https://erikdalton.com/blog/big-toe-kink-in-the-kinetic-chain/

  Limited first-toe extension leads to altered mobility at the talocrural joint. […] If the ankle cant dorsiflex properly, the knee and hip will not fully extend. […] The result is decreased hip flexor flexibility and repeated extension-rotation of the lumbar spine. […] This is a prime example of how a kink in a lower extremity can affect structures further up the kinetic chain. […] By systematically increasing dorsiflexion at the first metatarsal joint, inflammation and protective muscle guarding may be reduced, leading to symptomatic improvement. […] If discovered at an early stage with minimal spurring and the ability to engage the windlass mechanism, I believe manual therapy and a specialized corrective exercise program can maintain that mobility and prevent progression of the deformity.

• #35 Mechanism of orthotic therapy for the painful cavus foot deformity | springermedizin.de

  https://www.springermedizin.de/mechanism-of-orthotic-therapy-for-the-painful-cavus-foot-deformi/9664190

  People who have extremely high arched feet or pes cavus often suffer from substantial foot pain. Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear. It is generally thought that one of the primary functions of CFO is redistributing abnormal plantar pressures. This study sought to identify variables associated with pain relief after CFO intervention. […] Custom-made foot orthoses have been shown to be an effective treatment option for foot pain in a variety of clinical populations. However, the mechanism by which they produce an effect is not well understood. There are a number of theoretical explanations, including resisting or facilitating motion; plantar pressure reduction; altered muscle activity; and enhanced proprioception.

• #36 Mechanism of orthotic therapy for the painful cavus foot deformity | springermedizin.de

  https://www.springermedizin.de/mechanism-of-orthotic-therapy-for-the-painful-cavus-foot-deformi/9664190

  In summary, DPLI is calculated by the least square regression slope between the experimentally observed plantar pressure magnitude probability distribution and a Gaussian distribution with the same mean, standard deviation, and magnitude. […] The effect of custom orthoses on change in plantar pressure time-series was demonstrated in our previous publication. In summary, our preliminary results suggested that custom-made foot orthoses significantly increases DPLI on average by 44% compared to baseline, while no improvement was observed in the control group. […] However, redistribution of plantar pressure, measured with the DPLI, had a significant effect on pain relief. […] Our final model described 73% (R2) of the variance in pain relief with custom-made foot orthoses and consisted of higher initial pain level, higher BMI, cavus foot alignment as measured by Foot Posture Index, and changes in both the DPLI and decreased PTI.

• #37 Mechanism of orthotic therapy for the painful cavus foot deformity | springermedizin.de

  https://www.springermedizin.de/mechanism-of-orthotic-therapy-for-the-painful-cavus-foot-deformi/9664190

  We believe these results provide mechanistic support for custom-made foot orthoses in reducing pain in patients with pes cavus. Mechanistic theories for pain-relief from custom-made foot orthoses include resisting or facilitating motion; plantar pressure reduction; altered muscle activity; and enhanced proprioception.

• #38 Gout Attack In The Foot Symptoms And Signs

  https://st-charlespodiatrie.com/en-ca/2024/06/05/gout-attack-in-the-foot/

  Gout, a painful condition caused by the accumulation of uric acid crystals in the joints, is often associated with images of acute pain and reduced mobility. Among the various manifestations of gout, the one affecting the foot, known as a gout attack in the foot, is particularly debilitating and deserves special attention. […] The main cause of a gout attack in the foot is the accumulation of uric acid in the blood, often resulting from a combination of genetic and lifestyle factors. […] To fully understand the gout attack in the foot, it is essential to delve into the underlying mechanism of this debilitating condition. Gout is primarily caused by the accumulation of uric acid crystals in the joints, particularly in the big toe. Understanding how these crystals form and trigger acute inflammation is crucial for treating and preventing this condition.

• #39 Gout Attack In The Foot Symptoms And Signs

  https://st-charlespodiatrie.com/en-ca/2024/06/05/gout-attack-in-the-foot/

  Once formed, these uric acid crystals can deposit in the joints, especially where the temperature is slightly lower, such as the big toe. There, they trigger an inflammatory response from the immune system, causing intense pain, swelling, and redness characteristic of a gout attack. […] In addition to their direct effect on the joints, uric acid crystals can also damage surrounding tissues, causing a chain reaction that worsens inflammation and pain. […] It is also worth noting that a gout attack in the foot can be triggered by external factors such as excessive alcohol consumption, a diet rich in purines, stress, joint trauma, or dehydration. These factors can temporarily increase blood uric acid levels, promoting crystal formation and triggering an acute attack. […] By understanding this pathological mechanism, healthcare professionals can better target therapeutic interventions and help patients effectively manage their condition.

• #40

  https://www.ryandusart.com.au/toe-deformities

  Toe deformities are common problems that occur due to abnormal positioning of the foot bones, inadequate biomechanics, and diseases such as arthritis affecting bones and tissues of the foot. […] Claw toe is a deformity, where a toe bends and appears like a birds claw. It develops when there is an imbalance between the intrinsic and extrinsic muscle systems of the toe, resulting in altered anatomy. […] Hammer toe is a deformity of the second, third or fourth toes where it is bent at the middle joint so that it resembles a hammer. It can result in pain on top of the toe knuckle (proximal interphalangeal joint) and also the tip of the toe and can cause corns. Hammer toe is the result of a muscle imbalance that puts pressure on the toe tendons and joints. […] Mallet toe is similar to hammer toe except the joint involved is the upper joint instead of the middle, giving the toe a mallet-like appearance at the end of the toe. It can occur in the same mechanism and if left untreated can cause pain when walking.

• #41 Bunions – OrthoInfo – American Academy of Orthopaedic Surgeons

  https://orthoinfo.aaos.org/en/diseases–conditions/bunions/

  A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are associated with hallux valgus, a condition where the big toe drifts toward the smaller toes and the outside of the foot. […] Pain from bunions develops over the bony bump due to shoe irritation, and in the other toes due to crowding and altered mechanical forces in the ball of the foot. […] Bunions usually develop slowly. Pressure on the big toe joint causes the big toe to lean toward the second toe. Over time, the normal position of the bone, tendons, and ligaments changes, resulting in the bunion deformity. […] The enlarged joint is often inflamed due to abnormal mechanics and direct irritation. […] In some cases, an enlarged MTP joint may lead to bursitis, a painful condition in which the fluid-filled sac (bursa) that cushions the bone near the joint becomes inflamed. It may also lead to chronic pain and arthritis if the smooth articular cartilage that covers the joint becomes damaged from the joint not gliding smoothly.

• #42 Bunions – OrthoInfo – American Academy of Orthopaedic Surgeons

  https://orthoinfo.aaos.org/en/diseases–conditions/bunions/

  Bunions may be caused by wearing poorly fitting shoes in particular, shoes with a narrow, pointed toe box that forces the toes into an unnatural position. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help relieve pain and reduce swelling. Other medications can be prescribed to help pain and swelling in patients whose bunions are caused by arthritis.

• #43 Blue toe syndrome

  https://dermnetnz.org/topics/blue-toe-syndrome

  The characteristic blue discolouration and pain in blue toe syndrome are caused by impaired blood flow to the tissue resulting in ischaemia. The impairment of blood flow is due to one or more of the following factors: […] The blockage or narrowing of arteries by the small clots that lead to blue toe syndrome can result from a number of different conditions. […] Embolisation (formation of an embolus, a floating mass in the bloodstream that can clog the arteries) can also occur spontaneously. […] Thrombosis can form in the small vessels of the feet. […] Occlusion can also be due to syphilis, pyogenic infection (sepsis), Behet disease, and other forms of vasculitis. […] Abnormal venous drainage associated with extensive venous thrombosis results in phlegmasia cerulea dolens (a painful form of blue toe syndrome associated with leg oedema).

• #44 Blue toe syndrome

  https://dermnetnz.org/topics/blue-toe-syndrome

  Blue toe syndrome can be due to abnormal blood constituents. […] The clinical features of blue toe syndrome can range from an isolated blue and painful toe to a diffuse multi-organ system disease that can mimic other systemic illnesses. […] Pain in the affected blue toe or toes is usually of acute onset and occurs at rest. […] Cholesterol fragments blocking blood vessels to other organs can lead to multi-organ disorder. […] Blue toe syndrome is a clinical diagnosis based on patient history and findings on examination. […] The principles of treatment revolve around addressing the cause of the blue toe syndrome. This is usually in the form of relieving occlusion and restoring arterial or venous vessel continuity.

• #45 Foot Pain Types, Causes, Diagnosis, Treatment

  https://www.medicinenet.com/foot_pain/article.htm

  Pain in the foot indicates that there is something wrong with either the interaction of internal structures of the foot or with how the foot is interacting with external influences. […] When there is pain, the body reacts by changing the way it moves or functions in an effort to reduce the pain. These compensations or biomechanical changes may prevent normal movement and cause further injury in the foot and/or other parts of the body. […] Foot pain may be caused by many different diseases, deformities, biomechanical conditions, improper footwear, or injuries. […] Many systemic diseases such as diabetes, lupus, gout, and rheumatoid arthritis can cause foot pain. Rheumatoid arthritis can cause painful inflammation in the joints of the foot, accompanied by alignment changes that lead to foot deformities.

• #46 Foot Pain Types, Causes, Diagnosis, Treatment

  https://www.medicinenet.com/foot_pain/article.htm

  Biomechanical abnormalities from muscle and tendon tightness or laxity, flat feet, or high arched feet often lead to muscle imbalances, deformities, and foot pain. […] Trauma from an acute injury or from accumulative repetitive injury is a very common cause of foot pain. […] Delayed treatment of many foot pain can lead to complications, chronic long-term pain, disability, and arthritis of the affected foot. […] Proper evaluation and diagnosis of foot pain are essential in planning treatment. […] A good general guideline is to compare the injured side to the uninjured side. […] The types, causes, and severity (sharp pain versus a dull ache) also are good indicators of the seriousness of the injury. […] Your body will create various changes in movement when you have an injury. A podiatrist can evaluate these changes and help you make the appropriate corrections. Prolonged, uncorrected biomechanical changes may lead to secondary mechanical changes that are painful and difficult to correct and may lead to a poor prognosis and possibly a slow or incomplete recovery from the symptoms.

• #47 Turf Toe Injury – Hyperextended Big Toe | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/sports-medicine/conditions-treated/turf-toe/

  Turf toe is diagnosed based on your mechanism of injury and physical examination of your foot. X-rays are important to look for fractures, but an MRI may be necessary to evaluate the soft tissue (ligament and capsule) injury at that joint. […] Treatment begins with rest, elevation, ice, and anti-inflammatory medication. A stiff-soled shoe, walking boot, or cast may be used to limit motion at that joint and allow healing. Physical therapy can be used after the initial treatment to restore motion and strength. Surgical treatment from a sports medicine orthopedic surgeon may be recommended for turf toe if symptoms do not improve after several months of rest and physical therapy if the joint range of motion is severely limited, or if there are associated injuries such as a fracture. […] The timeline for returning to sports after turf toe varies based on the injury’s severity. Low-grade injuries may allow for a return in as early as two to three weeks, while high-grade injuries may require more than three months of recovery. Utilizing stiff sole inserts or shanks can aid in the return to sports.

• #48

  https://www.ryandusart.com.au/toe-deformities

  Certain disease conditions such as diabetes, stroke, osteoarthritis, and rheumatoid arthritis affect the functioning of muscles and nerves and can cause tightening of ligaments or tendons resulting in these deformities. […] If non operative treatment is ineffective the doctor may suggest surgery where the main goal is to restore normal toe alignment and return to normal, pain free function.

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