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Picture

1st MTP Mobility and Gait: Assess and Treat

8/25/2015

1 Comment

 
One of the essential aspects of the foot that is missed during examination is the 1st toe mobility, specifically the metatarsophalangeal (MTP) joint. During healthy gait, 15 degrees of dorsiflexion (DF) is required at the talocrural joint (TC). While the joint is frequently dysfunctional, the 1st MTP joint can be limiting as well. During preswing, the 1st MTP joint can reach as much as 55 degrees of extension. Unfortunately, people are often lacking 1st MTP mobility. To assess the mobility, passively bring the joint into an extended position while stabilizing the 1st metatarsal as depicted below:
Picture
Picture
Once you've identified a joint that is limited into extension, there are several manual treatments we can perform to increase the mobility. Below you will see a mobilization and manipulation technique. With the mobilization (1st row of pictures), you stabilize the metatarsal and mobilize the phalange in a dorsal direction close to the end-range of extension. With the manipulation (2nd row of pictures), you grasp the phalange close to the MTP joint while facing the patient and perform a distraction manipulation by radially deviating your wrists from an ulnarly deviated position. The manipulation brings the joint into a flexed position with distraction performed.
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Picture
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Picture
While manual treatments are great for improving MTP mobility, it is essential an exercise be assigned as well to maintain the gains and continue to improve the extension ROM. Patients spend the majority of their time outside the clinic, so they will be responsible for locking in the changes with an exercise. Below you will find two pictures, for recommended exercises. First is a row of pictures of a 1st MTP extension stretch in closed kinetic chain. Stabilize the phalange on the ground and bring the same knee into flexion and ankle into plantarflexion, which results in extension of the MTP joint. Hold for a prolonged periods (at least 30 seconds). The second row of pictures is repeated flexion of the 1st MTP. Grasp the phalange and bring into end-range flexion repeatedly, holding for a second.
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Hopefully, you'll find these treatment options useful for the 1st MTP joint. Make sure to be thorough with your assessments, as a limitation here can result in changes up the change. Limited extension here results in altered mobility at the talocrural joint. If the the ankle does not dorsiflex appropriately, the knee and hip do not fully extend. This can result in decreased flexibility in hip flexors which will lead to repeated extension-rotation of the lumbar spine. This is just one example of how a limitation in one spot can affect something else much farther up the chain. It doesn't hurt to be thorough in your examination.

-Chris


Review of the Stages of Gait
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Quick Gait Assessment
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1 Comment
steve
10/25/2021 12:06:40 pm

A little concerned that your posture book advertises that once you complete the program "its nearly impossible to get injured again." We all know that is absolutely nowhere near true. I applaud your entrepreneurship, but this claim may disappoint people if and when they sprain their ankle!

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test
  • I want Financial Freedom
  • I want Professional Growth
  • I want Clinical Mastery