pathology: drop foot / talipes equinus

yogabook / pathologie / drop foot / talipes equinus

drop foot / talipes equinus

Definition of

Malformation of the foot with a high heel, the OSG is fixed in dorsiflexion or the ROM is limited to a very small area, all of which is clearly in dorsiflexion. Typically, it is then hardly possible to put the heel down and a physiological rolling movement is also hardly possible. The gait is then exclusively on tiptoe and the gait pattern is significantly altered. The forefoot is therefore subjected to significantly more strain. Pointed foot is usually the result of a trauma in which the dorsiflexors of the ankle or their tendons are damaged. A habitual pointed foot is also known. It is not uncommon for children to have a pointed foot, but this should disappear. Pointed foot can occur together with other foot deformities, especially clubfoot, followed by hollow foot and flat foot

ICD Q66.8, M24.5

Cause

  1. Congenital, e.g. hereditary motor-sensitive neuropathy (HSMN)
  2. Infantile cerebral palsy
  3. Wearing a Thomas splint (to relieve pressure on the hip joint in Perthes‘ disease)
  4. Traumatic: Damage to the dorsiflexors or their tendons.
  5. Compartment syndrome of the lower leg, usually also traumatic
  6. Bedriddenness
  7. Multiple sclerosis
  8. Apoplexy
  9. Pointed foot as part of a clubfoot deformity
  10. habitual
  11. Compensatory: unilateral for leg length discrepancies
  12. neurological: spastic paralysis of the gastrocnemius and soleus
  13. flaccid paralysis of the dorsiflexors

Diagnosis

  1. Clinical, including shortening of the triceps surae and the archilles tendon
  2. Pedobarography
  3. X-ray
  4. MRI

Symptoms

  1. Standing in standard anatomical position not possible, rolling movement of the foot not possible

Complications

  1. untreated: Damage to the musculoskeletal system

Therapy

  1. Therapy of the cause
  2. KG
  3. Botulinum injections
  4. Surgical lengthening of the Achilles tendon
  5. Autologous blood therapy: injection of autologous conditioned plasma
  6. If necessary: surgery, arthroscopic, minimally invasive or open in the case of major disorders with extensive soft tissue correction. If necessary, arthrodesis, tendon lengthening (especially Achilles tendon)

Asana practice

Depending on the cause, a conservative restitutio ad integrum cannot always be expected. The attempt to eliminate or improve the pointed foot is almost exclusively based on stretching the plantar flexors, so the soleus and gastrocnemius in particular must be stretched. As the former is a monoarticular plantar flexor, its synergist, the gastrocnemius, must be relieved by significant flexion in the knee joint so that the effect of the plantar flexion reaches the soleus. For the gastrocnemius to be stretched, on the other hand, the knee joint must be extended. Since it is to be expected that a pronounced negative longitudinal muscle adaptation has taken place in the plantar flexors, strengthening the plantar flexors in the area of the ROM that lies between approx. 70 and 100° of the maximum sarcomere length, i.e. approximately in the third of the ROM before the maximum stretched state, can be useful in addition to stretching. Other plantar flexors such as the posterior tibialis should not play a significant role here.

The antagonists of the contracted plantar flexors should be checked for tone and, above all, function. An effect that goes beyond lifting the foot, for example in the sense of a genuine counterweight to the contracted plantar flexors, can neither be expected nor achieved. In terms of the physiology of movement, such as walking and running, these muscles are only there to lift the foot after plantar flexion has taken place, they do not contribute to propulsion and are therefore considerably weaker. Their task is to prevent the foot from tripping over its own toes and to return the foot to a position in which plantar flexion, which is relevant for propulsion, is possible again.

Since the pointed foot position in itself does not allow for a particularly stable stance and the muscles that stabilize in the direction of supination and pronation, i.e. primarily the tibialis anterior and fibularis longus as well as the tibialis posterior on the one hand and fibularis longus and fibularis brevis on the other, can tend to become contracted, these should be trained as dorsiflexion improves and the range of motion improved.

Asanas

  1. Asanas in 851: Stretching the plantar flexors
  2. Asanas in 856: Stretching the gastrocnemius
  3. Asanas in 871: Stretching the pronators
  4. Asanas in 872: Strengthening the pronators
  5. Asanas in 861: Stretching the supinators
  6. Asanas in 862: Strengthening the supinators
  7. Asanas in 841: Stretching the pronators
  8. Asanas in 842: Strengthening the pronators Pronators