A Study in Muscles and Orthoses when a Patient has PTTD
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Here I am just presenting the abstract of an article that looked at our common diagnosis of PTTD. As the foot collapses, the ankle and knee joints have greater stress, along with over contraction of the posterior tibial sidekicks: flexor hallucis longus and flexor digitorum longus. These medial ankle tendons are trying to supinate the subtalar joint and we commonly see digital hammertoe deformities with rapid progression. The article shows great joint force improvement with foot orthotics, both ankle and knee, but makes no mention of any effect on the FHL and FDL.
I love the compensation of tendons when they try to help right the ship. Achilles tendon weakness is even more common with the compensation of any muscle/tendon that can help plantar flex the ankle.
I would summarize the significance of this article highlighting the key points:
- Key Point: The Use of Foot Orthotics helps reduce abnormal force in the ankle and knee in a patient developing PTTD.
- If one tendon is weak anywhere in the lower extremity, like phasic muscles that can do the same function will try to compensate.
- The development of hammertoes is a common finding in PTTD with the compensatory contraction of the two long flexors.
Once the orthotic devices are dispensed, attention should be directed to preventing hammertoes with devices like Yoga Toes, Correct Toes, Budin Splints, and digital stretches. This can have a positive effect even if the hammertoes are well established by the time you see the patient.
