Issue link: https://www.massageandbodyworkdigital.com/i/72093
MYOFASCIAL TECHNIQUES foot. Be thorough, working the entire sole from toes to the origin of the flexors on the anterior calcaneus. EXTENSOR DIGITORUM BREVIS TECHNIQUE The extensor digitorum brevis (Image 12, page 115), the only muscle (along with its hallucis head) on the dorsal surface of the foot, complements the short toe flexors by pulling the MTPJ (the joint at the base of the toe) into extension or dorsiflexion. When tight, this up-bent dorsiflexion becomes the resting position of the toe joint. Use your fingertips, as in Images 10 and 11 (page 115), to release any contracted tissue here, this time using toe curling or flexion as active or passive client movements. Isolate each toe in turn, feeling for the specific head of the brevis that's involved in that toe's extension. TOE TENDONS, CAPSULES, AND SHEATHS It will be important to spend some time working slowly and deeply right around the joints of the toes themselves. Both the extensors (dorsally) and the flexors (on the plantar surface) merge with their longer counterparts (the flexor and extensor digitorum longus) into tendinous hoods within the toe (Image 13). In a hammertoe pattern, these fibrous sheaths become contracted on the concave sides of the joint (in the crease of the bent toe, Image 7). The joint capsules are also involved in maintaining a bent joint, as are the collateral ligaments of the toes, found at the sides of all three toe joints. They are largest and strongest at the MTPJ, lying between the base of the toes. These ligaments, and other structures between the long metatarsals of the foot, such as the adductors and lumbricals, will need to be gently lengthened before normal alignment is possible. As with our other techniques, use active and passive client movement, along with your direct pressure, to lengthen these shortened tissues. If your client has already had hammertoe surgery, working the ligaments and tissues of toes can help reduce pain once the surgery has healed (after at least 6–8 weeks). Although the toes and their 13 The flexor tendon sheaths (orange) are some of the fibrous connective tissue structures that surround the toe joints. They can contribute to toe- joint fixation. Work these structures combining pressure with active and passive movement. Image courtesy Primal Pictures; used by permission. Be sure to have a look at the next ligaments are painful, sensitive, or ticklish on many people, if you take your time and stay in close communication with your client, the sensation will be well tolerated. The normalization of hypersensitive areas can itself be very therapeutic. Combined with the tissue changes from your work, it will yield gratifying changes in flexibility and pain reduction. At this point, you've worked the short toe flexors and extensors, as well as the capsules, ligaments, and sheaths of the toe joints themselves. Although there is more to do, and you may need repeated visits to see a visible change in the resting position of the toes, in many cases, your client will already notice greater toe flexibility and comfort. column, where I'll talk about the long toe flexors and extensors and the role of the lower leg in toe deformities, as well as the whole-body implications of hammertoes, bunions, and more. Notes 1. Remedy Health Communities, "Hammer Toe Remedies," accessed April 2011, www. healthcommunities.com/hammertoesclaw- toes/hammertoe-remedies.shtml. 2 Anthony Watson, "Hammertoe Deformity," accessed April 2012, http://emedicine. medscape.com/article/1235341-overview. 3 W. Fishco, "Emerging Concepts in Hammertoe Surgery," Podiatry Today 22, no. 9 (September 2009): 34–9. Accessed April 2011, www.podiatrytoday.com/emerging- concepts-in-hammertoe-surgery. Til Luchau is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is also a Certified Advanced Rolfer and has taught for the Rolf Institute of Structural Integration for 22 years. Contact him via info@ advanced-trainings.com and Advanced-Trainings.com's Facebook page. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 117