Silly Question

[apocalypse]

Sorry, can't get my head around this for some reason.

Obviously, open chain ankle eversion strengthens the peroneii.

If I have a patient raise themselves onto the lateral border of their foot, does that also strengthen their peroneii in a closed-chain position.

I know....sorry...tough week in work.

Thanks

P.S. I have a patient with femoral antversion, mild tibial anteversion and some pronation of her feet. Her knee pain is improved if she goes into the above position. (lateral border of her feet)

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[Canuck Physio]

Are they merely completing an isometric contraction on the lateral border?

In which case yes, it will be strengthened in the lengthened position, but not necessarily throughout range.

[apocalypse]

Hi

Thanks for the reply.

No, I have them standing, then they raise themselves isotonically onto the lateral borders of both feet, then eccentrically let themselves down onto their feet.

Is this closed-chain peroneii?

Thanks

[Canuck Physio]

From my understanding of your description, the individual is lengthening the peroneii (evertors) as they are on their lateral border of foot. This would mean the opposite side (invertors) are working concentrically. The peroneii would merely be working to balance in a lengthened position. This is similar to a toe raise for example, where when the PFs are the primary movers, yet the DFs stabilize heavily while they are being lengthened.

[apocalypse]

Hey Canuck,

Thanks for the reply.

Do you mean a calf raise?
The PF are working concentrically and shortening,
On the way down, the DF are working eccentrically and lengthening

If my patient goes up onto their lateral border of their foot, then they are working, as you say, their inverters concentrically and shortening them, the peroneii are working to balance and then are working eccentrically back to neutral.

Thanks for that.

So, my patient, as I say, has femoral anteversion and and over pronation. I don't want to go down the orthotic route yet, what exercises could I do (I presume closed0chain is best) to strengthen her so that she rests out of pronation and therefore improve her anteversion of the femur and ultimately, hopefully improve her knee pain ? secondary to patello-femoral pain syndrome and chondromalacia patellae


Thanks

[physiofixme]

In a calf raise the plantarflexors work concentrically on the way up and then eccentrically on the way down as they are lengthening. To get the peroneii working eccentrically, they need to be lengthening ie going from an everted position to an inverted position under load/gravity. Hope this helps.