The dorsal muscles are at the top of the foot (Fig. 10.39). The interosseous muscles, which occupy the space between the metatarsal bones, are also referred to as the dorsal muscles, since they are very easy to reach from the top of the foot. It is quite easy to treat the dorsal and interosseous muscles. Pain from trigger points in them is local in nature and is not transmitted to other places.

Extensors brevis and interosseus muscles

The extensor digitorum brevis lie under the extensor longus tendons at the top of the foot. Both extensor groups work together to lift your toes off the ground with every step you take.

Between the metatarsal bones there are two groups of interosseous muscles - dorsal and plantar. Third group small muscles vermiform - parallel to the metatarsal on the sole, but not between them. The interosseous muscles allow the fingers to move from side to side and are involved in their flexion and extension. This mass of small muscles may seem like very little, but they play a big role in maintaining the balance of the body and adapting the feet to the ground. Their function is to restrain excess movements of the larger, but less sensitive muscles in the foot.

Symptoms

Pain from trigger points in the short extensors occurs immediately aroundthese muscles, which are located on top of the foot on her outside(Fig. 1 0.39). In the figure, the extensor of four fingers consists of three heads of muscles adjacent to the four fingers. Short extensor thumb- the only muscle that goes to the thumb.

Their common area of ​​pain distribution coincides with the area of ​​its distribution from long extensor of the fingers, anterior tibial and third peroneal muscles. Sometimes you have to explore all of these muscles to find trigger points that cause pain. One woman would have suffered with legs for the rest of her life if she had not caught the eye of some new information.

Pain from trigger points in interosseous muscles felt at the base of the toes, often extending to the tips of the toes (fig. 10.40). In some cases, the pain covers the entire back of the foot and goes up to the front of the lower leg (not shown). Trigger points in the interosseous muscles often cause cramps and swelling on the dorsum of the foot. A dull aching pain at the top of the foot can come from any dorsal plantar muscle. Trigger points in the first dorsal interosseous muscle can cause tingling in the thumb. In any of the zones, there is more numbness than pain.

The reasons

Walking, running, or climbing too frequently and vigorously can contribute to the formation of trigger points in any of the interosseous muscles or in any of the extensor muscles.
It is not uncommon for all of these muscles to have points, as they all depend on each other in this delicately balanced system of footwork. Be careful if the shoes are tight at the top of the foot. Tight shoes interfere with circulation and movement by creating problems with the interosseous muscles and extensor digitorum brevis. It would be nice to give up high heels, because they make the legs roll towards the toes and all the muscles gather in front of the feet. On the other hand, if you are not used to walking barefoot, this can also negatively affect the muscles, causing them to strain unnecessarily.

Treatment

Locate the short toe extensor muscles by their contraction as you lift your toes (Fig. 1 0.41). To massage the dorsal muscles, use only your fingertips or a weighted thumb.
These muscles are usually small and thin and do not require much pressure. To massage the interosseous muscles, dip the tips of two fingers or the thumb into the space between the metatarsal bones, above or below them (Fig. 10.42). Figures 10.43 and 10.44 show two other methods for interosseous massage. When the interosseous trigger points are active, it can cause a lot of pain and even trigger cramps if you push too hard. If, in an attempt to cope with a cramp in the arch of the foot, you begin to stretch it, cramps can occur in the interosseous muscles and in the short extensors at the top of the foot. If you are used to stretching your foot, pre-massage will reduce the risk.

The muscles of the thumb of the hand recover from injury quite quickly - within one to two weeks. However, with sufficiently serious and / or chronic injuries of the thumb, damage to the structure of its tendons is often observed. Tendons are practically avascular structures, their blood supply is minimal. They recover from damage about six times slower than muscles. In addition, it is quite difficult to limit the mobility of the thumb during daily activities in order to allow damaged tendons to fully recover and prevent their re-injury.

That is why in the process of recovery after such injuries, the correct approach to therapy is extremely important. The sooner treatment begins, the faster recovery occurs. My first recommendation is not to start therapy immediately after an injury. You should wait at least 3-4 days to allow the scar tissue to fully form, and then you can apply techniques that include friction (friction massage). During the first few days after injury, you can resort to a light and shallow massage - this will help relieve pain and inflammation.

FRICTION APPLICATION

Based on my experience, I can confidently say that the most effective in the treatment of injuries of the tendons of the thumb demonstrate techniques that include friction. You can use your thumb or middle and index fingers to apply frictions. It is best to change your fingers frequently so as not to injure yourself.

Remember that pressure should only be applied in one direction. After you have worked the tendon with frictions in one direction, change the direction of the frictions to the opposite. This will help you avoid fatigue, ensure that all tendon fibers are evenly affected, and reduce the likelihood of discomfort for the client.

Work the tendon fibers in one direction for 4-5 minutes, rest a bit and start working in the other direction - in total you should spend about 8-10 minutes on this.

As the client's condition improves, the duration of therapy can be reduced. After applying the friction massage, you can gently stretch your thumb, hand and forearm.

DETERMINATION OF THE DAMAGED AREA AND THERAPY OF INJURIES OF THE TENDONS OF THE LONG AND SHORT EXTENDERS OF THE THUMB

Determining the damaged area of ​​the tendon of the long or short extensor thumb is a very simple matter. Ask the client to extend the thumb so that the entire structure is in tension. Then apply friction strokes of low or medium intensity across the fibers of the tendon of the short or long extensor thumb (depending on the nature and location of the injury). Do this at various points along the tendon to pinpoint the location of the damaged fibers. Since pain in these injuries does not radiate to nearby structures, the location of damaged fibers can be easily determined by the localization of pain sensations.

Once you have determined which part of the tendon is damaged, ask the client to relax the finger and then proceed with the friction massage. Each stroke should completely cross the damaged area.

This approach is applicable in the treatment of any tendon injury. Remember that it is necessary to determine the location of the damaged area quickly enough - with tendon injuries, prolonged stress
contraindicated.

DETERMINATION OF THE DAMAGED AREA AND THERAPY OF INJURIES OF THE SHORT AND LONG FLEXOR TENDONS OF THE THUMB

The tendons of the long and short flexors of the thumb are not so easily amenable to therapy, and it is also quite difficult to determine the damaged area. We will focus on the tendon long flexor the thumb, since it is this tendon that is most often injured.

With one hand, hold the pad of the thumb as shown in the picture and ask the client to try to bend the finger. With the other hand, palpate the damaged tendon, located in the middle part of the eminence of the thumb (closer to the index finger) along its length, until you find the localization of pain. The client must hold the finger in tension for a while to give you the opportunity to find the damaged area. Once you have identified the damaged part of the tendon, the client can relax the finger. Perform friction at an angle of 90 degrees to the tendon fibers for 4-5 minutes, rest and repeat this action. The total duration of therapy should be 8-10 minutes, excluding one or two breaks.

DETERMINATION OF THE DAMAGED AREA AND THERAPY OF INJURIES OF THE TENDONS OF THE LONG AND SHORT MUSCLE THAT REDUCE THE THUMB

With injuries of the muscles that remove the thumb, the tendon of the long muscle that removes the thumb of the hand, located immediately behind the tendon, most often suffers. short extensor thumb of the hand. That is why we will focus on this particular tendon.

Have the client abduct the thumb to locate the tendon. It is located slightly anterior and posterior to the extensor pollicis brevis tendon. Have the client move their thumb from side to side so that you can separate the abductor thumb tendon longus and the extensor pollicis brevis tendon. They are located very close, therefore, in order to find the tendon of the abductor muscle, a little effort should be applied. Once you have located the tendon, palpate it to pinpoint the damaged area or areas. The main symptom of damage is local pain. Once you have located the damaged areas, ask the client to relax the thumb and proceed with therapy.

DETERMINATION OF THE DAMAGED AREA AND THERAPY OF MUSCLE TENDON INJURIES,
ADDUCTIVE THUMB BRUSH

Place your thumb on the medial interphalangeal joint of the thumb, and ask the client to bring the finger to the other fingers. Use your thumb or other fingers of the other hand to palpate distally and proximal to the interphalangeal joint. Palpate the tendon fibers to locate areas of pain, then ask the client to relax the finger and get to work. As the client's condition improves, include strengthening exercises that the client can do at home. If these exercises cause pain or discomfort, then it is not time to move on to this phase of therapy. Wait at least another week. Start with simple isometric exercises like the ones I'll describe below.

EXERCISES FOR THE CLIENT

I will describe these exercises using only one hand as an example. Ask the client to place the pad of their index finger on the thumbnail and then try to straighten the thumb, holding it in tension for a few seconds. Then ask the client to place upper part index finger under the thumb pad, and then try to bend the thumb, holding it in tension for a few seconds. After that, the client should place the tip of the index finger on the medial part of the thumb between its tip and the first joint, and then try to bring the thumb to the other fingers. The client should then place the tip of their index finger on side surface thumb and try to move it aside.

These exercises allow you to train your thumb in four planes without using any additional sports accessories. I recommend repeating these isometric exercises 5 approaches 4-5 times during the day. I believe that this is the most accessible and effective method strengthening the muscles and tendons of the thumb.

Dr. Ben E. Benjamin

Despite the apparent simplicity of movement, flexion and extension of the toes requires the effort of several muscles. Their well-coordinated work allows not only to move the fingers, but also to raise the foot itself. Interestingly, there is a separate muscle for the thumb, while all the rest move synchronously.

What muscle flexes the fingers

Long extensor toes

The long extensor of the fingers is part of the anterior muscle group of the lower leg and is located along its lateral edge. This anatomical formation begins at the level of the upper third of the tibia, attaching to the anterior edge of the fibula.

Descending towards the foot, the muscular part is transformed into a thin but strong tendon.

It is it that is subsequently divided into four thinner tendon bundles, one for each finger.

The place of attachment is the proximal ("near") phalanx. At the place of fixation, it is additionally divided into three small beams, with which you can use any, even the smallest part of the foot.

The long extensor also has an additional purpose. Together with the synergistic muscle (the third peroneal), it raises the outer edge of the foot, the action is called pronation. If it is firmly fixed, it brings the lower leg closer to it.

Which muscle is responsible for finger flexion

Muscles of the foot: dorsal and plantar

The long finger flexor allows you to properly push off the surface when walking or running. Also, this muscle formation is involved in maintaining the balance of the whole body in a standing position.

This muscle belongs to the posterior group of the lower leg and starts from the posterior surface of the tibia. Descending to the foot through the calcaneus, it is attached from below to the distal phalanges of the 2nd, 3rd, 4th and 5th fingers.

But do not think that the function of this muscle is limited only to the movement of the fingers.

It plays a huge role in the flexion of the foot itself and its supination.

When putting on a toe and maintaining balance in this position, you can’t do without it!

Correct formation muscle fibers, their normal tone allows the arch of the foot to occupy the correct anatomical position. This prevents the formation of flat feet.

How to check the performance of the flexor

Functional Muscle Tests

At various diseases the force of muscle contraction may weaken. In order to find out, there are a number of simple tests:

1. With one hand, the trainer or doctor holds the metatarsus in one position, and with the other, gently but firmly tries to bend the toes. The patient should try to straighten them, tensing the corresponding muscles as much as possible. If successful, muscle strength is assessed as 4 or 5 points (the maximum possible score).
2. The patient lies on his back, a soft roller is placed under his knee (you can roll up a towel). When forcibly holding the metatarsus, you must try to straighten your fingers. (2 or 3 points).
3. The situation is no different from the previous one. A trainer or physician palpates the extensor tendon. With a successful attempt to straighten the fingers, 1 point is assigned.

Normally, the muscle strength of a healthy person is estimated at 5 points. With insufficient nutrition or tissue innervation, it gradually decreases.

All exercises must be done carefully so as not to get an ankle sprain.

How does the thumb move?

Finger extensor stretch

The mechanics of his movements depends on several muscles at once. Such a complex anatomy is explained by the fact that it is this finger that largely ensures the balance of a person and makes him upright.

The long flexor of the thumb belongs to the posterior muscle group of the lower leg and, descending to the plantar part, is transformed into a tendon.

Interestingly, in the groove between the calcaneus and talus, the tendon of the pancake flexor of the thumb "gives" some of the fibers to the tendon of the long flexor.

Thus, this muscle is involved in the flexion of all toes to a greater or lesser extent.

The long extensor of the thumb belongs to the opposite, anterior group of muscles of the lower leg. At the same time, going down, it passes into a thin, but very strong tendon of the long extensor.

Why muscle function can be impaired

Various diseases of muscle tissue and tendons can affect the quality of their work. decline muscle tone can happen for several reasons:

• senile (age-related) atrophy due to metabolic disorders;
• failure of the endocrine system;
• chronic and systemic connective tissue diseases;
• fertentopathy, genetically determined diseases;
• polyneuritis, polyneuropathy of peripheral nerves;
• post-traumatic complications;

Separately, it is worth talking about tendinitis. With this disease, the tendon tissue of the long extensor of the big toe suffers, the cause is acute inflammation. Muscle structures of various sizes can also be involved in this pathological process. Dystrophic processes under certain favorable conditions can become chronic.

In diabetes mellitus, polyneuropathy of the lower extremities can lead to significant and serious tissue malnutrition at the local level.

A frequent complication of this disease is progressive lameness, problems with trophism up to the formation of dry gangrene.

With prolonged systemic use of certain medications, persistent pain in the foot may occur. This is due to the deposition of salts in the bone tissue, the formation of neoplasms or growths.

Valgus or varus deformity of the foot is one of the main non-surgical problems in traumatology. Its curvature with deviation inward or outward not only does not look aesthetically pleasing, but also significantly reduces the quality of life.

The foot remains mobile due to the presence various kinds muscles in its structure, including the short extensor of the big toe. Short muscles are those muscles that do not go beyond the area of ​​\u200b\u200bthe foot. The long ones are based at the ankle and attached to the foot. The most important function of these muscles is considered to be the flexion and extension of all fingers and the movement of the phalanges located on the feet.

Muscles localized in the toes are responsible for performing the correct movements of the bone levers in the ankle joint, and if they are damaged, the functioning of this entire department is disrupted. In the structure of the foot there are short and long muscles. There are also several flexors of the fingers: a short flexor of the foot of the little finger and other fingers. Foot mobility is provided by two extensor tendons.

short muscles

The extensor digitorum brevis is a muscle that looks like a wide, flat band that runs along the outside of the foot. It is attached to the heel bone, from where it moves to the fingers and there it is already transformed into three tendons. At the very top, they connect with other tendons, and then attach to the phalanges. The muscle is nourished with useful substances by the bloodstream, which moves along the tibial artery, and the supply of nerve sensitivity to these tissues is provided by the peroneal nerve.

long muscles

The long extensor of the big toes is attached to the tibia at one end, and at the other to the phalanges. Its main function: flexes the thumb, unbends it. The extensor unites with the so-called square muscle and is divided into four tendons. All these tendons are attached to the four phalanges on the lower extremities, which allows you to bend and unbend the foot and move it in different directions. foot is located on the side of the lower leg on its outer side and is attached to the tibia. Further, it passes through the region of the lower leg and, penetrating the structure of the foot, is divided into five processes that are attached to the phalanges. This structure is responsible for the extensions and folds. lower limb, its supination and is responsible for rotational movements.

Diseases and injuries of the long extensor are dangerous because they severely limit the mobility of the injured limb. For example, with tendinitis of the long extensor tendon, it becomes impossible to bend and straighten the fingers, the gait is disturbed, such a condition without proper treatment can lead to disability.

Strengthening the feet with exercise therapy

The extensor of the big toe can be strengthened so that it is not damaged by excessive stress or various diseases. For this, various physical therapeutic exercises. Such measures are considered an excellent prevention of leg pain.

There is such a term as the core of the legs, which means the totality of all the small muscles and tendons that stabilize the body during activity and movement. The function of these fabrics is to reduce and absorb the impact of walking while maintaining balance throughout the body. When these muscles are weakened exercise stress passes to the plantar fascia, in which, due to overstrain, pathological processes develop. The weakening of the ligamentous apparatus over time provokes a change in gait and becomes the root cause of the occurrence of pathologies in the knee and hip joints and also causes disorders in the spine.

To strengthen the tendons and muscles of the foot, it is necessary to perform therapeutic exercises several times a week. The advantage of such physical education is that anyone can perform it at home. Below are some of the exercises that help strengthen the ligamentous apparatus on the legs.

• You should take a towel with your toes and stretch it around the room for several meters. Next, form a lump from this towel with your fingers. Grab the towel again and move it in the opposite direction. Repeat using the other lower limb.
• Scatter small objects on the floor - buttons, medium-sized balls and sit on a chair. Now try to collect these items of the feet in some kind of box. Repeat with the other leg.
• The first few times this exercise is carried out in a sitting position, then standing. You should put your foot on the floor, then pull your fingers towards you and at the same time you need to form an arc with your feet.
• Sit on the floor, legs extended forward in a straight position. Now you need to tighten the foot and stretch it in such a way as if you were standing on heels. Fix the position and try to slowly turn the foot towards you. Repeat several times.

Noticeable results can be seen after a few months. regular classes. The muscles are gradually strengthened, the arch of the foot rises. Blood circulation improves, the sensitivity of the foot increases, the stability of the whole organism is restored.

The long flexor thumb is located deep under the gastrocnemius and soleus muscles and
covers the posterior tibial muscle. The muscle is located laterally on the back surface
shins. The belly muscle attaches to the posterior surface of the fibula, joining the tibialis posterior and flexor digitorum longus just behind the medial malleolus.

These muscles pass through the tarsal canal, formed by the medial surface of the calcaneus and the fibrous plate of the flexor tendon retinaculum. In structure and function, this structure is identical to the carpal tunnel. The tibial artery and tibial nerve also pass through the tarsal canal.

flexor hallucis longus, flexor digitorum longus and posterior tibialis muscle produce inversion of the foot and plantarflexia of the ankle. In addition, the flexor thumb longus flexes the thumb at the metatarsophalangeal and interphalangeal joints. This movement is necessary in the take-off phase of walking for efficient energy transfer. The center of gravity shifts from the heel through the foot to the big toe at the end of the stance phase and the energy generated by the hips, knees and shins passes through the foot and big toe, moving the human body forward.

The flexor hallucis longus plays a significant role in directing this energy. In addition, the long flexor of the big toe is involved in providing dynamic stabilization of the medial arch of the foot. Together with other muscles passing through the tarsal canal and the muscles of the foot, the long flexor of the thumb controls the pronation of the foot during walking, running and jumping. The long flexor of the big toe provides effective grip of the foot with the surface and helps us to effectively maintain balance when walking.

Problems with this muscle can flatten the medial arch of the foot and destabilize the ankle, resulting in pain, loss of sensation, and gait disturbance when walking.

Palpation of the long flexor of the big toe

The client lies on his stomach

1. Standing at the client's feet, use your thumb to locate the medial malleolus.

2. In a smooth sliding motion, slide your thumb into the space between your ankle and Achilles tendon. (Caution: the tibial artery and nerve also pass through this area. Move your finger if the client feels tingling and numb, and if you feel a pulse.)

3. There are three tendons in this area. Palpate the tendon located most
is the tendon of the long flexor of the big toe.

4. Ask the client to bend their thumb to make sure you did everything right.

CLIENT EXERCISE: SEATED TOE STRETCH

1. Sit on the floor with your feet straight in front of you.

2. With your knees relaxed, bend at the waist and lean forward.

3. Take the big toe with your fingers.

4. Gently pull your thumb back towards your knee for 5-10 seconds, then release.

This exercise can be done with all toes.