Jacks Test

jacks
Jacks Test (or the Hubscher maneuver) is a clinical test that is used to test the integrity of motions and forces at the first metatarsophalangeal joint and the windlass mechanism of the foot. The aim of the text is to dorsiflex the hallux while the foot is weightbearing and determine how hard the hallux is to dorsiflex and and easy it is to raise the arch of the foot during the test. This information is often used to guide interventions when there are problems with function of the joint and the integrity of the windlass mechanism at supporting the arch of the foot. It was originally described in the context of surgery for flat foot. There have been questions about the test’s validity, but it is still widely used in clinical practice.

Homeopathy for Bunions

Homeopathy for bunions does not work. It can not work as homeopathy does not work for anything. The scientific evidence on it is really clear. There is plenty of that evidence and it all shows that it does not work. Homeopathy is no better than a placebo. Any ‘clinical’ effect of it that is seen is due to that placebo effect. Those that promote homeopathy grasp at straws, misrepresent bad research and use all sorts of logical fallacies, data dredging and special pleading. They still do not get it. All the scientific investigations and government reports show that it does not work and can not or will not work. If it does not work for anything, then it can not work for bunions.

Hallux Rigidus

Hallux rigidus is not a bunion, but still affects the same joint as bunions – the first metatarsophalangeal joint. Like the bunion (hallux valgus), the term hallux refers to the big toe, so hallux rigidus is a rigid big toe. This means that there is no motion or next to no motion in that joint. When there is very limited motion it is often accompanied by osteoarthritis, though there can be some confusion about this.

The problem is often caused by osteoarthritis and there may be history of an old injury to the joint.

The consequences of a hallux rigidus is that it alters the way you walk. The big toe joint is so crucial for normal function, as it has to bend so the body can move forward over the foot. If the big toe joint does not move, then that movement has to be achieved by movement at other joints, which may or may not be able to take it. If they can’t then this can cause problems in those other joints.

The conservative treatment for hallux limitus is pain management initially, the use of physical therapy and the use of stiffer shoes or a rocker sole shoe to stop the joint from moving as much. Often the conservative treatments are not that satisfactory (just look at all the questions in forums about it!). Surgical options range from a fusion of the joint to help with the pain; to the removal of any bony blocks that is causing a limitation in the motion; to a type of joint replacement with a spacer in the joint.

Functional Hallux Limitus

Functional Hallux Limitus is a hypothetical problem that, like bunions, affects the first metatarsophalangeal joint. It is hypothetical as there is some controversy about it. Functional hallux limitus is defined as a condition in when the first metatarsophalangeal joint has a full normal range of motion during non-weightbearing, but during the weightbearing gait the joint just does not seem to want to bend. As a results there are some compensations, such as “overpronation”, elsewhere in the foot that can result in symptoms.

There are a number of different pathomechanical entities that can cause functional hallux limitus. Most of these exert there effect by preventing plantarflexion of the first metatarsophalangeal joint

If it is present then the standard approach to treatment is to use foot orthotic designs that facilitate motion of the joint by allowing plantarflexion of the foot.

Just to be clear: Bunions terminology

A bunion is really just an enlargement of the joint, typically the big toe joint. Invariably it is mostly bone, but there is often some bursa and soft tissue swelling involved as well.

Hallux Valgus is the term that was traditionally used to describe the angulation of the big toe (hallux) over towards the lessor toes. However, valgus is a term that describes a position in the frontal plane, whereas that angulation of the big toe over towards the lessor toes occurs in the transverse plane, so it should have been called hallux abductus and not hallux valgus. But, as well as abducting in the transverse plane, the hallux does also rotate in the frontal plane, so it does go into valgus in that place.

For the technically correct use of terminology, the correct term should be hallux abducto-valgus (HAV)