The importance of First Ray Function in Chronic Plantar Heel Pain

Chronic heel pain is one of the most common foot and ankle pathology that affects thousands of people every day. Common injuries include, plantar fasciitis, fat pad atrophy, bone oedema and nerve entrapments just to name a few. There are many risk factors for these injuries, including biomechanical issues, footwear and foot type for example.

However, one often-overlooked contributor is the function (or lack thereof) of something called the first ray. The first ray is primarily made up of bones including the first metatarsal, medial cuneiform, and the 1st metatarsophalangeal joint (the big toe joint).

The first ray’s mobility, alignment and range of motion play a crucial role in foot biomechanics, especially in two areas: the efficiency of the windlass mechanism and shock absorption. These are both important in preventing, managing and resolving heel pain.

What is the windlass mechanism?

The windlass mechanism is an important part in foot function. Simply put, it refers to the tightening of the plantar fascia as the toes dorsiflex (bend upwards) during gait. The tension created supports the main arch of the foot (the medial longitudinal arch) and stabilises the foot, to be ready for efficient propulsion, a ‘heel to toe’ gait.

If the first ray mechanism is restricted or hypermobile, it can cause the windlass mechanism to fail, leading to increased strain on the plantar fascia. This is often a major contributing factor to chronic heel pain.

How can we assess the windlass mechanism?

Our Melbourne podiatrists can assess the function of the windlass mechanism with a clinical tool called Jack’s Test.  This assesses the quality of the windlass mechanism. The test involves the podiatrist dorsiflexing (bending up) of the hallux (big toe) while the patient stands with their feet relaxed, in their ‘resting position’.

A positive result is when there is a visible elevation of the arch. This indicates a functioning windlass mechanism. On the other hand, a failure of the arch to elevate or restriction of the 1^st MPTJ during this test can signal a dysfunctional first ray. This often indicates biomechanical issues that may underlie chronic heel pain that need further assessment.

Our foot is our suspension – shock absorption

Poor first ray function also impairs the foot’s ability to absorb shock. During the loading phase of gait, a properly functioning first ray allows the foot to adapt to uneven surfaces and effectively deal with ground reaction forces. If the first ray is too rigid or hypermobile, it can reduce the foot’s natural shock-absorbing capability. This often results in the stress being transferred to the heel, resulting in mechanical overload and therefore leading to heel pain.

Can you treat 1^st ray dysfunction

In short – yes, in most cases you can. Podiatry treatment can include:

• Orthotics (to help support the arch to keep the first ray at the best possible angle to allow optimal 1^st ray function).
• Footwear advice and modification.
• Strengthening exercises (for certain muscles and tendons)
• Stretches (often aimed at increasing range of motion)
• Mobility (gentle manipulations of the bones and joints involved in the 1^st ray)
• Gait retraining

Melbourne Podiatrists & Orthotics can help you with your chronic plantar heel pain

By restoring or optimising first ray mechanics, our Melbourne podiatrists can enhance the windlass mechanism, improve shock absorption, and reduce stress on your plantar heel pain.

We deal with diagnosing and treating chronic heel pain every single day. We understand 1^st ray function and its influence on the windlass mechanism and shock absorption, enabling us to provide a comprehensive approach to diagnosis and treatment.

So if you are suffering from chronic plantar heel pain or plantar fasciitis, please be sure to make an appointment with one of our Melbourne Podiatrists today.

Do you suffer with plantar heel pain?

At our Melbourne foot clinic our podiatrists are experts in plantar heel pain and plantar fasciitis treatment.

So if you suffer from plantar heel pain, book an appointment with one of our friendly podiatrists today!