Patients with low back pain due to L5 and S1 nerve root stimulation are often accompanied by calf fistulas, especially at night. Strong calf muscles are responsible for walking on your toes. These muscles are particularly important in the push-out phase of walking on horizontal surfaces as well as on slopes and steps.
In order to be able to test the strength of the calf muscles, the best way is to have the patient stand on one leg. The patient then lifts the heel off the floor. Typically, there is at least a 5" span between the floor surface and the lower heel surface.
When examining a patient's toe walk, it is not only necessary to assess the ability to perform this type of walking, but also to assess the patient's ability to raise the heel by about 4-5".
Similarly, when the patient is instructed to walk on the heel, there should be at least a 3-3.5 inch span between the floor and the lower surface of the large toe joint known as the first metatarsal joint.
The muscles that perform the ankle flexion are:
- medial gastrocnemius [L5, S1 through the phrenic nerve]
- lateral gastrocnemius [L5, S1 through the phrenic nerve]
- The soleus muscle [L5, S1 through the phrenic nerve]
- posterior tibial muscle [L5, S1 through the posterior tibial nerve]
- Long toe of the flexor digitorum [L5, S1 through the posterior tibial nerve]
- Long flexor hallucis [L5, S1 through the posterior tibial nerve]
- Long humerus [L5, S1 through the supraorbital nerve]
- Short humerus [L5, S1 through the superior phrenic nerve]
Orignal From: Low back pain - squat foot flexion
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