Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y1 - Pathomechanics > 2-Rearfoot Varus > Flashcards

2-Rearfoot Varus Flashcards

1
Q

trendelenburg gait:

define

A
  • hip ABductors (gluteus MED/MIN) are not working properly
  • trunk LEAN TO the same side as the hip pathology (ipsilateral lean); meaning the lesion is on the contralateral side
    • https://www.youtube.com/watch?v=Rz7V1i8kYGU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ataxic gait:

define

A
  • the presence of abnormal, “jerky”, uncoordinated movements
  • wide base of gait
  • aka “drunken sailor gait”
  • caused by upper motor neurons

https://www.youtube.com/watch?v=020YoEy4eLA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

High Steppage/ Foot slap gait:

define

A
  • patient compensates by lifting affected foot higher than normal;
  • caused by (common peroneal nerve palsy –> can’t control anterior compartment group –> can’t dorsiflex their foot) –> causes foot drop due to inability to dorsiflex the foot

https://www.youtube.com/watch?v=jzJIpY6vRLo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

circumductive gait:

define

A
  • patient abducts her thigh and swings her leg in a semi-circle to attain adequate clearance for foot
  • unable to achieve adequate clearance for the foot to move through the swing phase on the affected side
  • causes incl: probs w/ hip/knee flexion or ankle dorsiflexion

https://www.youtube.com/watch?v=Q98WKpwIpkE&t=39s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

calcaneal gait/ triceps surae gait:

define

A
  • characterized by walking on the heel –> high contact pressure on heel
  • due to paralysis of the calf muscles –> overcompensation of anterior compartment (abnormal firing)
  • caused by poliomyelitis and in some other neurologic diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are following abbreviations:

STJ

MTJ

STJNP

RCSP

NCSP

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

relaxed calcaneal stance position (RCSP):

define

A

position of calcaneus relative to ground after all compensation has occurred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

neutral calcaneal stance position (NCSP):

define

A

position of calcaneus relative to the ground when STJ is in neutral position

**neutral does not necessarily mean parallel or perpendicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

From subtalar joint neutral position,

how much inversion/eversion?

A

twice as much supination/inversion of foot as pronation/eversion

(2:1 ratio)

2 degrees supination - 1 degree pronation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the ideal position of the foot in subtalar joint neutral position?

A

foot is NEITHER pronated NOR supinated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the relationship of forefoot and rearfoot when foot is:

in STJNP w/ the MTJ maximally pronated and locked?

A

when in this pronated position:

  • the forefoot to rearfoot should be perpendicular;
  • w/ mets 1-5 perpendicular to bisection of posterior calcaneus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

in normal foot w/ STJNP with MTJ maximally pronated and locked;

how much ankle dorsiflexion should there be with the knee extended?

A
  • You must have 10 degrees of DF of the foot relative to the leg with the knee extended.
  • This measurement mimics the position that occurs at 50-60% of stance phase, right before heel off
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which plane influence that could cause hyperpronation of the foot?

A

None!

There is no significant transverse or frontal plane influence on the foot from
the leg that would cause significant hyper-pronation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which plane determines the position of the calcaneus at heel strike?

A

• Frontal plane development of the foot and leg determines the position of the
calcaneus at heel strike

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

**angle at which “normal foot” strikes the ground?

why?

A
  • “normal” foot strikes the ground 2-3 degrees inverted
  • **because the STJ is supinated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how to calculate STJNP?

A

STJNP = (TROM/3) – eversion

e.g.

25 degrees inversion, 5 degrees eversion: (30/3) – 5 = 5 degrees
inverted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

*how to calculate available motion?

A

Available Motion = (TROM/3)

e.g.

  • 25 inversion, 5 eversion, STJNP 5 inverted, 5 tibial varum
  • Foot is contacting ground at 10 inverted (STJNP + tibial)
  • Total motion available = (TROM/3) = 10 (so this patient would be able to fully compensate for their RF varus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how to evaluate forefoot to rearfoot relationship?

(clinically)

A
  • put pt in PRONE (lying w/ feet off table)
  • find STJNP (palpate talonavicular joint congruency)
  • maximally pronate and lock MTJ (apply pressure to submet 4/5)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

“normal” forefoot to rearfoot relationship?

A

Mets 1-5 are in SAME PLANE, and perpendicular to calcaneal bisector

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

rearfoot varus:

define

A

any condition in the frontal plane that will cause the calcaneus to strike the ground more than 2-3 degrees inward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

list the conditions that can result in rearfoot varus?

(proximal –> distal)

A
  • coxa valga genu varum
  • tibial varum
  • talar varum
    • talar epiphyseal varum
  • subtalar varum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

coxa valga genu varum:

define, and causes

A
  • bow-legged, isolated closure of proximal medial epiphysis)
  • examples:
    • Ricket’s (children, vitamin d deficiency)
    • Blount’s (a growth disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

tibial epiphyseal varum:

define

A
  • progressive pathologic genu varum centered at the tibia –> pathologic genu varum in children 2 to 5 years of age
    • M>F
    • bilat in 50% of cases
  • aka infantile blount’s disease
24
Q

what happens at heel strike if foot is inverted too much

A
  • Calcaneus MUST EVERT via STJ pronation to bring the medial column of the
    foot down to the ground
    • e.g. if calcaneus is inverted 8 degrees at heel strike, the STJ must
      pronate      8 degrees tofully compensate
    • *Only occurs if motion is available –> if not sxs develop
25
Q

when referring to compensation, what joint is moving?

A

compensation refers to subtalar joint

26
Q

how are the types of rearfoot varus defined?

A
  • defined by the amount of achievable compensation
  • each type has its own characteristic sxs
27
Q

describe the compensation of rearfoot varus deformities?

A
  • Rearfoot Varus deformities will compensate to perpendicular, but not further
    • STJ pronates
    • MTJ partially UNLOCKS
    • Forefoot ABDucts on the rearfoot
28
Q

uncompensated rearfoot varus:

define

A
  • no available motion at the STJ <– so calcaneus can’t evert
  • calcaneus is forced to function in an INVERTED position throughout the entire stance phase of gait
29
Q

uncompensated rearfoot varus:

possible etiologies

A
  • tarsal coalition
  • STJ trauma
  • muscle spasticity (UMN problem)
  • LMN or other disease state
  • bowing of calcaneus (intrinsic deformity, structural w/in calcaneus, requires osteotomy)
30
Q

uncompensated rearfoot varus:

clinical signs

A

“peeking heel sign” is intrinsic deformity of the calcaneus itself

high arch, tending to be on lateral arch;

(forefoot has adducted/supinated appearance relative to rearfoot)

31
Q

which gene is associated w/ Charcot-Marie Tooth?

A

PMP22 duplications lead to Charcot-Marie-Tooth disease type 1A (CMT1A)

32
Q

Charcot-Marie Tooth:

type of disorder, sxs, muscle sxs

A
  • Lower motor neuron disorder (demyelinating polyneuropathy) <– needs neuro workshop
  • sxs:
    • poor muscle definition
    • extreme cavo-varus
    • extensor substitution hammertoes
    • inverted champagne bottle legs
  • muscle sxs:
    • peroneal musculature atrophy although anterior compartment (atrophies 1st)
    • unopposed posterior compartment maintains plantarflexion,
    • lesions submet 1/5
    • inc risk of lateral ankle sprains
33
Q

what is the characteristic description of Charcot Marie Tooth?

A

inverted champagne bottle legs

34
Q

what occurs if the rearfoot can’t compensate for the varus, but forefoot can?

A
  • Brings medial forefoot down to ground – TRIPOD EFFECT
    • Calcaneus, 1 and 5 are points of contact
  • 1st ray axis motion: DF/inv and PF/ev
    • 1st Ray PF and everts on its axis through action of Peroneus Longus
35
Q

relationship of metatarsals in uncompensated rearfoot VARUS, when the 1st ray is plantarflexed?

A
  • 1-5 relationship to calcaneus is everted relative to the calcaneal bisector
  • 2-5 is perpendicular
36
Q

since the first ray compensates in a case of uncompensated rearfoot varus,

which deformities will NOT occur?

A

hallux abductovalgus, hallux limitus/ hallux rigidus will not occur

  • No hypermobility, 1st ray is stable on ground –> but it may cause excess plantarflexion –> retracted position of hallux
  • However a cock-up hallux may develop as a result of the plantarflexion
37
Q

uncompensated rearfoot varus:

symptoms (arch and digits)

A
  • High-arched (Cavus) foot type
    • Maintained inversion of heel, PF 1st ray
    • Poor shock absorption – can present with heel pain syndrome (increased pressure, displacement of medial fat pad)
  • Digital contractures
    • Intrinsic muscles unable to stabilize proximal phalanx to ground, buckling
    • Mechanical advantage to a contracted position (extensor substitution)
38
Q

uncompensated rearfoot varus:

symptoms (sesamoids, sprains)

A
  • Tibial sesamoiditis: secondary to PF and everted position of the metatarsal
  • Increased incidence of bipartite sesamoids
    • to confirm, may get X-ray of contralateral side
  • predisposed to repeated lateral ankle sprains secondary to fixed supinated position
    • injury to ATFL, CFL, PTFL, avulsion fracture, and ankle fracture
39
Q

uncompensated rearfoot varus:

symptoms (skin, shoes, joints)

A
  • Callus along lateral column of foot
  • hyperkeratotic lesions on submet 1 and 5
  • Lateral shoe wear (increases chance of lateral ankle sprain)
    • ask pt if they’ve noticed a change in the wear pattern of their shoes
  • Lower back & lateral knee pain
40
Q

Iselin’s disease:

define, and type of deformity assoc. w/ it

A
  • painful inflammation of the apophysis (growth plate) at the base of the 5th met
    (aka apophysitis of 5th met base in children)
  • occurs in uncompensated rearfoot varus
41
Q

how can you differentiate Iselin’s disease from a fracture of the 5th met base?

A

The direction of the fracture line

  • Iselin’s disease = longitudinal
  • fracture = transverse
42
Q

where is the characteristic lesion pattern for uncompensated rearfoot varus?

why?

A

hyperkeratotic lesions on submet 1 and 5

  • Supination creates increased lateral pressure
  • 1st ray is plantarflexed – under tibial sesamoid (everted metatarsal)
  • Increased pressure during stance, especially propulsion

Pt can also have pain w/o callus formation

43
Q

treatment for uncompensated rearfoot varus?

A
  • palliative = debride lesions
  • orthotics <– goal is to stabilize high arch, redistribute weight away from met heads
    • forefoot extension
    • deep heel cup to shift fat pad back
    • lateral dutchman heel on shoe to prevent supinatory motion/prevent sprains
    • padding to offload tibial sesamoid
44
Q

compensation is relative to which joint?

A

subtalar joint

45
Q

partially compensated rearfoot varus:

definition/ motion

A
  • Some STJ pronation available
    • Calcaneus everts, but not enough to fully compensate
    • Medial forefoot doesn’t come all the way down to ground
    • May have proximal varum deformity which leads to an excessively inverted position at contact which the STJ can’t fully compensate for
  • Calcaneus still functions in an inverted position, lateral heel contact
46
Q

are sprains and lateral shoe wear seen more frequently in UNCOMPENSATED or PARTIALLY COMPENSATED rearfoot varus?

A

Sprains and lateral shoe wear seen MORE frequently in uncompensated

47
Q

partially compensated rearfoot varus:

clinical symptoms

A
  1. pump-bump (NOT A HAGLUNDS) - irritation on posterolateral calcaneus
  2. tailor’s bunion - **hallmark of partially compensated RF varus
    • bowing and splaying of 5th metatarsal
    • heloma molle
  3. 1st ray sxs
    • if hypermobile –> HAV + tailors bunion –> splay foot type
    • if PF of 1st met –> less severe, less symptomatic, may have callus or bipartite sesamoid
  4. lesions under submet 4/5 and pinch callus (at submet 1)
    • due to lateral foot contact first, then medial shift –> abductory motion on hallux
48
Q

pump bump:

assoc. w/ which deformity?

define

tx

A
  • assoc. w/ PARTIALLY compensated rearfoot varus
  • def: Enlarged posterolateral surface of calcaneus due to irritation/friction on posterolateral calcaneus due to eversion
    • aka: Retroachilles and/or retrocalcaneal bursa/irritation
  • tx:
    • Orthotics (decreases need for compensation)
    • NSAIDs (anti-inflammatory)
    • Injections – into bursa, avoid tendon (can rupture/break down)
49
Q

Haglund’s deformity:

assoc. w/; define

A
  • assoc. w/ cavus foot
  • def: bony enlargement on the back of the heel due to increased calcaneal pitch w/ prominence of posterosuperior calcaneus centrally
50
Q

Tailor’s bunion:

assoc. w/, define, tx

A
  • assoc: hallmark of partially compensated RF VARUS
  • def: Bowing/splaying of 5th metatarsal
    • Eversion/pronatory motion trying to bring medial forefoot down to the ground
    • Hypermobility of 5th ray axis
    • Prominent 5th met head, adductovarus 5th digit
    • *Heloma molle (soft corn) in 4th interspace
  • tx:
    • 5th metatarsal osteotomy/ ostectomy – depending on severity
    • digital derotational arthroplasty
51
Q

fully compensated rearfoot varus:

position and motion

A
  • Pronation available at STJ is equal to the amount of varus at heel strike
  • Heel can function perpendicular to the ground in stance
  • Forefoot is fully on the ground and weightbearing
  • Rapid contact phase pronators – heel everts to perpendicular
    • when you have heel contact; it gets into perpendicular position
52
Q

fully compensated rearfoot varus:

relationship of FF to RF

A
  • Forefoot ABDUCTS relative to the rearfoot
    • maintain an arch despite the hyperpronation
    • calcaneus ONLY compensates to perpendicular, so talus CANNOT diverge medially
    • medial bowing of achilles
53
Q

fully compensated rearfoot varus:

symptoms (achille’s and 1st ray)

A
  • Helbing’s sign – medial bowing of the achilles
    • due to eversion motion and if fully compensating for tibial./genu varum (not STJ varum along)
  • 1st Ray Hypermobility
    • Sagittal plane issue
    • Unlocking STJ and MTJ via pronation unlocks the 1st ray as you bear weight
    • Ground forces push up on the metatarsal which can cause jamming at the 1st MPJ, leading to HL/HR
    • Will only develop HAV if forefoot adducted on Rearfoot
54
Q

fully compensated rearfoot varus:

sxs (OTHER than achille’s/1st ray)

A
  • these do NOT develop lateral foot symptoms
  • pump bump
  • leg cramps; and postural changes
  • pain submet 2 (secondary to hypermobile 1st ray)
  • hammertoes (secondary to fatigue of intrinsics)
    • retracted position of toes –> anterior displacement of fat pad –> inc. submet pressure (metatarsalgia)
  • lesion patterns
55
Q

fully compensated rearfoot varus:

lesion pattern

A
  • Submet 2 – hypermobilltiy of 1st ray transfers weight laterally (so pressure is submet 2)
  • Plantar hallux IPJ – in HL/HR, limited ROM at 1st MPJ, so the IPJ compensates
56
Q

fully compensated rearfoot varus:

treatment

A
  • ORTHOTICS
    • Neutral position orthotics with medial Rearfoot post
    • Supports deformity, maintains RF in inverted position, controls frontal plane motion, foot does not have to pronate to reach ground ––> eliminates need for compensation (preventing sxs)
  • SURGERY
    • to address symptoms, will still need to control with orthotic post op

Y1 - Pathomechanics (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions