2- The Foot: Mechanics and Diagnosis (Tabor)

Question 1

How fast does she go?

Answer 1

SO FAST

Question 2

What is the function of the medial longitudinal, lateral longitudinal, and transverse arch?

a) raise the foot to withstand impact of running
b) support your heel to prevent fracture during a stride
c) distribute weight bearing forces across the entire foot

Answer 2

c) distribute weight bearing forces across the entire foot

Question 3

Which ligament(s)/tendon supports the medial longitudinal arch?

a) spring ligament
b) long plantar ligament
c) short plantar ligament
d) tendon of peroneus (fibularis) longus
e) plantar calcaneonavicular ligament

Answer 3

a) spring ligament
e) plantar calcaneonavicular ligament

the spring ligament IS ALSO KNOWN as the plantar calcaneonavicular ligament

Question 4

Which ligament(s)/tendon supports the lateral longitudinal arch?

a) spring ligament
b) long plantar ligament
c) short plantar ligament
d) tendon of peroneus (fibularis) longus
e) plantar calcaneonavicular ligament

Answer 4

b) long plantar ligament

c) short plantar ligament

Question 5

Which ligament(s)/tendon supports the transverse arch?

a) spring ligament
b) long plantar ligament
c) short plantar ligament
d) tendon of peroneus (fibularis) longus
e) plantar calcaneonavicular ligament

Answer 5

d) tendon of peroneus (fibularis) longus

Question 6

Which bones form the medial longitudinal, lateral longitudinal, and transverse arch respectively?

Answer 6

Medial Longitudinal - calcaneus, talus, navicular, cuneiforms, and 3 metatarsal

Lateral longitudinal arch = calcaneus, cuboid, lateral 2 metatarsals

transverse arch = cuboid, cuneiforms, and bases of metatarsals

Question 7

what forms the keystone of the medial longitudinal arch?

Answer 7

the head of talus

Question 8

What are specific tests for diagnoses clinical foot problems?

Answer 8

1) palpation of plantar fascia for tenderness

2) palpation of navicular, cuboid, and cuneiforms for flatening of the arches

Question 9

What is the common somatic dysfunction for the cuboid?

a) glides directly toward the plantar surface
b) lateral edge glides toward plantar surface; rotates medially around an AP axis
c) lateral edge glides toward plantar surface; rotates laterally around an AP axis
d) medial edge glides toward plantar surface; rotates medially around an AP axis
e) medial edge glides toward plantar surface; rotates laterally around an AP axis

Answer 9

e) medial edge glides toward plantar surface; rotates laterally around an AP axis

Question 10

What is the common somatic dysfunction for the navicular?

a) glides directly toward the plantar surface
b) lateral edge glides toward plantar surface; rotates medially around an AP axis
c) lateral edge glides toward plantar surface; rotates laterally around an AP axis
d) medial edge glides toward plantar surface; rotates medially around an AP axis
e) medial edge glides toward plantar surface; rotates laterally around an AP axis

Answer 10

b) lateral edge glides toward plantar surface; rotates medially around an AP axis

Question 11

What is the common somatic dysfunction for the cuneiforms?

a) the 2nd glides directly toward the plantar surface
b) the 4th glides directly toward the plantar surface
c) the 2nd glides directly toward the dossal surface
d) medial edge glides toward plantar surface; rotates medially around an AP axis
e) medial edge glides toward plantar surface; rotates laterally around an AP axis

Answer 11

a) the 2nd glides directly toward the plantar surface

Question 12

A 40 yo pt comes in complaining of severe discomfort in their feet and foot problems. You suspect that a supporting arch has collapsed causing Pes Planus. After analyzing their gate you notice over-pronation (i.e. flat feet). What else would you see in the talus?

a) talus drops inferior and laterally
b) talus drops inferior and medially
c) talus rises superior and laterally
d) talus rises superior and medially

Answer 12

b) talus drops inferior and medially

Question 13

A 26 yo female pt comes in complaining of foot pain. Her hx is significant for repetitive steroid injection. After taking off her high heel shoes that were way too tight for her large feet, you notice upon gait examination that she over-uses her feet with heel strikes. What do you suspect is the issue?

a) Plantar fasciitis
b) Calcaneal fat-pad atrophy/ Heel spur syndrome
c) Morton’s Neuroma
d) Morton’s Toe
e) Hallux Valgus

Answer 13

b) Calcaneal fat-pad atrophy/ Heel spur syndrome

Question 14

A 26 yo female pt comes in complaining of foot pain. Her hx is significant for repetitive steroid injection. After taking off her high heel shoes that were way too tight for her large feet, you notice upon gait examination that she over-uses her feet with heel strikes. You suspect Calcaneal fat-pad atrophy/ Heel spur syndrome is the issue. What may be the cause of her pain?

a) repetitive micro trauma leading to chronic inflammation and heel spur formation
b) having a first toe shorter than the second toe
c) repetitive micro damage to the nerve fibers that has produced degeneration and reparative fibrosis
d) irritation of the medial branch of the tibial nerve
e) hypermobility of the first metatrsocuneiform and high heels

Answer 14

d) irritation of the medial branch of the tibial nerve

Question 15

A 26 yo Army male pt comes in complaining of foot pain. He complains that thee pain is most intense first thing in the morning or after he has been standing attention all day. When he was a kid, his mom (which was a nurse) used to tell him all the time that he had flat feet and a tight Achilles tendon. What do you suspect is the issue?

a) Plantar fasciitis
b) Calcaneal fat-pad atrophy/ Heel spur syndrome
c) Morton’s Neuroma
d) Morton’s Toe
e) Hallux Valgus

Answer 15

a) Plantar fasciitis

Question 16

A 26 yo Army male pt comes in complaining of foot pain. He complains that thee pain is most intense first thing in the morning or after he has been standing attention all day. When he was a kid, his mom (which was a nurse) used to tell him all the time that he had flat feet and a tight Achilles tendon. You suspect plantar fasciitis is the issue. What may be the cause of his pain?

a) repetitive micro trauma leading to chronic inflammation and heel spur formation
b) having a first toe shorter than the second toe
c) repetitive micro damage to the nerve fibers that has produced degeneration and reparative fibrosis
d) irritation of the medial branch of the tibial nerve
e) hypermobility of the first metatarsocuneiform and high heels

Answer 16

a) repetitive micro trauma leading to chronic inflammation and heel spur formation

Question 17

A 48 yo m athletic trainer presents with a tingling/burning sensation radiating to his toes with intermittent symptoms of sharp and shooting pain. Originally it started as a dull ache/cramping sensation, with numbness. Trying to sprint, jump, squat or hop is nearly impossible with the pain. He says it feels like he is “walking on a marble” due to a huge mass-like feeling between his second and third (or third to forth) inter metatarsal spaces. You look at his shoes, and they are way too narrow for his feet. What do you think the problem is doc?

a) Plantar fasciitis
b) Calcaneal fat-pad atrophy/ Heel spur syndrome
c) Morton’s Neuroma
d) Morton’s Toe
e) Hallux Valgus

Answer 17

c) Morton’s Neuroma

Question 18

A 48 yo m athletic trainer presents with a tingling/burning sensation radiating to his toes with intermittent symptoms of sharp and shooting pain. Originally it started as a dull ache/cramping sensation, with numbness. Trying to sprint, jump, squat or hop is nearly impossible with the pain. He says it feels like he is “walking on a marble” due to a huge mass-like feeling between his second and third (or third to forth) inter metatarsal spaces. You look at his shoes, and they are way too narrow for his feet. You suspect he has a Morton’s Neuroma. What may be the cause of his pain?

a) repetitive micro trauma leading to chronic inflammation and heel spur formation
b) having a first toe shorter than the second toe
c) repetitive micro damage to the nerve fibers that has produced degeneration and reparative fibrosis
d) irritation of the medial branch of the tibial nerve
e) hypermobility of the first metatarsocuneiform and high heels

Answer 18

c) repetitive micro damage to the nerve fibers that has produced degeneration and reparative fibrosis

The repetitive to the nerve fibers causes the nerve to grow significantly in diameter.

Question 19

A 48 yo m athletic trainer presents with a tingling/burning sensation radiating to his toes with intermittent symptoms of sharp and shooting pain. Originally it started as a dull ache/cramping sensation, with numbness. Trying to sprint, jump, squat or hop is nearly impossible with the pain. He says it feels like he is “walking on a marble” due to a huge mass-like feeling between his second and third (or third to forth) inter metatarsal spaces. You look at his shoes, and they are way too narrow for his feet. You suspect he has a Morton’s Neuroma. Which is not a potential treatment?

a) remove the shoe
b) massage the foot
c) OMT
d) NSAID
e) none of the above

Answer 19

e) none of the above

ALL ARE POTENTIAL TREATMENTS/SOLUTIONS

Question 20

A 48 yo m athletic trainer presents with a painful callus on their 2nd toe. Remembering from OPP that this could be a Morton’s toe. What would you say the disorder is for a Morton’s toe?

a) repetitive micro trauma leading to chronic inflammation and heel spur formation
b) having a first toe shorter than the second toe
c) repetitive micro damage to the nerve fibers that has produced degeneration and reparative fibrosis
d) irritation of the medial branch of the tibial nerve
e) hypermobility of the first metatarsocuneiform and high heels

Answer 20

b) having a first toe shorter than the second toe

Question 21

A 48 yo m athletic trainer presents with a painful callus on their 2nd toe. Remembering from OPP that this could be a Morton’s toe. How would you treat this toe?

Answer 21

Orthotic with a 1st toe extension to redistribute body weight to the first toe.

Question 22

Dr. Hamstra comes in complaining of toe pain. You examine her foot and see a bunion formation. What do you think it could be?

a) Plantar fasciitis
b) Calcaneal fat-pad atrophy/ Heel spur syndrome
c) Morton’s Neuroma
d) Morton’s Toe
e) Hallux Valgus

Answer 22

e) Hallux Valgus

Question 23

Dr. Hamstra comes in complaining of toe pain. You examine her foot and see a bunion formation. You think it could be Hallux Valgus. Well, in order to impress her, what would you say was the potential cause?

a) repetitive micro trauma leading to chronic inflammation and heel spur formation
b) having a first toe shorter than the second toe
c) repetitive micro damage to the nerve fibers that has produced degeneration and reparative fibrosis
d) irritation of the medial branch of the tibial nerve
e) hypermobility of the first metatarsocuneiform and high heels

Answer 23

e) hypermobility of the first metatarsocuneiform and high heels

Question 24

Dr. Hamstra comes in complaining of toe pain. You examine her foot and see a bunion formation. You think it could be Hallux Valgus. What are options for treatment?

Answer 24

• Tape the great toe in position
• Orthotic bunion night splint
• Foam separator
• Wide toe box
• Surgery

Question 25

As a complication of turf toe, what is a degenerative-type arthritic condition that affects your MTP joint causing limited and painful first toe mobility?

a) Hallux Rigidus
b) Calcaneal fat-pad atrophy/ Heel spur syndrome
c) Morton’s Neuroma
d) Morton’s Toe
e) Hallux Valgus
f) Sesamoiditis

Answer 25

a) Hallux Rigidus

Question 26

A 18 yo baseball catcher comes in compalining of pain right under their great toe on the ball of the foot. Upon examination the great toe bends only slightly, but with great pain. What do you suspect it is?

a) Hallux Rigidus
b) Calcaneal fat-pad atrophy/ Heel spur syndrome
c) Morton’s Neuroma
d) Morton’s Toe
e) Hallux Valgus
f) Sesamoiditis
g) Plantar fasciitis

Answer 26

f) Sesamoiditis

Question 27

A 18 yo baseball catcher comes in complaining of pain right under their great toe on the ball of the foot. Upon examination the great toe bends only slightly, but with great pain. You suspect sesamoiditis, but what else is on your diff dx?

Answer 27

Stress fracture! (must consider)

Question 28

A 18 yo baseball catcher comes in complaining of pain right under their great toe on the ball of the foot. Upon examination the great toe bends only slightly, but with great pain. You suspect sesamoiditis. How would you treat it?

Answer 28

Manipulation of the sesamoids and first MPJ
NSAIDS
metatarsal head pad

Question 29

A toe that has the MTP joint extended and the PIP and DIP joints flexed is called what?

a) claw toe
b) hammer toe
c) mallet toe
d) lis franc injury
e) fifth metatarsal fracture

Answer 29

a) claw toe

Question 30

How can you treat Claw toe?

a) physical therapy, orthotics, deeper toe box or surgery
b) strengthening of the intrinsic muscles of the foot with the use of towel pulls and marble pickup
c) Non-weight bearing cast / short leg boot for 4-6 weeks
d) surgery

Answer 30

b) strengthening of the intrinsic muscles of the foot with the use of towel pulls and marble pickup

Question 31

A toe that is contracted at the PIP joint as a result of ill fitting shoes is called what?

a) claw toe
b) hammer toe
c) mallet toe
d) lis franc injury
e) fifth metatarsal fracture

Answer 31

b) hammer toe

Question 32

How can you treat a hammer toe?

a) physical therapy, orthotics, deeper toe box or surgery
b) strengthening of the intrinsic muscles of the foot with the use of towel pulls and marble pickup
c) Non-weight bearing cast / short leg boot for 4-6 weeks
d) surgery

Answer 32

a) physical therapy, orthotics, deeper toe box or surgery

Question 33

A toe with a DIP joint contracted in flexion that can lead to the development of a corn is called what?

a) claw toe
b) hammer toe
c) mallet toe
d) lis franc injury
e) fifth metatarsal fracture

Answer 33

c) mallet toe

Question 34

How do you treat mallet toe?

a) physical therapy, orthotics, deeper toe box or surgery
b) strengthening of the intrinsic muscles of the foot with the use of towel pulls and marble pickup
c) Non-weight bearing cast / short leg boot for 4-6 weeks
d) surgery

Answer 34

a) physical therapy, orthotics, deeper toe box or surgery [similar to hammer toe]

Question 35

A patient comes in with pain in their foot after their foot was crushed and twisted on the forefoot. What do you suspect is wrong?

a) claw toe
b) hammer toe
c) mallet toe
d) lisfranc injury
e) fifth metatarsal fracture

Answer 35

d) lisfranc injury

Question 36

A patient comes in with pain in their foot after their foot was crushed and twisted on the forefoot. Imaging with an Xray standing Ap, lateral, and oblique reveal a non-displaced injury. How would you treat the injury?

a) physical therapy, orthotics, deeper toe box or surgery
b) strengthening of the intrinsic muscles of the foot with the use of towel pulls and marble pickup
c) Non-weight bearing cast / short leg boot for 4-6 weeks
d) surgery

Answer 36

c) Non-weight bearing cast / short leg boot for 4-6 weeks

Question 37

A patient comes in with pain in their foot after their foot was crushed and twisted on the forefoot. Imaging with an Xray standing Ap, lateral, and oblique reveal a displaced injury. How would you treat the injury?

a) physical therapy, orthotics, deeper toe box or surgery
b) strengthening of the intrinsic muscles of the foot with the use of towel pulls and marble pickup
c) Non-weight bearing cast / short leg boot for 4-6 weeks
d) surgery

Answer 37

d) surgery

Question 38

From zones 1 to 3, which has the best blood supply in the fifth metatarsal?

Answer 38

zone 1

Question 39

A fifth metatarsal fracture occurs and you suspect a tuberosity avulsion, what type of fracture is this?

a) zone 1
b) zone 2
c) zone 3

Answer 39

a) zone 1

Question 40

A fifth metatarsal fracture occurs and you suspect a tuberosity avulsion, how would you treat this fracture if 2 mm were displaced?

a) ortho referral
b) weight bearing as tolerated with a short leg cast
c) non-weight bearing with a short leg cast
d) surgery

Answer 40

b) weight bearing as tolerated with a short leg cast

Question 41

A fifth metatarsal fracture occurs and you suspect a tuberosity avulsion, how would you treat this fracture if 4 mm were displaced?

a) ortho referral
b) weight bearing as tolerated with a short leg cast
c) non-weight bearing with a short leg cast
d) surgery

Answer 41

a) ortho referral

Question 42

A fifth metatarsal fracture occurs and you suspect a Jones fracture (which is the MOST COMMON NON-UNION fracture), what type of fracture is this?

a) zone 1
b) zone 2
c) zone 3

Answer 42

b) zone 2

Question 43

A fifth metatarsal fracture occurs 2 weeks ago and you suspect a Jones fracture (which is the MOST COMMON NON-UNION fracture). How would you treat this fracture?

a) ortho referral
b) weight bearing as tolerated with a short leg cast
c) non-weight bearing with a short leg cast
d) surgery

Answer 43

c) non-weight bearing with a short leg cast

Question 44

A fifth metatarsal fracture occurs and you suspect a Jones fracture (which is the MOST COMMON NON-UNION fracture). How would you treat this fracture if it had been non-union for 3 months?

a) ortho referral
b) weight bearing as tolerated with a short leg cast
c) non-weight bearing with a short leg cast
d) surgery

Answer 44

a) ortho referral

Question 45

A fifth metatarsal fracture occurs and you suspect a diaphyseal stress fracture due to direct injury or ankle inversion sprain, what type of fracture is this?

a) zone 1
b) zone 2
c) zone 3

Answer 45

c) zone 3

Question 46

A fifth metatarsal fracture occurs and you suspect a diaphyseal stress fracture due to direct injury or ankle inversion sprain. How would you treat this fracture?

a) ortho referral
b) weight bearing as tolerated with a short leg cast
c) non-weight bearing with a short leg cast
d) surgery

Answer 46

a) ortho referral
d) surgery

Both are considered in all cases, nonhealed at 3 months, or reccurance.

Question 47

A 12 yo female gymnast complains of medial foot pain on both feet. On exam you see pain over the navicular. Remembering Dr. Tabor saying that this is known as an Accessory navicular, which is almost always bilateral, how would you treat it?

a) tell her to walk it off
b) surgery
c) orthotics/bracing and taping
d) NSAID

Answer 47

c) orthotics/bracing and taping

Question 48

What are the two of the most common foot problems experienced by pregnant women?

Answer 48

overpronation and edema

Question 49

What are etiologies of overpronation?

Answer 49

Hormone relaxin and weight gain.

Question 50

What two things my instigate a Morton’s Neuroma?

Answer 50

Over pronation and tight footwear.