23: Abnormal STJ motion - Mahoney Flashcards
movement of the STJ axis occurs in what planes
transverse and frontal
due to anatomical position of the axis, very little normal movement occurs in sagittal plane
normal position of STJ acis
16 from sagittal
42 from transverse
48 from frontal
what planes can we find angular deviations of STJ axis?
sagittal plane and transverse plane (usually a pt has both)
CKC internal rotation of the leg causes the STJ to …
pronate
external rotation of leg causes the STJ to supinate
normal STJ pitch
pitch = location from the transverse plane
- normal pitch ranges from 35-45 degrees (42 avg)
higher pitch/ more vertical STJ axis leads to …
- less STJ inversion and eversion in response to rotation of the leg
- more abduction and adduction of the foot in response to internal and external rotation of the leg
- more postural and leg complaints
more vertical/higher pitch, more motion occurs in _______ plane
horizontal or transverse
The more horizontal the STJ axis (the lower the pitch), the more motion occurs in the frontal plane
causes more inversion/eversion
low STJ axis/low pitch
more adduction/abduction of foot
more vertical axis to the STJ
How can we determine whether STJ axis is high or low clinically?
With the foot in STJ neutral, a high axis exists if the examiner can move the heel with more adduction/abduction than inversion/eversion
(very subjective and unreliable)
patients will generally relate more medial knee pain than foot complaints
high pitched STJ axis
because allows more abduction/adduction it places an increased strain on the knee
severe foot abnormalities b/c each degree of rotation of leg means more STJ inversion and eversion
low pitch axis (less than 35)
low pitched axis allows more frontal plane calcaneal rotation with every degree of transvers plane motion of tibia
where do you find a keratoma with low pitch axis?
under 2nd and 3rd met heads
also see medial arch strain
with a normal STJ axis, more of the WB surface of forefoot is ________ to STJ axis
lateral
When STJ axis is oriented within normal range (through 1st intermetatarsal space), more of the weight bearing surface of the calcaneus (rearfoot) is medial to the STJ axis and the more of the weight bearing surface of the forefoot is lateral to the STJ axis
normal transverse plane orientation is 16 degrees
how do you measure transverse plane deviation of STJ ?
kirby method (pushing on foot with dots)
- Place STJ in neutral and lock MTJ by stabilizing the 5th metatarsal head
- Palpate for the axis by applying force medial and lateral to the STJ axis
- There will be no rotation when directly on the axis
why does a medially displaced STJ axis lead to pronation?
STJ axis is considered medially displaced if the axis is noted to lie medial to the 1st intermetatarsal space
This is important because the foot will lose some of its supinatory torques from the calcaneus and gain additional pronatory torque from the forefoot’s longer lever arm on the lateral side of the axis
s/s medially deviated STJ axis
- STJ pronates to its end ROM [i.e., if the deformity(ies) causes the calcaneus to evert past 3°, the calcaneus will continue to evert until it has used up all of its available STJ eversion]
- Forefoot symptoms
- Arch fatigue
- Medial midfoot and rearfoot ligamentous strain
- Pathologies of the lower leg, knee, pelvis and spine
STJ axis is considered laterally displaced if …
the axis is noted to lie lateral to the 1st intermetatarsal space
leads to more lateral foot and ankle pain
why does a laterally displace STJ axis lead to more supinatory foot?
laterally displaced STJ axis will cause loss of pronatory torque from the lateral forefoot and gain additional supinatory torque from the medial forefoot and the calcaneus
As the STJ axis increases its distance from the transverse plane …
more abduction occurs AND more transverse plane movement occurs
A patient exhibits a flatfoot with a transverse plane dominance. Which of the following is /are true?
A: The axis of motion lies in the frontal and sagittal planes
B: The axis of motion lies in the transverse and sagittal planes
C: The STJ is more horizontal
D: Forefoot abduction will predominate
E: Calcaneal eversion will predominate
A and D
when is position of calcaneus most critical?
stance phase of gait
how are positional displacement of calcaneus and STJ axis related?
calcaneal position changes the applied force to STJ axis
A line that bisects the longitudinal axis of the tibia will pass through …
the middle of the talus which is locked in the ankle mortise (tibio-talar unit)
A line that bisects the middle of the calcaneus will almost always lie lateral to the tibio-talar bisection (called the calcaneal translational displacement)
what x ray do you order to assess calcaneal position?
long leg axial
“calcaneal translational displacement”
A line that bisects the middle of the calcaneus will almost always lie lateral to the tibio-talar bisection
5-10 mm is the normal amount of lateral displacement
if calcaneal translational displacement is greater than 10 mm lateral to bisection of tibia …
then ground force causes the heel to evert (body of the heel is lateral to the STJ axis)
If medial to the bisection of the tibia, then ground force causes heel to invert (body of the heel is medial to the STJ axis)
what is a koutsogiannis osteotomy?
One of the options to correct a flatfoot is to transpose the body of the calcaneus more medially in order to create a supinatory moment of the STJ
what happens if you remove a wedge of bone with the base lateral (dwyer osteotomy) ?
One of the options to correct a cavus foot is to move the body of the calcaneus more laterally in order to create a pronatory moment of the STJ
In these cases, the calcaneus is also inverted and is determined by measuring the calcaneal tibial angle
normal calcaneal tibial angle
between 2 degrees varus and 4 degrees valgus
pes cavus will have greater than 2 degrees varus typically
If the STJ axis lies closer to the horizontal (transverse) and sagittal planes, the deformity …
If the STJ axis lies closer to the vertical (frontal) and sagittal planes, the deformity is …
If the STJ axis lies closer to the frontal and horizontal planes, the deformity …
If the STJ axis lies closer to the horizontal (transverse) and sagittal planes, the deformity is frontal plane dominant and there is more inversion-eversion
If the STJ axis lies closer to the vertical (frontal) and sagittal planes, the deformity is transverse plane dominant and there is more adduction-abduction
If the STJ axis lies closer to the frontal and horizontal planes, the deformity is sagittal plane dominant and there is more dorsiflexion-plantarflexion
A foot that is pronated will have the body of the calcaneus positioned:
greater than 10 mm lateral to tibiotalar bisection
