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Y1 - Pathomechanics > 3-Rearfoot Valgus > Flashcards

3-Rearfoot Valgus Flashcards

1
Q

rearfoot valgus:

define

A
  • frontal plane deformity
  • calcaneus is EVERTED relative to the floor at heel strike
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2
Q

at what age range is rearfoot valgus commonly seen?

is it always pathologic?

A

Seen in early childhood development with subsequent development of equinus due to valgus ankle

(not always pathologic in pediatric phase)

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3
Q

list the etiologies of REARFOOT VALGUS:

from proximal to distal

A
  • coxa vara/ genu valgum
  • genu valgum
  • tibial valgum
  • ankle valgum
  • STJ valgum
  • calcaneovalgus (triplanar, flexible flatfoot)
  • tarsal coalition (one of the most common causes)
    • calcaneonavicular (most common)
    • talocalcaneus
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4
Q

coxa vara/ genu valgum:

layman’s terms, etiology, and clinical presentation

A
  • “knock-kneed”
  • etiology:
    • developmental abnormalities
    • internal femoral torsion
    • elderly patients w/ arthritis
  • clinical presentation:
    • REARFOOT VALGUS
    • flatfoot
    • wide base of gait
    • significant LATERAL CREASING of dorsal and lateral foot
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5
Q

ankle valgus:

etiology, structure, foot deformity

A
  • etiology:
    • deformed or fractured fibula
    • premature closure of the fibular epiphysis
    • fibular hemimelia/agenesis
    • tibial pathology (fx, premature closure of lateral distal tibial epiphysis)
  • structure:
    • fibula bears 20% of weight, acting as lateral strut/ support for ankle joint
    • if fibular pathology –> the ankle will shift into valgus
  • deformity: –> produces rearfoot valgus at STJ
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6
Q

rearfoot valgus:

movement re: calcaneus, leg, STJ, MTJ

A
  1. calcaneus strikes EVERTED w/ no mechanism to invert –>
  2. leg is internally rotating (IR)
  3. normal body weight and IR of leg –> needed/normal pronation for gait
    • striking everted leads to severe pronation and symptoms
  4. STJ maximally PRONATES and unlocks MTJ –> collapse of medial arch & flatfoot
  5. as ground rxn force pushes up on medial forefoot –> significant inversion (rotation) about longitudinal axis of MTJ –>
  6. brings lateral forefoot to the ground
  7. results in forefoot supinatus (*not varus)
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7
Q

supinatus vs. forefoot varus

(what’s the difference(s)?)

A
  • supinatus:
    • soft tissue deformity
    • triplane
  • forefoot varus:
    • fixed, osseous deformity of frontal plane
    • frontal plane
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8
Q

supinatus is maintained by, and how much inversion?

A
  • Maintained by TA tendon –> dramatic effect on first ray/medial column
  • Results in as much as 20 degrees of forefoot inversion relative to the
    rearfoot (compensatory deformity)
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9
Q

forefoot varus:

FF relative to RF, and etiology

A
  • Forefoot is inverted relative to the rearfoot
  • Ontogenetic/result of abnormal frontal plane development of the head/neck of the talus relative to the body
    • (ontogenetic: origin/development of organism; from time of fertilization –> mature form)
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10
Q

rearfoot valgus:

clinical presentation (foot structure)

A
  1. Medial buldge
    • talar head and navicular tuberosity protrude MEDIALLY
    • due to transverse plane dominance of the oblique MTJ
  2. ABduction of foot w/ added ABduction of FF on RF
  3. Longitudinal arch drops
    • due to motion in sagittal plane around oblique MTJ
  4. Medial column rotates at TNJ –> too many toes sign
    • due to frontal plane motion at longitudinal MTJ leading to supinatus
    • **Reverse arch forms
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11
Q

characteristic sign of rearfoot VALGUS

A

too many toes sign

(over pronation or posterior tibial tendon insufficiency)

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12
Q

rearfoot valgus:

sxs beyond foot deformity

A
  • Callus
    • hallux IPJ pinch callus due to rolling off mechanism
    • possibly submet 2 callus due to hypermobility of 1st ray
  • ADductovarus 5th digit w/ dorsolateral corn
  • Medial heel wear on shoes
  • Lateral shift of calcaneal fat pad –> medial heel pain, and calcaneal apophysitis (kids)
  • Hallux abductovalgus (HAV/bunion) <– excess pronation
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13
Q

rearfoot varus:

postural, sinus tarsi, foot position sxs

A
  • Postural sxs <– due to instability
    • unable to do single/double heel raise
  • Sinus tarsi sxs <– secondary to lateral pinching
    • pain during attempted supination <– peroneus brevis is tight/contracted/in spasm
    • (peroneal spastic flatfoot (peroneus brevis, NOT LONGUS)
    • if present in children, likely tarsal coalition
  • (possibly HL/HR) <– Equinus <– limited DF <– contracture of Achille’s (due to pronation)
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14
Q

rearfoot valgus:

evaluation

A
  • single/double heel raise
    • this mimics propulsion
    • NEGATIVE/NORMAL - calcaneus should INVERT
    • POSITIVE/abnormal - calcaneus EVERTED/ABducted, FF is INVERTED relative to RF during supinatus
      • if it does not invert –> indicative of peroneus tertius rupture/ disease OR rearfoot valgus
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15
Q

ankle valgus:

tx

A

*CANNOT BE TREATED W/ AN ORTHOTIC

  • Consider wedge osteotomy of the tibia (medial base)
    • inverts tibial plafond into neutral position
  • Epiphysiodesis in peds pts w/ open tibial growth plates
    • staple across distal medial tibial epiphysis to stop growth medially while allowing the lateral aspect to grow
    • REBALANCE joint position
  • MAFO (molded ankle-foot orthosis) holds foot in alignment w/ leg
    • imparts STJ stability; but has potential to cause medial ulcerations
    • medial ulcerations result depending on degree of deformity and for diabetic patients (who may have decreased sensation and may not detect the irritation)
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16
Q

rearfoot valgus:

treatment options

A
  • usually symptom based
    • dual medial/lateral column w/ independent fxn
    • deep heel cup
  • orthotic management
17
Q

rearfoot valgus:

orthotics goals and fxn

A
  • general orthotic goals
    • maintain STJ neutrality (in the patient’s STJ neutral)
    • allow for normal pronation/supination
    • provide stability in all 3 planes
    • allow medial/lateral column function
    • allow normal foot development in pediatrics
  • pt won’t tolerate neutral position orthotics
18
Q

a pt w/ rearfoot valgus can’t tolerate neutral position orthotics.

why?

A
  • they can’t compensate for the deformity –> so it doesn’t help to be in a rigid orthotic that supports the deformity
  • INSTEAD, needs a soft orthotic to alleviate sxs while allowing for some pronation
19
Q

what type of deformity benefits from Dynamic Stabilizine Innersole Systems (DSIS)?

(and what is it?)

A
  • for REARFOOT VALGUS
  • DSIS
    • long medial and lateral phalange –> prevents ABduction of FF
    • deep heel cup –> prevent migration of fat pad/ prevent excess pronation
    • NOT COMPLETELY RIGID – has central cut out to allow spreading of foot and independent fxn of medial/lateral columns
    • Triplane control – calcaneus held in 5 degrees inversion, some sagittal TNJ control
    • if you can control the rearfoot, peroneus longus may be able to de-rotate the medial column and reduce the supinatus

Y1 - Pathomechanics (3 decks)

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