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Y1 TP2 Musculoskeletal System > 5. Lower Limb Foot And Ankle > Flashcards

5. Lower Limb Foot And Ankle Flashcards

1
Q

Tibia and fibula

A
  • Bones are triangular in shape
  • Interosseous membrane = between tibia and fibula
  • Intermuscular septa (anterior and posterior)
  • Compartments (anterior and lateral)
  • Medial surface of tibia = subcutaneous
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2
Q

Tibia function

A

• Tibia is involved with knee joint and takes weight of lower limb

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3
Q

Fibula function

A

• Fibula important in ankle joint stability – but doesn’t take weight

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4
Q

Ankle bones

A

3 bones of the Ankle: tibia, fibula and talus

• Medial malleolus: expansion of tibia
• Lateral malleolus: expansion of tibia
– More prominent, more posterior and 1cm more distal

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5
Q

Ankle joint - synovial joint

A

Uni-axial: dorsi and plantar flexion
– around axis passing through talus

  • Synovial joint – articular surfaces covered in hyaline cartilage
  • Mortise joint= a hole / recess cut into a part which is designed to receive a corresponding projection
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6
Q

Tibiofibular syndemosis

A

Inferior tibiofibular joint with 3 ligaments
– Anterior tibiofibular
– Interosseous membrane btw tibia and fibula
– Posterior tibiofibular

These ligaments hold the ankle joint together
• Can be injured

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7
Q

3 zones of foot and bones

A
  • Forefoot – metatarsals and phalanges
    • Midfoot – navicular, cuboid, cuneiforms
    • Hindfoot – talus and calcaneus

Great toe=hallux=1st toe
• Sesamoids = bone inside a tendon

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8
Q

Bones of the forefoot

A

Numbered from medial side 1st is big toe, 5th is pinky
• Each bone has base, shaft and head

  • Phalanges
  • Metatarsals
  • Tarsometatarsal line
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9
Q

Forefoot -phalanges

A

– Each digit has 3 phalanges, proximal, middle, distal (except 1st)
• Apart from big toe that only has 2

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10
Q

Forefoot- metatarsals

A

– Bases articulate medially with cuneiforms and laterally with cuboid
– Head artic with proximal phalanx
– 1st and 5th bases have large tuberosities tendon attachments

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11
Q

Forefoot - tarsometatarsal line

A

– splits foot into forefoot and midfoot

• Diagonal line

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12
Q

Bones of the midfoot

A
  • Navicular (L. little ship)
  • cuboid
  • Cuneiforms (L cuneus, wedge shaped)
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13
Q

Midfoot - navicular

A

• Boat shaped

– between talus and 3 cuneiforms

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14
Q

Midfoot - cuboid

A

• Between calcaneus and Metatarsals

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15
Q

Midfoot-Cuneiforms (L cuneus, wedge shaped)

A
  • Between navicular and metatarsals

* 3 of these

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16
Q

Bones of the hindfoot

A

Talus

Calcaneus

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17
Q

Hindfoot- Talus

A

Most of surface covered by cartilage (no muscle / tendon attachments)
• Superior surface, (trochlea) receives weight of body
• Transmits weight to calcaneus and forefoot
• Head, neck, body

Fractures – can occur through neck of talus, disrupt blood supply = avascular necrosis

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18
Q

Ankle joint – stability

A
  • The Trochlea is narrower posteriorly
  • Dorsiflex (like walking up a hill) – forces wide anterior part of trochlear posteriorly between malleoli – spreading the tibia and fibula slightly apart & tightening the 3 tibiofibular ligaments
    • Going down a hill = plantar flexion
  • Ankle relatively unstable in plantar flexion – most injuries occur
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19
Q

Hindfoot – calcaneus

A

Transmits weight
• Posterior part has calcaneal tuberosity = bit that you stand on

  • Articulates with talus (talus is above it)
  • Anterior surface articulates with cuboid
  • Medial has sustentaculum tail (talar shelf)
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20
Q

Ankle collateral ligament

A

• Joint capsule thin = allows movement

Lateral ligament
• Anterior talofibular
• Calcanofibular ligament
• Posterior talofibular

Medial ligament (deltoid) 
• Medial malleolus to 2 talus, 1 calcaneus and 1 navicular (4 parts)

Lateral ligament is weaker than the strong medial ligament

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21
Q

Lateral ligament

A
  • Anterior talofibular
  • Calcanofibular ligament
  • Posterior talofibular
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22
Q

Medial ligament

A

• Medial malleolus to 2 talus, 1 calcaneus and 1 navicular (4 parts)

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23
Q

Foot joints -role

A

Flexion and extension occurs in ankle and forefoot

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24
Q

2 foot joints

A
  • Interphalangeal joins

* Metatarsalphalangeal joints

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25
Q

Subtalar joint

A
  • where talus articulates with calcaneus – between talus and calcaneus
  • Orthopaedic surgeons include the talocalcaneal part of talocalcaneonavicular joint – between talus, calcaneal and neviculum
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26
Q

Transverse tarsal

A

• compound joint: calcaneocuboid joint and talonavicular part of talocalcaneonavicular joint

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27
Q

3 ligaments - important for maintaining longitudinal arch of foot

A

Spring Ligament (Plantar Calcaneonavicular)
Short plantar ligament (Plantar calcaneocuboid)
Long plantar Ligament

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28
Q

Spring Ligament (Plantar Calcaneonavicular)

A

– between sustentaculum tali and navicular

– Supports head of talus

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29
Q

Short plantar ligament (Plantar calcaneocuboid)

A

– between the calcaneus and cuboid

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30
Q

Long plantar Ligament

A

– Also calcaneus to cuboid

– some fibres extend to bases of metatarsals (form a tunnel for peroneus longus)

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31
Q

Anterior compartment - function

A

Dorsiflexor or extensor compartment
• Dorsiflex ankle, plus each muscle does one other thing
If anterior compartment wasn’t working you would have foot drop so toes would drag against the ground

• Important for
– swing phase of walking
– posture

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32
Q

Boundaries of the anterior compartment

A
  • I/Ointerosseous membrane
  • Lateral surface of tibia
  • Medial surface of fibula/ anterior intermuscular septum
  • Deep fascia of leg
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33
Q

What does the anterior compartment contain

A
  • 4 muscles

* Deep peroneal nerve

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34
Q

Extensor retinaculum

A
  • Thickenings of fascia - prevent tendons from bowstringing
    • Physically holds tendons close to the bone
  • Superior extensor retinaculum
  • Inferior extensor retinaculum
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35
Q

2 parts of Extensor retinaculum

A
  • Superior extensor retinaculum

* Inferior extensor retinaculum

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36
Q

Muscles of anterior compatment

A

tibialis anterior

extensor digitorum longus

Extensor hallucis longus

Peroneus (fibularis) tertiarus

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37
Q

tibialis anterior

A

Against tibia

  • P: Lateral surface of tibia and I/O membrane
  • D: Medial cuneiform and base of 1st metatarsal
  • I: Deep Peroneal (fibular) (L4,L5)
  • A: Dorsiflexes ankle and inverts foot
  • With tibialis posterior invert foot
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38
Q

extensor digitorum longus

A

• P: Medial surface of fibula and I/O membrane
• D: Forms extensor expansion over proximal phalanxes of lateral 4 digits
– divides into central band
- inserts into base of Middle phalanx
– 2 lateral bands -converge and insert into base of Distal phalanx
• I: Deep Peroneal (fibular) (L4,L5)
• A: Dorsiflexes ankle and extends lateral 4 digits

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39
Q

Extensor hallucis longus

A

Deep muscle
• P: Middle part of anterior surface of fibula and I/O membrane
• D: Base of distal phalanx of hallux
• I: Deep Peroneal (fibular) (L4,L5)
• A: Dorsiflexes ankle and extends great toe

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40
Q

Peroneus (fibularis) tertiarus

A

Like and extension of extensor hallucis

Not always present
• P: Inferior 1/4 anterior fibula and I/O membrane
• D: Dorsum of base of 5th metatarsal
• I: Deep Peroneal (fibular) (L4,L5)
• A: Dorsiflexes ankle and helps in foot eversion
• May help to protect anterior tibiofibular ligament – most commonly injured nerve

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41
Q

Nerve of anterior compatment

A

Deep peroneal nerve

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42
Q

Deep peroneal nerve

A

Arises from common peroneal nerve

• Accompanies anterior tibial artery on the I/O membrane
• In foot supplies muscles extensor digitorum and hallucis brevis
And supplies 4 muscles above
• and small area of skin in dorsum of 1st webspace

Lesion can result in foot drop

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43
Q

Artery of anterior compartment

A

Anterior tibial

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44
Q

Anterior tibial artery

A

• Comes off popliteal through popliteal fossa

  • Passes anteriorly through a gap in the superior part of the I/O membrane
  • Descends on membrane with DPN
  • Changes name midway between malleoli to dorsalis paedis artery
  • Palpated lateral to EHL tendon
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45
Q

Palpation of pulses

A 
Find the 
	• Popliteal
	• Femoral
	• Posterior tibial
	• Dorsalis pedis

Learn to palpate those 4

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46
Q

Lateral compartment

A

Evertor compartment

• Important for
– walking
– posture (resist when centre of gravity shifted medially)

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47
Q

Lateral compartment boundariés

A
  • anterior intermuscular septum
  • lateral surface of fibula
  • posterior intermuscular septum
  • deep fascia

2 muscles and a retinaculum

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48
Q

Peroneaal (fibular) retinaculum

A
  • Tendons pass with common synovial sheath behind lateral malleolus
  • Peroneus brevis is in contact/ grooves lateral malleolus
  • Peroneus longus lies posterior to brevis (not in contact with malleolus)
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49
Q

Peroneus (fibularis) longus

A
  • P: Head & superior 2/3 of lateral surface of fibula
  • D: Passes through groove in cuboid and to base of 1st metatarsal and medial cuneiform
  • I: Superficial peroneal (fibular) nerve, (L5, S1, S2)
  • A: Evert foot and weak plantar flexor of ankle
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50
Q

Peroneus (fibularis) Brevis

A
  • P: Inferior 2/3 of lateral surface of fibula
  • D: Tuberosity on base of 5th metatarsal
  • I: Superficial peroneal (fibula) nerve, (L5, S1, S2)
  • A: Evert foot and weak plantar flexor of ankle
51
Q

Nerve of lateral compartment

A

Superficial peroneal (fibular)

52
Q

Superficial peroneal (fibular)

A
  • Arises from common peroneal nerve
  • Descends in lateral compartment – supplies muscles
  • Become subcutaneous
  • Supplies skin distal 1/3 anterolateral surface leg
  • Splits into branches that supply most of skin dorsum of foot
53
Q

Blood vessels of lateral compartment

A

• Perforating arteries and veins from anterior tibial artery and peroneal (fibular) artery
There isn’t one dedicated atery in the lateral compatment

54
Q

Plantar skin

A

• Sensate – feeling
• wt bearing areas thicker – thicker skin
– heel, lateral margin and “ball of foot”
– Fibrous septa
= Shock absorber
=Anchors skin

55
Q

Plantar fascia

A

(Deep fascia)
• Helps protect deep structures from injury
• Helps support longitudinal archesof the foot

56
Q

Walking

A
  • Heel
    • Lateral border of foot
    • Ball of the foot
57
Q

Fibrous septa

A

Skin is anchored to fascia with fibrous septa

58
Q

Plantar aponeurosis

A

= Thick central part of deep fascia

  • Longitudinally arranged
  • lots of Bundles of collagen
  • Arises from calcaneus
  • Distally divides into 5 bands for each of the digits (become continuous with fibrous digital sheaths)
  • Reinforced distally by transverse fibres – help keep everything together
59
Q

Compartments of the Foot

A

• Vertical intermuscular septa extend from margins of aponeurosis towards 1st and 5th metatarsals

  • Central (2) compartment – superficial and deep parts
  • Medial compartments
  • Lateral compartments
  • Interosseous compartments
  • Dorsal compartment (extensor hallucis brevis and extensor digitorum brevis)
60
Q

Muscles of the foot

Layer 1: AFA

A
  • Abductor Hallucis
  • Flexor digitorum brevis
  • Abductor digiti minimi
61
Q

Layer 2: 222

A

• Two tendons =
– Flexor Hallucis longus
– Flexor digitorum longus

• Two muscles =
– Lumbricals
– Quadratus plantae

62
Q

Layer 3: FAF

A
  • Flexor Hallucis brevis
  • Adductor Hallucis (oblique and transverse heads)
  • Flexor digiti minimi brevis
63
Q

Layer 4:

A

• Dorsal and plantar interossei

64
Q

Muscles on dorsum of foot

A

• Intrinisc muscle = in the foot

* Extensor digitorum brevis and Extensor hallucis brevis 
* both Originate from calcaneus 
* Aid in extending toes

• Extrinsic = muscles and tendons from leg that pass through foot
65
Q

Plantar Neurovascular Supply

A
  • Tibial nerve and posterior tibial artery divide into medial and lateral plantar nerves and arteries
  • Deep to abductor hallucis brevis
  • Medial plantar nerve & artery divide into common plantar digital nerves (sensory) and arteries that supply medial 3 and half digits
    • Provides sensation to first 3 and a half toes
  • Lateral plantar nerve & artery divide into superficial and deep branches
  • Superficial supply lateral supplies sensation of 1 and half digits
  • Deep branches pass medially
  • Artery forms deep plantar arch
  • Gives plantar MT arteries
66
Q

Dorsal Neurovascular Supply

A
  • Anterior tibial artery becomes dorsalis paedis artery
  • Continues between EHL extensor hallucis and EDL extesor digitoris longus tendons
  • Tarsal arteries
  • Dorsal metatarsal arteries – branches
  • Communicate with deep plantar arch via perforating branches
67
Q

Cutaneous innervation of foot (revision) - sensation of the foot

A

• Saphenous nerve: Branch of femoral. Medial side of foot
• Dorsum of foot – superficial & deep peroneal
• Sole of foot- medial & lateral plantar
• Laterally sural nerve: Branches from tibial and common peroneal nerves
• Heel by
– medial calcaneal branches of tibial nerve
– lateral calcaneal branches of sural nerve

68
Q

Arches of the foot

A

• Foot has flexibility due to arrangement of bones, ligaments and tendons
– Shock absorbers
– Springboards

Longitudinal arch of foot – 2 longitudinal arches
• Medial Longitudinal arch higher, formed by calcaneus, talus, navicular, 3 cuneiforms and 3 metatarsals • Lateral longitudinal arch – formed by calcaneus, cuboid, lateral 2 metatarsals Transverse arch of foot formed by cuboid, cuneiforms and bases of metatarsals

69
Q

Arches of Foot - Factors that maintain and support arches

Passive

A 
• Shape of united bones (above) 
• Fibrous tissue layers 
– Plantar aponeurosis 
Calcaneal to cuboid 
– Long plantar 
– Short plantar 
– Spring
70
Q

Arches of Foot - Factors that maintain and support arches

Dynamic

A
  • Intrinsic muscles
  • FHL and FDL
  • Tibialis anterior and Tibialis posterior and peroneus longus = other tendons that support arches of the foot
71
Q

Venous drainage - deep veins

A

– paired veins accompany all arteries

2 veins tend to accp=ompany every arter

72
Q

Venous drainage - surperficial veins

A

– variable
• Tend to become varicose veins – dilated under skin
• Dorsal and plantar venous network
• Medial marginal vein becomes great saphenous vein – pass behind medial malleous, medial patella,
• Lateral marginal vein becomes short (small) saphenous vein

73
Q

Lymphatic Drainage

A
  • Medial superficial lymphatic accompany GSV (great saphenous vein) drain in to superficial inguinal lymph nodes (then deep ILN)
  • Lateral superficial lymphatic accompany short saphenous to popliteal lymph nodes (then deep lymphatics)
  • Deep lymphatics vessels from foot follow main blood vessels carry lymph to deep ILN – inguinal lymph nodes
  • Deep ILN drain into external and common iliac, then lumbar lymphatic trunks
74
Q

Elective -Common foot and ankle disorders

A

—> things seen in day to day practice
• Ankle osteoarthritis
• Hallux valgus (Bunions)
• 1st MTP joint osteoarthritis (big toe arthritis)
• Claw, hammer and mallet toes (bending of toes)
• Flat foot deformity
• Achilles tendinopathy (sprain in achilles tendon)

75
Q

Trauma Common foot and ankle disorders

A
  • Achilles tendon rupture
    • Sprained ankle
    • Ankle fracture
76
Q

General Common foot and ankle disorders

A
  • Diabetes

* Charcot arthropathy

77
Q

Primary osteoarthritis

A

• Primary= as you get older you get degernation of joint due to wear and tear
○ (older, less pain than trauamtic arthritis and better ROM range of movement compared to secondary OA)

78
Q

Secondary Osteoarthritis

A

—>pathology precedes arthritis like infections
○ Most commonly post- traumatic
○ Septic arthritis
○ Medical condition (rheumatoid arthritis, inflammatory arthropathy)
○ Main problems CF – Pain, stiffness

79
Q

Degernative joint

A
  • Narrow joint space
    • Condyles aren’t as smooth as normal
    • Sclerotic margins and cysts
80
Q

Hallux valgus (bunion)

A
  • More common in women
    • Medial deviation of the 1st Metatarsal – big toe faces outwards but metatarsal faces medially
    • Lateral deviation of the toe (+/- rotation)
    • 1st MT head becomes prominent (erythema, callous, pain)
    • Most common complaints - Pain, cosmesis (cosmetic issue), footwear problem
81
Q

Hallux valgus (bunion) -Degernative changes

A
  • Metatarsals goes medially

* Phalanges go laterally

82
Q

Bunion casues

A

Due to abnormal biomechanics in overpronated foot (flatfoot)
• Trauma
• Arthritis
• Metabolic disorders (gout, inflammatory arthropathy)
• Collagen disorders (familial) - especially if child has bunion
• Wearing heels since a young age
• Once present the extrinsic muscles continue to increase the deformity

83
Q

Bunion treatment

A
  • Splints = don’t really work but pschologically help patient
    • Change in foot wear – seperation between great tor and second toe
    • Surgery (extensive and very painful)
84
Q

Hallux ridges OA of 1sr MTP

A
  • OA of the 1st Metatarsophalangeal joint – joint degerantes, narrows, red, bursitis
    • Multiple times the body weight passes through this joint when weight bearing
85
Q

Hallux ridges OA of 1sr MTP

Causes

A
  • idiopathic,
    • trauma,
    • sepsis,
    • metabolic/inflammatory condition
86
Q

Clinically - Hallux ridges OA of 1sr MTP

A
  • Pain on dorsiflexion of 1st MTPJ
    • Compensatory alteration of gait, walking on the lateral border of the foot to off load the medial side – to deal with pain
    • Look at how the sole of their shoes are wearing
    • Progressive stiffness limiting movement
    • Dorsal osteophyte may rub in shoes
    • Reduced dorsiflexion of great toe
87
Q

Toe deformity – claw toe

A

—> difficult to wear shoes as the rub inside shoes, cause ulcers on joint surface dorsal

* Multiple toes 
* Hyperextension at MTPJ (metatarsal pharyngeal joint) with flexion at PIPJ (proxiaml interpharyngeal joint) 
* Corns/blisters - corns on tip, blisters on dorsum 
* Flexible/rigid
88
Q

Toe deformity – claw toe

Causes

A
  • tight tendons and ligaments
    • Neurological, Cerebral palsy, stroke
    • trauma,
    • inflammatory arthropathy (RA)
89
Q

Toe deformity – hammer and mallet toe

A
  • Hammer - Flexion at PIPJ
    • Mallet – fixed at DIPJ dorsal interpharyngeal joint
    • Normally walk on the nail
    • Commonly second toe fi
90
Q

Toe deformity – hammer and mallet toe

Common causes

A
  • Pressure due to hallux valgu = as big toe moves, second toe moves upwards to compensate
    • poor footwear
91
Q

Flat foot – pes planus

A
  • Collapse of the medial arch
    • In children the medial arch is not fully developed (subcutaneous fat) - but a lot of parents want to give an in sole to do something but it doesn’t make a difference
    • Normal for child to have flat foot don’t develop arch after age 10

What happens? - excessive stretching of the spring ligament and plantar aponeurosis. The talar head drops, the arch flattens and the midfoot deviates laterally

92
Q

Flat foot – pes planus

Causes

A
  • Idiopathic
    • Injury
    • degenerative (tibialis posterior dysfunction)
93
Q

Flat foot – pes planus

2 types

A

Flexible – no issue, don’t do anything
Fixed – bony problems in foot, are tarsals fused together

Test for if it is felxible or fixed
• Good up on tiptoes = arch will reform
○ Less likely to need surgert for flat foot
• Other test = dorsiflex big toe and arch will reform (jack’s test) used for children
Tarsal coalition – calcaneum, navicular are completely separate
• Coalitions can’t be fixed with in soles, need commodative insole to fit foot shape

94
Q

In soles

A
  • Only help to remove the pain

* Don’t visually change foot

95
Q

Achilles tendinopathy

A

One of the larger tendons in the lower limb

Withstands stresses from walking and running

96
Q

Tendinopathy

A
  • Insertional (into calcaneum) – any age group, not always related to activity
    • Non-insertional (body of tendon) – Younger age group, active
97
Q

Achilles tendinopathy

Common causes

A

Degenerative

98
Q

Achilles tendinopathy

Clinical features

A
  • Pain and stiffness particularly after inactivity (morning)
    • Pain at back of heel (worse with activity)
    • Tendon thickening
    • Swelling
    • Palpable spur (insertional)
99
Q

Achilles tendinopathy

Treatment

A

Treatment —> insoles but beware of achilles tendon rupture

100
Q

Achilles tendon rupture

Aetiology

A

Occurs at middle age Middle age - Pre-existing tendon pathology
• Mainly middle age men who have been inactive and now want to be active

Aetiology:-
• Deceased perfusion blood supply
• Increased stiffness (reduction in proteoglycans, with decreased water content and increased cross-linking of collagen)
• Decreased collagen turnover and reduced ability to repair
• Calcium deposition in the tendon

101
Q

Achilles tendon rupture

Features

A
  • Commonly occurs in middle-aged men
    • Forceful push-off (jumping, running)
    • Fall/slip into a hole suddenly
    • Forcefully DF ankle
102
Q

Achilles tendon rupture

CF clinical features

A

Partial/Complete Tear – proximal to the calcaneum

CF clinical features 
 – Sudden pain – Being “kicked in the heel” 
	• Sound – pop/snap 
	• Palpable gap 
	• Unable to push-off
103
Q

Simmonds Thompson test

A
  • Positive when squeezing of the calf muscles fails to elciti planatrflexion (movement) of the foot)
    • Test for achilles tendon rupture
104
Q

Sprained ankle

A

—> Partial / complete rupture of ligaments around the ankle – more commonly lateral.

105
Q

Sprained ankle

Causes

A
  • weak muscles / ligaments around the joint
    • Neurological, ligamentous
    • Proprioception and balance
    • Uneven surfaces
    Increased stress on the ligaments when the foot is pushed beyond its range of motion
106
Q

Sprained ankle

Treatment

A

Rehab – wobble boards, yoga boards, trampolines

107
Q

Ankle sprain with 5th metatarsal avulsion fracture

A
  • Bruising on side of foot
    • Can be associated with an avulsion fracture of the 5th metatarsal base due to the pull of Peroneus brevis on its attachment

Child – be wary as this might just be normal in them, examine child properly

108
Q

Ankle fractures

Common

A
  • Inversion/eversion, internal and external rotation of the joint
    • Associated rupture of medial and lateral ligaments of the ankle joint
    • Can result in a fracture dislocation of the ankle joint
    • If below the distal tibiofibular joint the syndesmosis is intact and the fracture is considered stable
109
Q

Ankle fractures

Treatment

A

• Reducing it and pain

Try and return anatomy as close to normal

110
Q

Diabetes – general conditions

A 
--> Very commonly affects the foot 
	• Infection 
	• Skin breakdown 
	• Peripheral neuropathy resulting in loss of sensation 
	• Peripheral ischaemia

Combination of the above can cause ulceration and other complications of diabetes

Could lead to amputation below the knee

111
Q

Charcot arthropathy

A

—> Progressive destruction of the tissues in the foot – bones, joints and soft tissue

* Caused by a combination of peripheral neuropathy, abnormal weightbearing, inflammatory changes, fractures, osteolysis 
* The patient is commonly unaware of the damage being done due to loss of sensation and there fore contining normal activities exacerbating the damage being caused – thign sjust keep getting worse
112
Q

Gait

A

–> pattern of walking

Can have normal and abnormal gait

113
Q

The phases of the gait cycle

A
  • Heel/initial contact 9heel hits ground first)
    • Foot-flat – load - forefoot to the ground
    • Midstance – move forward
    • Heel-off
    • Toe-off (pre-swing)

Stance and swing phases
• 60% Stance
• 40% Swing

Heel stance
Mid stance
Toe off

* Step is one foot = hell down to next heel down
* Stride = both feet, so it is two steps
114
Q

Kinetics- Cause Movement

A
  • Muscles – provide stability and propulsion

* Work both concentrically (shortening – acceleration) and eccentrically (lengthening – deceleration).

115
Q

Abnormal gait

A
  • Antalgic / painful limp = spend less time on the affected leg, quickly move off it
    • High stepping / foot drop (Tibialis anterior dysfunction)
    • Spastic – Hemi/diplegia
    • Trendelenburg gait Parkinsonian
    • Ataxic/broad based/cerebellar

If right leg is hurting – give crutch to painful leg, so your pushing on the crutch instead of on the painful leg

116
Q

Antalgic

A
  • Limp
    • Pain
    • Short stance phase on affected leg
    • Lack body weight to shift to the affected leg
    • Short swing on unaffected leg
    • Uneven pattern
117
Q

High steppage

A

Foot drop
• Sciatica
• Neuromuscular

Toes point down
Increased hip flexion on affected side to clear the foot
Foot slap = hear the foot go down as the dorsiflexors of foot aren’t working can’t hold it up

118
Q

Diplegic

A 
Neuromuscular – CP 
Scissoring – can't abducted 
Tight muscle groups 
Ankle – plantar flexed 
Forefoot – initial contact
119
Q

Hemiplegic gait

A 
Stroke, cerebral palsy, trauma 
	• Flexed upper limb 
	• Extended lower limb 
	• Short step unaffected leg
	•  Circumduction of the affected leg – swing leg round
120
Q

Trendelenberg

A 
Hip abductor weakness 
	• Pain, neurology.. 
	• Pelvis drops on the unaffected side in stance 
	• Torso swings to the affected side 
	• Waddling 
	• Bilateral

Look at patient from behind to see pelvis tilt

121
Q

Parkinson’s

A
  • Neurological
    • Difficulty to initiate movement
    • Short shuffling steps – patients tend to trip as they can’t lift leg
    • Bend forward
    • No arm swing
122
Q

Ataxic

A
  • Cerebellar disorders - Genetic, alcohol, sensory
    • Broad based
    • Unco-ordinated
    • Arms to balance
    • Appear ‘drunk’
123
Q

Extrinsic muscle- function

A

Eversion
Inversion
Plantarfiexion
Dorsifiexion

124
Q

Intrinsic muscles - function

A

Fine motor actions

Y1 TP2 Musculoskeletal System (10 decks)

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