Ankle Flashcards
the higher the value, the better the chance to rule in the condition or pathology
Specificity
navicular drop test
- To quantify the amount of foot pronation
- Intended to represent the sagittal plane displacement of the navicular tuberosity from a neutral position to a relaxed position in standing.
- Assess change in height of the navicular from a subtalar neutral position to relaxed standing (6-8 mm normal; > 10-15 excessive)
IF THERE IS NOT SUFFICIENT EVERSION IN A VARUS
DEFORMITY THEN THE FOOT CANNOT COMPENSATE USING EVERSION AND WILL REMAIN IN A VARUS POSITION WHEN IN WEIGHTBEARING. IN THIS CASE THE MEDIAL BORDER OF THE FOOT WILL NOT TOUCH THE FLOOR, OR TOUCH IT VERY LIGHTLY. This foot will be _________ in WB.
supinated
what muscle keeps the 1st ray on the ground during gate?
fibularis longus
(eversion and plantar flexion)
which joint of the foot has the biggest component in pronation and supination?
both subtalar joint and midtarsal joint
Uncompensated rearfoot varus in non weight bearing
No or extremely limited STJ eversion
How to find subtalar joint neutral
- Pt in prone
- Palpate medial and lateral talus
- Apply a force in DF to 4th and 5th metatarsals and IN and EV
- When talus feels equally in both fingers
- Mesure with gonio
Varus or vertical, valgus is rare.
During pronation the axes of the STJ/MTJ are parallel giving more mobility
Subtalar joint ROM measurement technique
- More IN (avg = 38.7°)
- than EV (avg = 9.9°)
presence of subtalar joint eversion during NWB,
in WB: low arch, calcaneus everts to vertical or more, medial talar bulge, lateral fatpads bulge
compensated rearfoot varus
Orthotic goal with uncompensated rearfoot varus
bring the ground to the foot
- medial rearfoot varus POST
- will prevent the need for compensations from initial contact to early
IF THERE IS SUFFICIENT EVERSION IN A VARUS
DEFORMITY THEN THE FOOT WILL COMPENSATE BY EVERTING A GREAT DEAL UNTIL THE MEDIAL BORDER OF THE CALCANEUS IS ON THE FLOOR. This foot will be _________ in WB.
hyper-pronated
Forefoot varus, inverted forefoot
Manter originally described two axes of rotation for movement at the transverse tarsal joint:
longitudinal and oblique
subtalar joint rearfoot varus vs valgus
orthotic goal of a compensated rearfoot varus
- controll but not eliminate STJ eversion from initial contact to MST
- Medial rearfoot varus post (corrective post, not supportive)
- Arch support
the higher the value, the better the chance to rule out the condition or pathology
Sensitivity
if the calcaneus everts to vertical or beyond
compensated calcaneus varus
calcaneal varus or rearfoot varus
uncompensated calcaneus varus
the primary movements of the longitudinal axis of the midtarsal joint are
eversion and inversion
laud walker, calcaneus remains varus (> 7 deg), Med to high arch, LE is ER
uncompensated rearfoot varus in WB
if the calcaneus everts but not to vertical
partially compensated
1st ray of the foot is composed of
the functional unit of 1st metatarsal & 1st cuneiform
Self-report measures for the foot and ankle
- LEFS: Lower Extremity Functional Scale
- FAAM: Foot and Ankle Ability Measure
which is the most stable ray of the foot?
2nd and 3rd rays
Uncompensated rearfoot varus in weight bearing
- calcaneus remains varus (> 7 deg)
- Med to high arch
- LE is ER
locking o the midfoot occurs as
- during supination, STJ and MTJ axes are not parallel giving less mobility
The windlass action causes the longitudinal arches of the foot to rise when the toes are extended as well as stiffening the fibrous tissues of the ball of the foot during push-off.
WINDLASS MECHANISM
the primary movements of the oblique axis of the midtarsal joint are
- abduction and DF
- adduction and PF
what happens at the subtalar joint at heel strike?
supination, then it goes into pronation
during the loading phase of walking, the 1st ray _______ and ______
dorsiflexes and everts
which is the most mobile ray of the foot:
1st ray and 5th ray
If the calcaneus is in the same position as the subtalar joint
uncompensated calcaneus varus
calcaneal valgus or rearfoot valgus
The transverse tarsal joint, also known as the midtarsal joint, consists of two anatomically distinct articulations:
- talonavicular joint
- calcaneocuboid joint.
Excessive navicular drop has been reported in patients with a history of
- ACL tears
- and is thought to predispose individuals to shin splints
- and medial tibial stress syndrome.
- It may also help identify individuals who would benefit from prefabricated orthotics and modified
activity in those with patellofemoral pain syndrome. - Headlee et al also found a positive NDT as being indicative of plantar intrinsic muscle fatigue.
Forefoot valgus, everted forefoot
Plantar-flexed first ray
During walking, the 1st ray _______ and ______ during the propulsion phase
Plantarflexes and inverts
