ARJC & nerve compression conditions - final

Question 1

what is the most common foot joint with age related joint changes?

Answer 1

1st MTP
- 2x more load
- 40-60% BW, more with sports

Question 2

1st MTP:
more rigid for ______ with greatest forces from just before heel off to toe off

Answer 2

propulsion

Question 3

etiology for age related joint changes in 1st MTP

Answer 3

longer 1st ray
trauma
genetics
excessive pronation

Question 4

symptoms of age related joint changes in 1st MTP
- onset
- location of pain
- morning
- _____ joint P!
- gait?

Answer 4

gradual onset
pain on top of big toe (compression as jt hyperext)
AM stiffness < 30 min after static positions
dorsal joint P!
antalgic or asymmetrical gait, part. on incline

Question 5

signs of ARJC in 1st MTP: observation
– hallux valgus
– claw toe
– hammer toe
– mallet toe

Answer 5

– w excessive pronation –> greater loading onto 1st ray
– MTP hyperext + IP flex
– MTP hyperext vs neutral + PIP flex + DIP hyperext vs neutral
– neutral MTP & PIP w flexed DIP

Question 6

signs of ARJC in 1st MTP: observation
– dorsal _____
– gait

Answer 6

– spur
– possible hip ER and/or vertical limp or vaulting due to loss of motion at heel/toe off
excessive pronation / impaired LE control

Question 7

signs of ARJC in 1st MTP: ROM
- capsular pattern
- pain into
- hyperext deg for normal gait

Answer 7

• capsular pattern of restriction:
  ext > abd (hallux limitus/rigidus)
  P! particularly into CPP of ext
  need 65 deg hyperext for normal gait

Question 8

signs of ARJC in 1st MTP:
- combined motions
- stress tests
- accessory motion

Answer 8

• consistent block
• compression/distx possibly (+) if symptomatic
• hypomobility of 1st MTP w DF and/or sesamoid bones

Question 9

what is proper footwear for someone with ARJC in foot?

Answer 9

orthotics - to unload involved cartilage
arch support - to address ex. pronation
stiffer shoe with larger toe boxes
rocker bottom shoe

Question 10

where should MT be applied to in someone with ARJC

Answer 10

MTP
sesamoids
ankle

Question 11

what should MET focus on for ARJC

Answer 11

addressing excessive pronation
a lot of reps

Question 12

what is a newer surgery for age related joint changes of 1st MTP

Answer 12

lapiplasty w focus on 3D correction of dysfunction thru midfoot to better address the excessive pronation

Question 13

compression of interdigital nerves is
- morton’s neuritis =
- morton’s neuroma =

Answer 13

• acute - inflammatory
• chronic - fibrous cyst

Question 14

cause of morton’s neuritis/oma

Answer 14

excessive pronation
small toe boxes w/w/o heels
limited 1st MTP ext shifts load onto lateral foot

Question 15

pathomechanics of morton’s

Answer 15

excessive pronation leading to excessive inter-metatarsal compression

Question 16

what is tarsal tunnel syndrome aka post. tibial neuralgia

Answer 16

entrapment of tibial n. at flexor retinaculum/medial malleolus

Question 17

cause of tarsal tunnel syndrome

Answer 17

excessive pronation leading to excessive tension and compression of tibial n. (inflamming it)

Question 18

nerve compression Rx:
- POLICED minus ??
- JM/othotic/MET to reduce:
- MET to create:

Answer 18

• compression - most often the cause
• compression by assisting with abnormal mechanics
• neural motion/flossing

Question 19

functional testing: