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MSPT I > Biomechanical Foot Exam of Foot & Ankle > Flashcards

Biomechanical Foot Exam of Foot & Ankle Flashcards

1
Q

Criteria for Normal Function of the Foot

A
  • Tibia vertical
  • Calcaneus vertical-5o Varus
  • Forefoot is perpendicular to bisection of calcaneus
  • 10o true ankle DF @ all times**
  • 1st Ray in plane of 2-4th rays
    • ​does’t hang lower, or go higher
  • **70-75o 1st MTP EXT****
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2
Q

Biomech. Exam of Foot & Ankle

Observe:

A
  • Observation of foot & LE in WB and NWB
  • check Gait
  • check ROM
  • check Biomech. Align.
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3
Q

Biomech. Exam of Foot & Ankle

Observation of foot in Standing & Sitting

What are we looking at?

A
  • Arch ht.
  • Heel pos.
  • Orientation of forefoot
    • ​Ex. “Too many toes sign”
  • Callus formation
    • ​bring in shoes!!!
    • where is most WB distribution?
  • Shoe wear
    • ONLY observe shoes w/ @ least 100mi walk/run
      • ​New shoes will tell you nothing!!!
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4
Q

Biomech. Exam of Foot & Ankle

Range of Motion:

where?

A
  • Ankle jt (Talocrural)
  • Subtalar jt
    • inv/Ev
  • Mid-Tarsal jt
  • 1st ray mvmt
  • 1st MTP
    • enough for EXT?
    • 70-75o req’d***
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5
Q

Relationship b/w Subtalar Jt & Mid-Tarsal Jt Motion

Sub-talar Pronation

P.DEAB

(DF, Ev, ABD)

A
  • Sub-Talar Pronation (floppy foot)
    • INC Mid-tarsal motion
    • Forefoot MORE mobile
    • accomodates surfs.
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6
Q

Relationship b/w Subtalar Jt & Mid-Tarsal Jt Motion

Sub-Talar Supination

IPAD

(Inv, PF, ADD)

A
  • Sub-Talar Supination (Rigid foot)
    • DEC Mid-tarsal motion
    • Forefoot more rigid
    • transmits forces—-when we NEED rigid foot
    • NEED rigid foot for push-off
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7
Q

Significance of Sub-talar jt & Mid-tarsal jt motion Relationship in Gait

Loading to Midstance

A
  • LR–>MSt
    • Sub-Talar Pronation=forefoot more mobile
      • ​#FloppyFoot
      • improves shock absorb.
      • Foot MORE adaptable to changing terrain
        • ​==> more stable BOS
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8
Q

Sig. of Sub-talar & Mid-tarsal Motion Relationship in Gait

Midstance to Toe-off

A
  • MSt–>Toe-off
    • Sub-talar Supination= Forefoot more Rigid
      • ​#RigidFoot
      • Provides rigid lever for efficient push-off
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9
Q

Consequences of Altered Sub-Talar & Mid-tarsal Motion Relationship

Excessive Pronation

Too Floppy

A
  • Excessive Pronation
    • Foot NOT RIGID ENOUGH during Toe-off
      • ​too floppy
      • ​ineff. push-off
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10
Q

Consequences of Altered Sub-talar & Mid-tarsal Motion Relationship

Excessive Supination

Too Rigid

A
  • Excessive Supination
    • Foot remains TOO RIGID t/o Gait
    • LESS shock absorb
      • ​now more force to BONE instead of soft tissues
    • LESS adaptability to changing terrain
      • ​LESS stable

*NOTE: we want force taken up by mm’s, THEN ligs, tendons, bones***

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11
Q

Pes Cavus aka

A

High Arch

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12
Q

Pes Cavus

High Arch

like a “Cave”

A
  • Forefoot PF’d
  • Rearfoot Supinated during WB
  • Rigid Foot
  • Pt. Over-Supinates
    • ​Poor shock absorb.
  • Limtd DF
    • ​Ankle must DF to get tibia perp. to ground.
    • Pt will appear to have limtd DF during stance bc most of range already used up
  • Prone to disorders assoc’d w/ over-supination
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13
Q

Pes Planus aka

A

Flattened Arch

Flat Foot

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14
Q

Pes Planus

Flattened Arch

A
  • Flattened arch and valgus rearfoot during WB
    1. Rigid Pes Planus
      * ​result of bony structural abnorm. of arch
      • Flat all the time*
    1. Flexible Pes Planus
      * ​result of weak supinator mm’s (Tib. Post.)
      • ​Flattens out IN WB
      • Mm weakness
  • Pt. appears to Over-Pronate during gait.
  • ​Prone to other disorders of foot related to over-pronation
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15
Q

Abnormal Pronation

What is it?

A
  • Pronation that is excessive in range OR that which occurs when foot SHOULD BE supinating:
    • ​@heel strike, push-off (when we need a rigid (supinated) foot!
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16
Q

Abnormal Pronation

Caused by Abnorms in all 3 planes:

A
  1. Frontal Plane
    1. ​tibial varus
    2. subtalar varus
    3. forefoot varus
  2. Transverse Plane
    1. ​Hip anteversion
    2. Internal femoral torsion
    3. Internal tibial torsion
  3. Sagittal Plane
    1. ​Equinas
    2. Limtd knee or hip EXT.
    3. *Leg length (longer side)
17
Q

Effects of Abnormal Pronation–Floppy Foot

Foot Injuries:

A
  • callus/pain under 2-4 MT heads AND plantar medial 1st MTPJ AND medial heel from pinch
  • Hallux Rigidus/valgus
  • Morton’s Neuroma
  • Plantar Fasciitis
  • Metatarsal Stress Fx’s
    • 2nd/3rd MT’s
18
Q

Effects of Abnormal Pronation–Floppy Foot

Leg Injuries:

A
  • Achilles tendinitis —-bc alwasy stretched
  • Tib. Post tendinitis
  • Tib/Fib Stress Fx
  • Ant/Med knee pain
    • bc IR tibia
19
Q

Modified Low-Dye Taping

For Over/Abnormal Pronated Foot

A

see pics

20
Q

Navicular Sling Taping

For Over/Abnormal Pronated Foot

A
  • anchor tape just dist. and slight ant. to Lat. Malleolus
  • Pass tape under plantar aspect of foot
  • Tape should cover navicular on Med. aspect of foot
  • Provide support to med. arch by lifting UP on tape to elevate navicular
  • Maint. tension on tape and secure in spiral fashion around lower leg
21
Q

Abnormal Supination

What is it?

A
  • Supination that is excessive in range OR that which occurs when foot should be pronating
    • ​i.e. Midstance****
22
Q

Abnormal Supination

Components:

A
  • Rigid everted forefoot
    • ​implies inad. INV about LMTJ axis
  • Forefoot valgus
  • PF’d first ray
  • Equinas deformity in which heel cannot reach ground
  • *Leg length (shorter side)
23
Q

Pronated Foot makes leg ____________

Supinated Foot makes leg _________

A

Pronated foot makes the leg Longer

Supinated foot makes the leg Shorter

24
Q

Effects of Abnormal Supination

Foot Injuries:

A
  • Callus/pain under 1st-5th MT heads
  • Sesamoiditis and/or Stress Fx’s
    • ​5th MT
  • Hammer toes
  • Haglund’s deformity
    • Pump bump
  • Chronic lat. ankle sprain
    • ​bc alwasy in INV
25
Q

Effects of Abnormal Supination

Leg Injuries:

A
  • Achilles tendinitis
  • Peroneal tendinitis
    • ​bc always working ecc. controlling INV.
  • Lateral Knee and Hip pain
26
Q

Rigid PF’d 1st Ray

usually assoc’d w/:

A
  • Usually assoc’d w/ uncompensated rearfoot varus
27
Q

Rigid Plantarflexed 1st Ray

What happens to get this?

A
  • Limtd S-T motion maintains calcaneus in INV’d pos. t/o stance phase
  • Develop lateral instability of ankle & callus under 1st & 5th MT heads
28
Q

Rigid PF’d 1st Ray

Requires what?

A
  • Req’s accomodative orthotic w/ cut-out for 1st ray OR bar from 2nd-5th MT
    • ​builds ground UP under 2-4th MT heads
    • also now 5th MT ends up WB more than it should ***
29
Q

Equinas Deformity

A
  • Less than 100 True ankle jt DF
  • Creates LARGE deforming force @ S-T & M-T jts
  • Need for abnorm. pronation persists thru heel-off
  • Req’s intervention to restore DF and/or heel lift
30
Q

Subtalar Neutral

What is the pos. of the foot?

A
  • Foot pos. where subtalar, talonavicular, calcaneocuboid are congruous
31
Q

Subtalar Neutral

How is the Clinically done?

A
  • Foot is placed in neutral by centering Navicular ON Talus
    • ​pt in relaxed standing
    • kneel @ side of pt—use tips of thumb and index to palpate med. and lat. aspects of head of talus
    • pt rotates trunk to one side, then other, in order to medially rotate tibia (producing pronation) OR laterally rotate tibia (producing supination)
    • Have them “stop” when talar head does NOT bulge to either side===> Subtalar Neutral
      • ​NOTE: MOST pts pronated in relaxed standing—–to get STJ neutral—-pt must supinate foot to achive “neutral” pos. that is neither pronated nor supinated

*AFTER foot placed in neutral position===> possible to determine relative Varus/Valgus of Rearfoot and Forefoot

32
Q
A

MSPT I (10 decks)

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