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Unit 17 > E&I - Week 1 > Flashcards

E&I - Week 1 Flashcards

1
Q

What movements are paired with pronation of the foot?

A

Eversion, Abduction, DF

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2
Q

What movements are paired with supination of the foot?

A

Inversion, Adduction, PF

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3
Q

Linkages of the PF and DF with other dimensions of the foot is due to what?

A

Oblique M/L axis of rotation of the foot which leads to associated motion at the talocrural joint

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4
Q

What is one quick way you can find subtalar neutral?

A

Have the patient move in closed chain pronation and supination - this is reflective of the talus rolling on the calcaneus: since the calcaneus is fixed by gravity, it has to be the talus that is sliding

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5
Q

Pronation and supination in WB occur as leg and talus _________ __________ over fixed calcaneus.

A

horizontally rotate

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6
Q

What do you need to stabilize in order to assess transverse tarsal joint motion and how do you do this?

A

The subtalar joint Hold at the navicular and move distal

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7
Q

What motions are available at the transverse tarsal joint?

A

Abduction/Adduction DF/PF

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8
Q

Where do you grip to assess transverse tarsal DF/PF?

A

Sustenaculum tali (basically cup the heel of the foot in your hand with one hand and turn at the navicular with the other).

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9
Q

Where will you find the most motion at the tarsometatarsal joint?

A

1st/4th/5th TMT joints

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10
Q

Where will you find the least motion at the TMT joint?

A

2nd and 3rd TMT joints

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11
Q

What upstream changes can occur in a foot that is pronated?

A

tibial IR (it follows the subtalar joint) valgus @ the knee hip IR and adduction contralateral pelvic hip drop

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12
Q

What conditions can occur with pes planus?

A

plantar fasciitis posterior tibialis insufficiency anterior knee pain ACL injury

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13
Q

What occurs to the talus in pes planus conditions?

A

displaced medially and plantarward from the navicular

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14
Q

In what population is pes planus most common?

A

pediatric

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15
Q

What is the difference between rigid pes planus and flexible pes planus and how can you test for this?

A

Rigid - arch dropped in WB and in NWB (in a heel raise the flat foot remains) Flexible - arch dropped only in WB (if you can dynamically create the arch then you’re good)

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16
Q

What is tarsal coalition?

A

A bony structure abnormality associated with rigid pes planus where two of your tarsal bones are fused (usually malformation at the navicular).

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17
Q

What kind of condition can a peroneal spasm create?

A

flexible type pes planus

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18
Q

What kind of tendon dysfunction can create a flexible type pes planus dysfunction?

A

tibial

19
Q

Which type of pes planus is more likely to be seen in patients with Ehler’s, Down’s, Marfan’s?

A

flexible type

20
Q

What kind of symptoms might you expect to hear about from someone with flexible pes planus?

A

Usually painless in kids and will resolve by adolescence BUT can involve arch or foot pain with WB and will commonly have tenderness to head of the talus and posterior tibialis tendon.

21
Q

What are some clinical signs of posterior tibialis insufficiency?

A

swelling along tendon (basically right @ navicular), limited DF, pes planus but can’t rise or will rise only one side (make more difficult by having them invert), will see “too many toes” due to excessive pronation, will ultimately need MRI to confirm.

22
Q

What are some major signs of plantar fascia dysfunction?

A
  1. Pain in the medial aspect of the inferior heel 2. Pain w/ first steps in the AM (you sleep in PF) 3. Pain increases after prolonged WB
23
Q

What can pes cavus be caused by?

A

Neuropathy/neuro disease, post trauma or fx, idiopathic

24
Q

What is Charcot-Marie Tooth and what condition is it associated with?

A

hereditary peripheral nerve damage (causes wasting of the intrinsic foot musculature which can cause pes cavus)

25
Q

What is the biggest difference between pes cavus and pes planus symptomatically?

A

pain is not at the arch in the case of pes cavus - it is often at the 1st met head and they will often have calluses on the met heads due to loading

26
Q

Other then the met heads, what other two foot structures are often compromised with pes cavus?

A
  1. Plantar fascia 2. Achilles tendon
27
Q

What 3 structures will be notably painful in a lateral ankle sprain?

A
  1. ATFL (lateral mall to lateral side of talus) 2. Calcaneofibular ligament (lateral mall to lateral calcaneus) 3. Sinus tarsi (tunnel bw calcaneus and talus)
28
Q

What clinical signs might be present upon seeing a lateral ankle sprain?

A

TTP forceful inversion MOI swelling / ecchymosis ROM / strength impairments positive talar tilt??? positive anterior drawer test limits in fx

29
Q

What two types of instability will someone with chronic ankle instability have?

A

mechanical and functional (perceived!) instability IN ADDITION TO recurrent sprains

30
Q

What is a syndesmotic ankle injury and how do you test for it?

A

a high ankle sprain posterior tib fib and anterior tib fib ligaments are torn along with interosseus membrane basically the bones of the lower leg separate which means the test for this is to squeeze these bones together

31
Q

What is this? What are some clinical symptoms associated with this?

A

The bulge is achilles tendinopathy and reflects long term changes to the tendon.

  1. pain @ achilles tendon
  2. pain during exercise
  3. palpable crepitus or nodular swelling
  4. limits in function
32
Q

How do you know the difference between paratenon and tendon involvement with reference to achilles tendinopathy?

A

Paratenon is the SHEATH that the tendon is in. If you hold the nodule and then actively and passively DF/PF, the nodule will remain under your fingers if this is a paratenon issue. If as you grip the point of maximal tenderness moves, it’s the achilles tendon.

33
Q

What are some possible pathologies of the 1st metatarsal?

A

hallux limitis

hallux rigidis

turf toe

hallux valgus

34
Q

What is hallux limitis? What is hallux rigidis?

A

Limitis: Limited extension of the first toe only when loaded - when unloaded, full ROM.

Rigidis: you are limited in both loaded and unloaded. This is degeneration of the 1st MTP joint (and can happen due to long-term hallux rigidis).

35
Q

How much extension is needed at the first met?

A

50-60 deg

36
Q

What is turf toe and what is a possible MOI?

A

A forced hyperextension of the first met injury which could happen from someone with hallux limitis having something fall on the posterior end of the foot and push them into hyperex.

37
Q

What structures are often damaged in injury to plantar soft tissue structures?

A

plantar plate

collateral ligaments

sesamoid ligaments

FHL and FHB tendons

38
Q

If someone has turf toe where will they be tender? What test will they be unable to pass?

A

1st MTP capsule, collateral ligaments, and sesamoid complex

Dorsoplantar Drawer Test - they will have increased laxity OR pain

39
Q

What is hallux valgus? What kinds of things can cause it?

A

progressive lateral deviation of proximal 1st phalanx with respect to 1st met

etiology: foot wear, excessive loading, genetics, laxity, age, pes planus, hallus limitis

40
Q

What are the patho-mechanics of hallux valgus?

A

Deformity will lead to lateral subluxation of phalanx/FHL which will cause the FHL to become an adductor, which pulls the PIP medially.

41
Q

What is an LAA? What is it useful for?

A

Medial Longitudinal Arch Angle: 1st Met to navic tub to medial malleolus - when measured the less obtuse the angle the more the arch is dropped OR the smaller the angle the worse the drop.

42
Q

How do you measure the rearfoot angle?

A

base of calcaneus to achilles tendon insertion to center of achilles at height of the medial malleolus to 15cm above mark #3

the actual angle is the lower calcaneus line to the line bisecting the lower leg

43
Q

How is the forefoot angle measured?

A

bisecting rearfoot and measuring angle to edge of table (this is an extrinsic measure)

44
Q
A

Unit 17 (4 decks)

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