Exam 2 Flashcards
Rigid foot, high-arched
pes cavus
Flexible foot, flattened arch
pes planus
Talocrural joint motion in dorsiflexion
talus rolls anteriorly and glides posteriorly
Talocrural joint motion in plantarflexion
talus rolls posteriorly and glides anteriorly
Need …. of DF during walking and …. during running.
10 degrees
20 degrees
Several articular surfaces of the subtalar joint:
Posterior facet of the talus is….
Posterior facet of the calcaneus is….
Middle and anterior facets of the talus are…..
Middle and anterior facets of the calcaneus are….
Glide associated with subtalar eversion….
Glide associated with subtalar inversion…
concave convex convex concave lateral medial
What glide is associated with subtalar eversion?
lateral glide
What glide is associated with subtalar inversion?
medial glide
Open chain pronation for calcaneus: (3)
eversion
abduction
dorsiflexion
Closed chain pronation for calcaneus and talus?
Calcaneal ….
Talar…
Talar…
eversion
adduction
plantarflexion
Supination open chain for calcaneus.
inversion
adduction
plantarflexion
Supination closed chain for calcaneus and talus.
inversion
talar abduction
talar dorsiflexion
Windlass mechanism
great toe extension resulting in tightening of the plantar aponeurosis
Four points of normalcy for foot and ankle
- tibia is vertical
- calcaneus is in line with the tibia
- metatarsals are in a plane that is perpendicular to the calcaneus.
- metatarsals are in the same plane
Forefoot varus
NWB
WB
pinky toe toward examiner’s body. Big toe towards patient’s body.
forefoot inverted
STJ neutral
Calc vertical
forefoot flat
STJ pronated
Calc everted
Forefoot valgus
NWB
WB
Big toe towards examiner’s body and pinky toe towards patient’s body.
forefoot everted
STJ neutral
Calc vertical
forefoot flat
STJ supinated
Calc inverted
Forefoot varus WB position in terms of motion
foot pronates too long when it should be supinating at end of stance
Forefoot valgus WB position in terms of motion
foot supinates too soon
Rearfoot varus
NWB
WB
forefoot/rearfoot inverted
STJ neutral
Calc inverted
Forefoot flat
STJ pronated
Calc vertical
Rearfoot varus may require a lot of activation of … to control excessive pronation.
posterior tibialis
Equinus
Due to
WB implications
a plantarflexed foot
often due to tight gastroc and achilles
never reach 10 degrees dorsiflexion
Progressive adduction of the 1st metatarsal and lateral deviation of the great toe, creating a larger medial angle
hallux abducto valgus
Short limb causes foot….
Long limb causes foot….
supination
pronation
Callus formation from subtalar joint caused by
shear forces and instability of bone
When hip is neutral and you move into flexion what is the glide? extension? abduction? adduction? internal rotation? external rotation?
posterior anterior inferior superior posterior anterior
When the hip is in 90 flexion and you move into flexion what is the glide? extension? abduction? adduction? internal rotation? external rotation?
inferior null anterior posterior inferior superior
Angle of inclination
angle in the frontal plane between the neck of the femur and the medial side of the femoral shaft
Normal angle of inclination?
125 degrees
Coxa valgum?
greater than 125
Coxa varus?
less than 125
Deviations from normal angle of inclination can be from?
birth or due to fracture
Coxa valgum tends to …. the limb. The shaft of the femur is more aligned with …. forces. There is a … mechanical advantage of hip muscles. There is …. hip stability. May lead to…
lengthen vertical weight bearing forces decreased decreased osteoarthritis, dislocation
Coxa varum tends to… the limb. There is … bending moment at the neck of the femur. There is a …. moment arm for hip muscles so they dont have to generate as much force. There are also …. joint reaction forces. Hip joint is thought to be more…. relative to coxa valgum. May lead to..
shorten increased longer decreased stable joint fracture
Angle of torsion
angle between the line that runs through the femoral head and neck and a line that runs between the femoral condyles. (rotation between the neck and the shaft of the femur)
Normal anteversion:
Excessive anteversion:
Retroversion:
15 degrees (8-20 degrees)
over 15 or 20 degrees
less than 15 or 8 degrees
What is our angle of torsion when we are born?
40 degrees
When there is excessive anteversion, there is …. hip IR ROM, … ER ROM, ….joint stability (more of the joint exposed…), … muscle lever arm (…joint forces), related posture is….
increased decreased decreased anteriorly decreased increased toeing in with gait
When there is retroversion, there is …. hip ER ROM, … IR ROM, related posture is…
increased
decreased
toeing out gait
Test for angle of torsion?
craigs
Two impingements of the femoroacetabular?
CAM
Pincer
CAM impingement is when there is a ….
There is poor clearance of neck with …. and ….
thicker shape of the femoral neck.
hip flexion and abduction
Pincer impingement is when there is a….
the acetabulum sits ….
hip abduction … the superior labrum.
an extension of the acetabulum superiorly
posteriorly and is deeper
pinches the superior labrum
Muscle imbalances in the frontal plane in terms of the hip?
tredelenburg test
pelvic drop
Tensile forces affect what structures?
ligaments, tendons, muscles
Compression forces affect what structures?
cartilage and bone
Shear forces affect what structures?
cartilage
Rotation forces affect what structures?
ligaments and cartilage
Repetitive forces affect what structures?
tendon, muscles, bone
First degree ligament sprain:
Second degree:
Third:
0-25%, tear, instability
26-75% tear, some instability
76-100% tear, definite instability
How long does it take for a ligament injury to heal?
6 weeks if non-surgical and 3-6 months if surgical
Muscle strain degrees:
first
second
third
mild, minimal swelling, loss of ROM and function
moderate, moderate swelling, significant loss of ROM and function
severe, extensive swelling, severe loss of ROM and complete loss of function
How long does it take for a muscle strain to heal?
1-6 weeks
Foot and ankle common sprains
lateral
high ankle
Lateral sprain is
inversion with plantarflexion
What ligaments are affected in a lateral sprain of the ankle?
talofibular ligament, calcaneofibular ligament, posterior talofibular ligament
High ankle sprain affects what ligaments?
anterior and posterior tibiofibular ligaments
Acute phase of healing
inflammation
3 days usually but can last 7-10 days
Subacute phase of healing
migratory and proliferative stage
lasts 10 days to 6 weeks
Remodeling/maturation phase
chronic
6 weeks to a year
Normal knee alignment
5-10 degrees of valgus
Genu recurvatum
hyperextension of the knee above 10 degrees from neutral
Genu recurvatum is resisted by
posterior capsule and knee flexor muscles
Pronation in closed chain causes tibial …. rotation, ….flexion, …..internal rotation, hip…..
internal
knee
hip
flexion
Supination in closed chain causes tibial….. rotation, knee….., femoral …..rotation, and hip….
external
extension
external
extension
What is the screw home mechanism?
full knee extension coupled with 10 degrees of tibial external rotation that takes place during the last 30 degrees of knee extension
How is the screw home mechanism unlocked?
In open chain?
In closed chain?
popliteus muscle
internal rotation of the tibia on the femur
external rotation of the femur on the tibia
Knee extension glide
anterior tibial glide on femur
Knee flexion glide
posterior tibial glide on the femur
Function of MCL
resists valgus and extension forces at the knee as well as extreme rotation
Function of LCL
resists varus and extension forces at the knee as well as extreme rotation
NWB, ACL prevents….
WB, ACL prevents…
excessive anterior translation of the tibia on the femur due to the pull of the quads.
prevents excessive posterior translation of the femur on the tibia
PCL becomes more…with flexion.
taught
NWB for PCL prevents….
WB prevents…
posterior translation of the tibia on the femur
anterior translation of the femur on the tibia
What meniscus moves more than the other?
lateral
Medial meniscus is more …. shaped and attaches to ….
C
MCL/capsule
Lateral meniscus is more ….shaped and attaches to…
O
capsule
Which way does the meniscus move knee extension? Flexion?
anterior (with tibia)
posterior (with tibia)
Which way do the menisci move in external rotation of the tibia?
Internal rotation?
lateral moves anteriorly
medial moves posteriorly
lateral moves posteriorly
medial moves anteriorly
Major function of patellofemoral joint?
improves mechanical advantage of quads (moveable pulley)
Normal Q angle
Average
10-15 degrees
13-15 degrees
How does the patella move in knee extension?
In knee flexion?
superior and lateral
inferior and medial
Angle of inclination
angle between neck of femur and the medial side of the femoral shaft
Angle of torsion
angle between a line that runs through the femoral head and neck and a line that runs between the femoral condyles
Anterior pelvic tilt tight muscles?
Lengthened muscles?
hip flexors
erector spinae
hip extensors
abdominals
Posterior pelvic tilt tight muscles?
Lengthened muscles?
hip extensors
rectus abdominis
hip flexors
erector spinae
Hip flexion tests what muscles?
psoas and iliacus
Hip external rotation tests what muscles?
posterior glute max obturator gemelli piriformis quadratus femoris
Hip internal rotation tests what muscles?
anterior glute med/min
TFL
Foot inversion tests what muscles?
tib post
Foot eversion with plantarflexion tests what muscles?
peroneus longus/brevis
Hallux and toe MTP flexion tests what muscles?
flexor hallucis brevis
lumbricals
Hallux and toe DIP and PIP flexion tests what muscles?
flexor hallucis longus
flexor digitorum brevis/longus
Hallux and toe MP and IP extension tests what muscles?
extensor hallucis longus
extensor digitorum brevis/longus
