Exam 2: Foot & Ankle Pathomechanics

Question 1

What are four etiologies that can cause tissue stress to the foot

Answer 1

1. Weight bearing activities
2. Biomechanical faults/limitations of the hip, knee, or foot
3. Disease process
4. Shoes

Question 2

True or False:

There is a gradual progression from one segment of the foot to another segment.

Answer 2

True

Question 3

What are 6 reasons to treat pathomechanics of the foot

Answer 3

1. Pain/fatigue
2. Instability
3. Postural attitude
4. Ulcerations
5. Improved performance
6. Proximal joint problem

Question 4

What are 7 general pathomechanic hindfoot/rearfoot conditions

Answer 4

1. Ankle Sprains
2. Heel/arch pain
3. Sever’s disease
4. Subtalar/ankle pain
5. Tendon injuries
6. Retrocalcaneal exostosis
7. Tarsal Tunnel Syndrome

Question 5

What are 3 general pathomechanic midfoot conditions

Answer 5

1. Lisfranc ligament sprain
2. Spring ligament sprain
3. Stiffness from crush injuries

Question 6

What are 6 general pathomechanic forefoor conditions

Answer 6

1. Metatarsal head pain
2. Hallux Valgus
3. Hallux limitus/rigitus
4. Morton’s neuroma
5. Morton’s foot
6. Plantar ulcerations

Question 7

During initial contact, the pretibial muscles fire (concentrically/eccentrically) in response to the plantarflexion torque of gravity and body weight.

Answer 7

eccentrically

Question 8

What would happen if the pretibs didn’t eccentrically control the foot during initial contact

Answer 8

You get a foot slap

Question 9

During initial contact, the pretibial muscles fire (concentrically/eccentrically) in response to the (dorsiflexion/plantarflexion) torque of gravity and body weight.

Answer 9

eccentrically; PF

Question 10

Which phase of gait do the pretibial muscles fire eccentrically in response to the PF torque of gravity and body weight

Answer 10

initial contact

Question 11

Which phase of gait do the pretibial muscles eccentrically contract to slow down the PF caused by gravity and body weight then ceases at foot flat

Answer 11

loading response

Question 12

During loading response, the pretibial muscles (concentrically/eccentrically) contract to slow down the PF caused by (gravity/muscle force) and body weight then ceases at foot flat.

Answer 12

eccentrically; gravity

Question 13

Which phase of gait is ankle DF controlled by eccentric contraction of the soleus

Answer 13

Mid Stance

Question 14

During mid stance, ankle (DF/PF) is controlled by eccentric contraction of the (gastroc/soleus)

Answer 14

DF; soleus

Question 15

Which muscle works the hardest during mid stance and terminal stance

Answer 15

soleus

Question 16

Ankle dorsiflexors are working (concentrically/eccentrically) during IC and LR, but work (concentrically/eccentrically) during the swing phases.

Answer 16

eccentrically in LC/LR

concentrically in swing phases

Question 17

Which phase of gait does the gastroc and soleus concentrically contract to lift the heel off of the floor at 80% of its max capacity

Answer 17

terminal stance

Question 18

In terminal stance, the gastroc and soleus contract (concentrically/eccentrically) at ___% of its max capacity to lift the heel off of the floor

Answer 18

concentrically; 80%

Question 19

Explain why the soleus, gastroc, posterior tib, FDL, FHL, peroneus longus/brevis all plantarflex

Answer 19

Because they run posterior to the axis of motion at the talocrural joint which results in plantarflexion

Question 20

Which phase of gait do the PF’s, mostly the FDL, FHL, and peroneus longus) assist in causing knee flexion

Answer 20

Pre-swing

Question 21

During pre-swing, the PF’s assist in causing knee (flexion/extension).

Answer 21

flexion

Question 22

During pre-swing, the (dorsiflexors/plantar-flexors) assist is causing knee flexion

Answer 22

PF’s

Question 23

During which phase of gait do the DF’s contract to counteract the PF torque of gravity which keeps the toe from dragging

Answer 23

Initial swing

Question 24

During initial swing, the (DF/PF)’s contract to counteract the (DF/PF) torque of gravity to keep the toes from dragging

Answer 24

DF’s; PF

Question 25

During which phases of gait do the DF's continue to contract to equalize PF force of gravity and assure toe clearance

Answer 25

mid swing and terminal swing

Question 26

Movement of the Calcaneus in the ____ plane, is a reflection of the ____ joint.

Answer 26

frontal; subtalar

Question 27

During initial contact the calcaneus is _____.

Answer 27

inverting

Question 28

During midstance the calcaneus is ______

Answer 28

perpendicular to the surface

Question 29

During terminal stance and pre-swing, the calcaneus is _____

Answer 29

inverting

Question 30

How many degrees of eversion do you need to unlock the midtarsal joints during loading response

Answer 30

4-6

Question 31

How many degrees of inversion do you need to lock the midtarsal joints in terminal stance

Answer 31

4

Question 32

Where does the plantar fascia run and what is its significance

Answer 32

It runs from the calcaneus to the met heads and is the foundation for the arch. Without a plantar fascia the foot would flatten out and overly pronate resulting in a major loss of stability

Question 33

Explain the importance of MTP joint motion, especially the first MTP joint

Answer 33

You need adequate DF of the first MTP joint so you don't drag your toes when you walk. Adequate extension of the first MTP joint is needed for push off

Question 34

If a patient doesn't have adequate first MTP joint extension for push off, how are they likely to compensate

Answer 34

Push off the medial side of the toe instead of directly over it

Question 35

What are three requirements of gait

Answer 35

1. Absorb shock 2. Adapt to the supporting surface 3. Propel body forward

Question 36

To observe gait in the frontal plane, you need to be in a (frontal/side/posterior) view

Answer 36

posterior

Question 37

To observe gait in the sagittal plane, you need to be in a (frontal/side/posterior) view

Answer 37

side

Question 38

To observe gait in the transverse plane, you need to be in a (frontal/side/posterior) view

Answer 38

frontal

Question 39

To observe gait in the frontal plane, you need to be in a (frontal/side/posterior) view

Answer 39

frontal

Question 40

In initial contact, the heel is slightly (inverted/everted) making the foot (rigid/unrigid)

Answer 40

inverted; rigid

Question 41

In midstance, the heel is (parallel/perpendicular) to the supporting surface which means the foot is (rigid/unrigid)

Answer 41

perpendicular; unrigid

Question 42

During heel off, the heel is slightly (inverted/everted) to the supporting surface making the foot (rigid/unrigid)

Answer 42

inverted; rigid

Question 43

When viewing gait in the sagittal plane (side view), explain what we are looking for during initial contact, midstance, and heel off.

Answer 43

IC: Looking for isolated heel contact with a neutral heel Mid Stance: normal tibial progression creating DF Heel off: Neutral ankle as the heel comes off the supporting surface

Question 44

When viewing gait in the transverse plane (front view), explain what we are looking for during initial contact

Answer 44

The forefoot is slightly inverted and the leg is slightly externally rotated

Question 45

When viewing gait in the transverse plane (front view), explain what we are looking for during mid stance)

Answer 45

The medial side of the foot should make contact with the supporting surface due to STJ pronation and leg internal rotation

Question 46

When viewing gait in the transverse plane (front view), explain what we are looking for during heel off

Answer 46

The leg should be externally rotated and the STJ supinates

Question 47

If a patient has an abnormally pronatory foot, list the planes of motion that are effected

Answer 47

sagittal, frontal, and transverse plane

Question 48

If a patient has an abnormally supinatory foot, list the plane of motion that is effected

Answer 48

frontal plane

Question 49

If your assessing a patient with a pronatory foot in the sagittal plane, which motion would you expect to be limites

Answer 49

DF

Question 50

A patient with a pronatory foot may lack adequate DF, what are 5 compensations that might occur to give the patient adequate DF AND which compensation is better on the body

Answer 50

1. Increase pronation even more 2. Knee hyperextension 3. Hip extension 4. Hip external rotation 5. Short stride length *** this is the best compensation to make

Question 51

If your assessing a patient with a pronatory foot in the frontal plane, what are 4 conditions you are likely to see

Answer 51

1. Increased tibia vara 2. Forefoot varus 3. Weak posterior tibialis and fibularis longus 4. Weak hip abductors

Question 52

If your assessing a patient with a pronatory foot in the transverse plane, what are 4 conditions that you are likely to see

Answer 52

1. Weak external hip rotators 2. Femoral anteversion 3. Tight medial hamstrings 4. Internal or external tibial/malleolar tension

Question 53

If your assessing a patient with a supinatory foot in the frontal plane, what are 3 conditions you are likely to see

Answer 53

1. Rigid plantarflexed 1st ray of forefoot valgus 2. Fixed calcaneal position with high degree of tibia vara 3. muscle imbalance with stronger invertors

Question 54

The (unrigid/rigid) plantarflexed 1st ray tends to force the STJ joint into (supination/pronation) during stance. This promotes lateral ankle (stability/instability)

Answer 54

rigid; supination; instability

Question 55

If you have a patient with a supinatory foot with tibia vara, will the calcaneus have little or a lot of movement

Answer 55

little

Question 56

Would a supinatory foot muscle imbalance be due from an upper or lower motor neuron pathology

Answer 56

Both