exsc 460 exam 2 Flashcards
anterior line of gravity passes through what?
anterior superior iliac spine
bisects the knee
bisects the ankle
foot at the second toe
bones in the hindfoot
talus and calcaneus
hindfoot joint
subtalar or talocalcaneal joint
function of hindfoot
conversion of rotatory forces of the lower extremity
movements of hindfoot
gliding and rotation
pronation and supination
bones in the midfoot
navicular, cuboid, and cuneiforms
midfoot joint
transtarsal joint
function of midfoot
transmits movement from rearfoot to forefoot and promotes stability
2 axis’ of the midfoot
oblique and longitudinal
when subtalar joint pronates,
transtarsal planes become parallel and foot becomes flexible
as subtalar joint supinates,
transtarsal planes converge medially and foot becomes rigid and lever-like
bones in forefoot
metatarsals and phalanges
name the 2 functions of the feet
support: stability for upright posture with minimal muscle effort, flexibility to adapt to uneven terrain
locomotion: rotation of tibia and fibula during gait, flexibility for shock absorption during gait, rigid lever during push-off
function of the arches
absorb and distribute GRF produced by body during ambulation or static erect posture
assist ambulation by increasing speed and agility
longitudinal arch
may be divided into medial and lateral
Feiss’ line used during assesment: line drawn from inferior tip of medial malleolus to plantar surface of first metatarsal phalangeal joint. navicular tuberosity
Hallux Valgus
big toe deviates away from midline of body and toward midline of foot
metatarsus primus varus
etiology of hallux valgus
mal foot posture, pronated or flat foot forefoot varus tight shoes hereditary abnormal mechanics during 1st phase of gait arthritis
pathological changes of hallux valgus
abnormal excess stress on medial aspect of head of 1st metatarsal callus formation bursitis exostosis bunion formation severe loss of plantar flexion
management of hallux valgus
prevention: proper fitting shoes, properly fitting orthotics, improve ankle dorsi flexion ROM
conservative: doughnut pad, toe crests, toe splint, ice massage for inflammation and pain, exercises to strengthen flexor and extensor muscles of great toe.
surgeries to fix hallux valgus
weight bearing xray required
structural: problem is osseous
positional: problem is soft tissue
combined: requires surgical correction of bone and soft tissue
Hallux Varus
big toe deviates towards midline of body and away from midline of the foot. uncommon in the west.
etiology of hallux varus
congenital: majority of cases
acquired: idiopathic, develops spontaneously in middle age, related to chronic arthritis
Management of Hallux Varus
mild cases respond to passive stretching exercises for adductor hallucis and proper footwear.
more severe cases require surgery.
mallet toe
flexion contracture of distal phalanx
diagnosis of mallet toe
can occur on any of 4 lateral toes
pathological changes of mallet toe
usually asymptomatic, possible formation of corn of callus over dorsum of affected joint
claw foot
condition characterized by extension of the metatarsophalangeal joints and flexion of interphalangeal joints.
etiology of claw foot
congenital or acquired
associated with forefoot adductus, arthritis, or neuromuscular pathology
result of defective lumbricals and interossei muscles
associated with pes cavus or equinus
pathological changes of claw foot
hard corns or calluses over dorsal surface of toes
may effect gait and functional ability
management of claw foot
if acquired, corrective footwear
if congenital, surgery
Hammer toe
condition characterized by extension of the metatarsophalangeal and distal interphalangeal joints and flexion in the proximal interphalangeal joint
etiology of hammer toe
seems to be congenital because bilateral.
caused by improperly fitting shoes
significant number are idiopathic
diagnosis of hammer toe
usually involves only one toe, primarily 2nd but sometimes 3rd
pathological changes of hammer toe
calluses or hard corns develop over proximal interphalangeal joint of affected toe.
management of hammer toe
proper fitting shoes: adequate toe box
taping of affected toe
severe: surgical fusion
Pes Planus
flat foot, depression or loss of longitudinal arch, decrease in angle of inclination of calcaneus
assessment of pes planus
anterior line of gravity
heel should be in neutral position
Feiss’ line
types of pes planus
rigid, congenital: secondary to tarsal coalition
flexible, acquired: break down of support tissue over extended period of time.
diagnosis of rigid pes planus
rare, talus drops medially and inferiorly, navicular drops, produces medial bulge
accompanying soft tissue contractures
diagnosis of flexible pes planus
when non weight bearing arch appears normal
management of pes planus
no pain: no treatment
conservative: arch supports, proper fitting shoes, exercise to strengthen muscles responsible for maintenance of longitudinal arch.
surgery reserved for severe cases after conservative management failed.
assessment of pes planus
anterior line of gravity
heel should be in neutral position
Feiss’ line
types of pes planus
rigid, congenital: secondary to tarsal coalition
flexible, acquired: break down of support tissue over extended period of time.
diagnosis of rigid pes planus
rare, talus drops medially and inferiorly, navicular drops, produces medial bulge
accompanying soft tissue contractures
diagnosis of flexible pes planus
when non weight bearing arch appears normal
treatment of pes cavus
if recognized early, stretching and orthotics
when late structural changes, surgery is required.
plantar fasciotomy
treatment for flexible pes cavus is orthotics.
Pes Cavus
high arch, excessively high longitudinal arch
Etiology of Pes Cavus
primary: develops after 3 years-idiopathic
dropping of forefoot, forefoot is pronated, contracture of plantar fascia, heel varus, clawing of toes.
secondary: number of causes, neurological disorders, myopathies, soft tissue overactivity or weakness, direct trauma to foot.
flexible or rigid
diagnosis of pes cavus
high arch
tight plantar fascia
claw foot
heel varus
pathological changes of pes cavus
painful calluses form on plantar surfaces of metatarsal heads and on dorsum of clawed toes.
forefoot is thickened and splayed.
toes don’t touch the ground.
function diminished in activities involving prolonged ambulation.
shock absorption reduced leads to increased stress fractures and strains.
treatment of pes cavus
if recognized early, stretching and orthotics
when late structural changes, surgery is required.
plantar fasciotomy
treatment for flexible pes cavus is orthotics.
Equinus
condition where foot is plantar flexed on itself or on leg
metatarsal equinus
foot is plantar flexed on itself at level of tarsometatarsal joint
forefoot equinus
foot is plantar flexed on itself at level of midtarsal joint
osseous block
normal dorsi flexion at the ankle is limited due to an impingement of tibia on neck of talus
muscular
an acquired or congenital shortness of gastrocnemius and soleus prohibits dorsiflexion at ankle, most common cause
diagnosis of equinus
10 degrees of dorsiflexion needed for normal midstance phase of gait.
compensations:
apropulsive gait
early heel-off
flexion or recurvatum at the knee
abnormal pronation of midtarsal and subtalar joints
pathological changes of equinus
calluses
claw foot or hammer toe
hallux valgus
plantar fasciitis
treatment of calcaneal varus
orthotics with medial heel wedge to correct heel varus while allowing normal subtalar pronation.
Calcaneal (heel) varus
deformity exhibited when non weight bearing by an inverted calcaneus. calcaneus is closer to midline.
Etiology of calcaneal varus
failure of calcaneus to completely derotate from original infantile position. feet develop in supinated position.
diagnosis of calcaneal varus
subtalar joint pronates to bring calcaneus vertical to the ground and forefoot in contact with the ground.
component of supinated foot.
pathological changes of calcaneal varus
reduced shock absorbing ability.
lateral ankle sprains.
treatment of calcaneal varus
orthotics with medial heel wedge to correct heel varus while allowing normal subtalar pronation.
Calcaneal (heel) valgus
deformity exhibited while non weight bearing by an everted calcaneus. calcaneus is further from the midline.
etiology of calcaneal valgus
failure of toddlers arches to develop properly
secondary to femoral neck anteversion, genu valgum,
due to medial weight thrust
diagnosis of calcaneal valgus
Helbing’s sign, medial bowing of achilles tendon
navicular tuberosity is lower (Feiss’ line)
component of pronated foot
pathological changes of calcaneal valgus
associated with problems involving pronated feet
treatment of forefoot varus
orthotic devices
forefoot varus
deformity exhibited when forefoot is inverted to bisection of posterior calcaneus
etiology of forefoot varus
result of failure of head and neck of talus to completely derotate from original infantile position
diagnosis of forefoot varus
during weightbearing, compensation at triplanar subtalar joint usually allows medial forefoot to contact the ground.
produces heel valgus, seen as medial bowing of Achilles tendon.
pathological changes of forefoot varus
resembles pes planus or pronation
8 degrees of forefoot varus should result in 8 degrees of calcaneal eversion.
hallux valgus
callus formation under head of 5th metatarsal
treatment of forefoot varus
orthotic devices
Calcaneal (heel) valgus
deformity exhibited while non weight bearing by an everted calcaneus. calcaneus is further from the midline.
etiology of calcaneal valgus
failure of toddlers arches to develop properly
secondary to femoral neck anteversion, genu valgum,
due to medial weight thrust
diagnosis of calcaneal valgus
Helbing’s sign, medial bowing of achilles tendon
navicular tuberosity is lower (Feiss’ line)
component of pronated foot
pathological changes of calcaneal valgus
associated with problems involving pronated feet
treatment of supination
orthotics with lateral posting in forefoot and hindfoot.
strengthening weak muscles and stretching tight ones. surgery reserved for rigid cases.
forefoot varus
deformity exhibited when forefoot is inverted to bisection of posterior calcaneus
etiology of forefoot varus
result of failure of head and neck of talus to completely derotate from original infantile position
diagnosis of forefoot varus
during weightbearing, compensation at triplanar subtalar joint usually allows medial forefoot to contact the ground.
produces heel valgus, seen as medial bowing of Achilles tendon.
pathological changes of forefoot varus
resembles pes planus or pronation
8 degrees of forefoot varus should result in 8 degrees of calcaneal eversion.
hallux valgus
callus formation under head of 5th metatarsal
treatment of forefoot varus
orthotic devices
Pronation
deformity of foot consisting of combination of heel valgus and forefoot abduction
etiology of pronation *
compensatory due to problems such as: forefoot varus rearfoot varus limited ankle dorsiflexion tibia vara genu varum
diagnosis of pronation
may be evident during static posture, excessive pronation or pronation for too long at wrong phase of gait cycle.
forefoot abduction
navicular tuberosity is lower
Helbing’s sign
pathological changes of pronation
can lead to subsequent malalignments in the lower limb.
bilateral pronation causes accentuated lumbar lordosis
treatment of pronation
orthotics
medial posting needed in the hindfoot
exercise for muscle imbalance or tightness
surgery rare
Supination
deformity of foot consisting of a combination of heel varus and forefoot adduction
etiology of supination
failure of the foot to derotate from original infantile position. muscle imbalance compensatory due to: forefoot valgus rearfoot valgus limb length discrepancy
diagnosis of supination
forefoot adduction: anterior line of gravity runs lateral to second toe.
navicular tuberosity is higher due to rotation of forefoot.
lateral bowing of achilles tendon.
pathological changes of supination
ankle sprains and overuse injuries, loss of force absorption, stress fractures
treatment of supination
orthotics with lateral posting in forefoot and hindfoot.
strengthening weak muscles and stretching tight ones. surgery reserved for rigid cases.
Pronation
deformity of foot consisting of combination of heel valgus and forefoot abduction
etiology of pronation *
compensatory due to problems such as: forefoot varus rearfoot varus limited ankle dorsiflexion tibia vara genu varum
diagnosis of pronation
may be evident during static posture, excessive pronation or pronation for too long at wrong phase of gait cycle.
forefoot abduction
navicular tuberosity is lower
Helbing’s sign
pathological changes of pronation
can lead to subsequent malalignments in the lower limb.
bilateral pronation causes accentuated lumbar lordosis
treatment of pronation
orthotics
medial posting needed in the hindfoot
exercise for muscle imbalance or tightness
surgery rare
Supination
deformity of foot consisting of a combination of heel varus and forefoot adduction
etiology of supination
failure of the foot to derotate from original infantile position. muscle imbalance compensatory due to: forefoot valgus rearfoot valgus limb length discrepancy
diagnosis of supination
forefoot adduction: anterior line of gravity runs lateral to second toe.
navicular tuberosity is higher due to rotation of forefoot.
lateral bowing of achilles tendon.
pathological changes of supination
ankle sprains and overuse injuries, loss of force absorption, stress fractures
treatment of supination
orthotics with lateral posting in forefoot and hindfoot.
strengthening weak muscles and stretching tight ones. surgery reserved for rigid cases.
Club Feet-Talipes
congenital gross deformity of the foot. direction may vary: equinus calcaneus varus valgus
etiology of talipes
cause is idiopathic, theories: intra-uterine compression arrest in fetal development dysplasia of muscles abnormal tendon insertion
club foot combinations
talipes varus talipes valgus talipes equinus talipes calcaneus talipes equino varus: most common
treatment of talipes
conservative: gradual manipulative reduction
stretching contracted tissue
corrective casting, changed every 1-2 weeks for 6-8 weeks.
correction is maintained by daily stretching by parents.
wearing of clubfoot or prewalker shoe.
operations confined to soft tissue prior to 8 or 9 yrs of age.
