Foot Anantomy Flashcards
The First Ray
first metatarsal and first cuneiform bones. Pronation of the subtalar joint lowers the first ray to the ground in early stanceand dissipates the shock of heel impact.
Second Ray
2nd metatarsal and 2nd cuneiform etc.
Fifth ray: just the 5th metarsal
First rocker:
calcaneus
Second rocker:
Talus: Dome creates the lower part of our second rocker
Third rocker:
Metatarsophalangeal joint
Midfoot:
Navicular, Cuboid, Cuneiforms
Pronation
DF, abduction, eversion
Supination:
PF, adduction, inversion
ER of normal foot:
7 degrees
see two toes
Compensated foot-
refers to a change in the structural alignment or position of one part of the foot to neutralize the effect of a structural problem in another part of the foot
Uncompensated
Uncompensated doesn’t tell you it the foot is normal or abnormal. It just is tell you that is isn’t changing its static position to deal
Relaxed calcaneal stance
The medial and lateral metatarsals are on ground
The lower extremity is vertical to floor (4deg)
The heel should be slightly twisted in (varus or inverted by 4 degrees)
Compensated Rearfoot Varus
The Subtalar joint possesses an adequate amount of pronation and the medial calcaneus is in contact with the ground.
Medial Translation (Shift)of the talus and lateral shift of the calcaneus
Increased rotation of the tibia
Flattening of arch – if mobile arch
Gait with compensated rearfoot varus:
Prolonged eversion of rear foot and flattening of arch
Heel whips to re-orient the foot
knees into valgum
Pelvis may anteriorly rotate
Some common conditions with compensated rearfoot varus
Subtalar joint arthritis Achilles tendinopathy Posterior tibial tendinopathy Medial tibial stress syndrome Knee pain with rotation of tibia Hip pain with rotation of femur
Shoes that might help/ Compensated RF Varus
Stability shoes with an insert
Need heel counter
Need torsional rigidity
Need excellent match of arch of foot/shoe
Need depth for insert
Need to address forefoot problems which may arise
Uncompensated rear foot varus
Calcaneus in varus Tibia in ER High arch Toe in contact w/ ground (PF 1st ray) Pressure on outer border of foot Often associated with wider foot typing
Gait with Uncompensated Rearfoot varus
High rigid arch through gait (compensated it was flattened)
Pressure on lateral border of foot
May have heel whip to compensate for out toe
The heel drives in and pulls out at an angle and there may be a pump bump
Conditions with uncompensated rearfoot varus
Medial Tibial Stress Syndrome: Shin Splints Metatarsalgia Cuboid syndrome Stress fractures Lateral ankle sprains Knee pain
Large Uncompensated Rearfoot Varus
High Arched Foot (valgus forefoot)
Supinated Foot
Pes Cavovarus
The medial condyle of the calcaneus cannot be lowered to the ground.
May be associated with the forefoot being dropped into equinus so toe is like a door stop
Gait with Pes Cavus
Walks like on a tight rope
Heel in varus but first ray and rest of foot in valgus to compensate
Forefoot is also in equinus
Very intoed gait with big toe that when viewed from behind the patient appears during stance then disappears (peak a boo)
Shoes for Pes Cavo Varus
Neutral shoes may not have enough support as these feet need a high arch
Do need cushion but not at the risk of loosing heel
Torsionally stable shoe
Good heel counter
Cushion
STABILITY with cushion
DEPTH/WIDTH!!!!!!
Gait with compensated forefoot varus and rearfoot valgus
Severe midfoot collapse
Outoeing – too many toes sign
Splaying of toes
Pronation fully through gait cycle
Conditions with compensated forefoot varus and Rearfoot Valgus
Plantar fasciitis Strain of the spring ligament Post tib tendinopathy Metatarsalgia Bunions with hallux limitus
Uncompensated forefoot varus
The forefoot will not reach the ground
The rearfoot may also be rigid and not able to evert to reach the ground
May see big toe pressing into ground to stabilize
May see shift at talus or leg with ankle more medially
Often seen with tib varum or bowing of legs
Abdictovarus forefoot
abducted toe sign medium/low arch varus forefoot alignment mildy inverted heel alignment; abducted forefoot medial heel ppivot
Possible symptoms of abductovarus forefoot:
shin splints plantar fascitis cuboid syndrome medial knee pain tailor's bunion
Gait with uncompensated forefoot varus
More pressure on outer border of foot
More pressure on first ray and big toe
The foot may compensate with a heel whip
There may be other compensations up the chain
Severe Pes planovalgus
abducted toe sign lateral column instability flat arch everted heel alignment large toe sign
Symptoms of Pes planovalgus
pronates thru propulsion
severe MTJ instability
propels from central MTHs
Severe pes cavus
peek a boo hallux
cavus high arch
inverted heel alignment
ER of tibial/fibular rotation
Symptoms of pes cavus
poor shock attenuation
excessive supination
narrow or cross over gait
Shoes for intoeing or outoeing?
Need a shoe that is flexible enough that we can incorporate a gait plate which controls the in toeing and out toeing. If the shoe is too stiff/too controlling the gait plate can’t work
Measuring WC seat height/leg length
Measure from the user’s heel to the popliteal fold and add 2 inches to allow clearance of the footrest
Average adult size of seat height/leg length:
19.5-20.5 inches
How far is the bottom of the footrest from the floor?
2 inches
You can fit 2-3 fingers under the distal thigh (between the thigh and the seat)
Measurement of seat depth:
Measure from the user’s posterior buttock, along the lateral thigh to the poplitealfold; then subtract 2 inches to avoid pressure from the front edge of the seat against the poplitealspace
Average adult size of seat:
16 inches
Measure of seat depth:
Can you can fit 3-4 fingers between the front edge of the seat and the patient’s poplitealfold with your palm horizontal to the seat?
Measurement of seat width:
Measure the widest aspect of the user’s buttocks, hips or thighs and add 2 inches. This will provide space for bulky clothing, orthosesor clearance of trochantersfrom the armrest side panel
Average adult size of seat width:
18 inches
Measurement of back height:
Measure from the seat of the chair to the floor of the axilla with the user’s shoulder flexed to 90, then subtract 4 inches. This will allow the final back height to be below the inferior angles of the scapula
Average adult size of back height:
16-16.5 inches
Measurement of armrest height:
Measure from the seat of the chair to the olecranon process with the user’s elbow flexed to 90, then add 1 inch
Average adult size of armrest:
9 inches above the chair seat
