Foot Anantomy

Question 1

The First Ray

Answer 1

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.

Question 2

Second Ray

Answer 2

2nd metatarsal and 2nd cuneiform etc.

Fifth ray: just the 5th metarsal

Question 3

First rocker:

Answer 3

calcaneus

Question 4

Second rocker:

Answer 4

Talus: Dome creates the lower part of our second rocker

Question 5

Third rocker:

Answer 5

Metatarsophalangeal joint

Question 6

Midfoot:

Answer 6

Navicular, Cuboid, Cuneiforms

Question 7

Pronation

Answer 7

DF, abduction, eversion

Question 8

Supination:

Answer 8

PF, adduction, inversion

Question 9

ER of normal foot:

Answer 9

7 degrees

see two toes

Question 10

Compensated foot-

Answer 10

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

Question 11

Uncompensated

Answer 11

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

Question 12

Relaxed calcaneal stance

Answer 12

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)

Question 13

Compensated Rearfoot Varus

Answer 13

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

Question 14

Gait with compensated rearfoot varus:

Answer 14

Prolonged eversion of rear foot and flattening of arch
Heel whips to re-orient the foot
knees into valgum
Pelvis may anteriorly rotate

Question 15

Some common conditions with compensated rearfoot varus

Answer 15

Subtalar joint arthritis
Achilles tendinopathy
Posterior tibial tendinopathy
Medial tibial stress syndrome
Knee pain with rotation of tibia
Hip pain with rotation of femur

Question 16

Shoes that might help/ Compensated RF Varus

Answer 16

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

Question 17

Uncompensated rear foot varus

Answer 17

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

Question 18

Gait with Uncompensated Rearfoot varus

Answer 18

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

Question 19

Conditions with uncompensated rearfoot varus

Answer 19

Medial Tibial Stress Syndrome: Shin Splints 
Metatarsalgia
Cuboid syndrome
Stress fractures
Lateral ankle sprains
Knee pain

Question 20

Large Uncompensated Rearfoot Varus

High Arched Foot (valgus forefoot)

Answer 20

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

Question 21

Gait with Pes Cavus

Answer 21

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)

Question 22

Shoes for Pes Cavo Varus

Answer 22

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!!!!!!

Question 23

Gait with compensated forefoot varus and rearfoot valgus

Answer 23

Severe midfoot collapse
Outoeing – too many toes sign
Splaying of toes
Pronation fully through gait cycle

Question 24

Conditions with compensated forefoot varus and Rearfoot Valgus

Answer 24

Plantar fasciitis
Strain of the spring ligament
Post tib tendinopathy
Metatarsalgia
Bunions with hallux limitus

Question 25

Uncompensated forefoot varus

Answer 25

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

Question 26

Abdictovarus forefoot

Answer 26

``` abducted toe sign medium/low arch varus forefoot alignment mildy inverted heel alignment; abducted forefoot medial heel ppivot ```

Question 27

Possible symptoms of abductovarus forefoot:

Answer 27

``` shin splints plantar fascitis cuboid syndrome medial knee pain tailor's bunion ```

Question 28

Gait with uncompensated forefoot varus

Answer 28

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

Question 29

Severe Pes planovalgus

Answer 29

``` abducted toe sign lateral column instability flat arch everted heel alignment large toe sign ```

Question 30

Symptoms of Pes planovalgus

Answer 30

pronates thru propulsion severe MTJ instability propels from central MTHs

Question 31

Severe pes cavus

Answer 31

peek a boo hallux cavus high arch inverted heel alignment ER of tibial/fibular rotation

Question 32

Symptoms of pes cavus

Answer 32

poor shock attenuation excessive supination narrow or cross over gait

Question 33

Shoes for intoeing or outoeing?

Answer 33

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

Question 34

Measuring WC seat height/leg length

Answer 34

Measure from the user’s heel to the popliteal fold and add 2 inches to allow clearance of the footrest

Question 35

Average adult size of seat height/leg length:

Answer 35

19.5-20.5 inches

Question 36

How far is the bottom of the footrest from the floor?

Answer 36

2 inches | You can fit 2-3 fingers under the distal thigh (between the thigh and the seat)

Question 37

Measurement of seat depth:

Answer 37

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

Question 38

Average adult size of seat:

Answer 38

16 inches

Question 39

Measure of seat depth:

Answer 39

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?

Question 40

Measurement of seat width:

Answer 40

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

Question 41

Average adult size of seat width:

Answer 41

18 inches

Question 42

Measurement of back height:

Answer 42

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

Question 43

Average adult size of back height:

Answer 43

16-16.5 inches

Question 44

Measurement of armrest height:

Answer 44

Measure from the seat of the chair to the olecranon process with the user’s elbow flexed to 90, then add 1 inch

Question 45

Average adult size of armrest:

Answer 45

9 inches above the chair seat