Foot and ankle Flashcards
hindfoot and forefoot varus and valgus
Varus = eversion/inversion Valgus = eversion/inversion
varus = inversion valgus = eversion
Finding subtalar neutral
pt in prone
make sure their limb is in neutral torsion
put them in neutral DF
middle finger and thumb anteriorly on talus
grab with your other hand on the 4th and 5th ray
move left and right until you feel talus equally under each finger
what are you looking at to find rearfoot angle at subtalar neutral?
you are looking at calcaneus in relation to the tibia
what is normal hindfoot and forefoot varus and valgus?
rearfoot varus
forefoot varus
what does “normal” rearfoot and forefoot varus lead to in gait
Varus means inversion, therefore
leads to more pronation during walking, because your foot needs to meet the ground
if you have severe varus in both hindfoot and forefoot thats going to lead to A TON of pronation
severe hindfoot and forefoot varus is going to lead to what motion at the foot during gait
excessive pronation! they have to get their foot to the ground
what if you have a severe mismatch of varus and valgus btwn hindfoot and forefoot?
every time you put your foot down there is a torsional effect on the midfoot which could cause irritation.
internal tibial torsion is going to cause the subtalar joint to what?
pronate!
what position is the patient in when measuring LAA (longitudinal arch angle)
standing!
as the angle gets more obtuse or acute in LAA, that signals that the arch is dropped
acute
what are the four points you mark to measure static rearfoot angle.
1) base of calcaneous
2) achilles tendon insertion
3) achilles at height of medial mal
4) 15 cm above mark 3
too many toe sign assesses for what related set of issues?
excessive pronation due to collapsed arch causing forefoot ABD
how do you perform the navicular drop test
pt is in sitting
find subtalar neutral
palpate navicular and measure from the ground to this point
have pt stand
measure again
> 5cm difference is signifcant
how many cm is significant for navicular drop test?
5 cm from sitting to standing
two main actions of the posterior tib
PF and inversion
where does posterior tib insert?
plantar surface of navicular, cuniforms and base of 1st and2nd met
if pt has pain right on the plantar surface of their medial arch what are you thinking?
insertional inflammation of posterior tib
posterior tib
origin
where it runs
insertion
origin: interosseous membrane btwn tib and fib posteriorly
tendon runs posterior to medial mal, wraps around
inserts: plantar surface of navicular, cuniforms and base of 1st and 2nd met
every time someone w/pes plantus takes a step, what is happening to the posterior tib muscle?
its being stretched out its full length and trying to work eccentrically.
Recipe for overuse!
over the counter vs custom inserts for pes planus?
over the counter is fine for most people.
if they have a severe deformity hen youd consider custom
if someone has notable rear foot and forefoot varus, what would you want to maybe recommend they use everday
orthotic in their shoe on the medial side to bring the floor to their foot!
pes planus or posterior tib overuse
if someone is overpronating, what other motion do you want to make sure you’re also looking at?
DF, lack of DF could cause someone to have to excessively pronate to get their foot to meet the ground
general purpose of orthotic
bring the floor to the foot to reduce stress
who might benefit more from an orthotic someone with a flexed or rigid deformity?
rigid! flexible you’d probably only want it temporarily
what are two pathoanatomic diagnoses that might benefit from an orthotic
posterior tib overuse
pes planus