Foot/Ankle Pathological Joint Deviations Flashcards
what are some causes of increased plantarflexion (equinus)?
- PF contracture - equinus – bony or spastic
- PF hypertonicity - Extensor synergy pattern – esp in swing
- Weak dorsiflexors (or lack of selective DF control in TSw)
- Compensation for weak quads to limit LR
- Ankle/heel pain
- decreased proprioception
- To vault
what are some effects of increased plantarflexion at IC/LR w/ forefoot contact?
- loss of heel rocker // absent ankle rocker if progresses into stance
- decreased tibial advancement
- decreased shock absorption by limited knee flexion
- poor position for heel rocker
- decreased BOS
- decreased stride length
What are the differences between increased PF @ IC/LR with Foot Slap vs forefoot contact?
uncontrolled PF after heel contact, makes a slapping sound and associated w/ steppage gait
what are the three major compensations of increased PF in stance?
- premature heel rise
- knee hyperextension
- forward trunk lean
effects of increased PF in terminal stance?
- increased heel rise
- decreased BOS 2° decreased WB surface
- increases pressure on MT heads
effects of increased PF in swing?
- interferes w/ foot clearace
- req’s circumduction/vaulting/hip hike/flex to clear foot
- interferes w/ foot position for IC
wffects of increased PF in foot drop/toe drag?
compensates with increased hip/knee flexion
- may cause LOB
- may cause toe injury
- interferes w limb advancement
what are postural compensations for increased PF?
Ankle Equinus
Hip Flexion
Genu Recurvatum
Lumbar Lordosis
What happens with Equinus Foot when the arch flattens and foot pronates?
- aggravates plantar fasciitis and bunions
- create posterior tibial tendonitis
- can cause achille’s tendonitis, calf cramps, shin splints
what are the conservative treatments for equinus foot?
calf stretches, night splints, heel lifts, orthotics
what are the surgical treatments for equinus foot?
sometimes surgery is needed to correct
what are the causes / effects of vaulting on the reference limb?
Causes:
- Assists to clear swing limb
- Compensation for:
- limited DF or knee flexion (contra LE)
- longer swing limb (contra LE)
- increased PF stance limb
Effect
- increased demand on PF’s on stance limb
- increases COG trajectory
- decreased step length
what are the three primary causes for increased dorsiflexion?
- 1° cause = soleus weakness unable to stabilize tibia
- 2° cause = fixation of ankle at neutral (AFO/bony fusion)
- 3° cause = stance knee flexion beyond midstance
what are the effects of increased DF in IC/LR?
- Increased heel rocker effect on knee (req’s 30° vs 15°flex)
- increased demand on hip & knee extensors
- Accelerated tibial advancement
what are the effects of increased DF in stance?
- increased demand on hip & knee extensors as tibia pulled forward
a) Prolonged heel contact – w/ increased fwd tibial movement OR
b) Excessive knee flexion with heel rise may hide increased fwd tibial mvt
c) Loss of normal PF in Pre-swing - Interferes w/heel rise and decreases step length on opposite limb (TSt)
what are the effects of increased DF in impaired heel rise/heel off?
- Interferes w/forward progression over forefoot
- decreases step length opposite limb
- decreases stability of tibia –> sustained knee flexion thru preswing,
delayed knee flexion in swing
what are the causes of excessive ankle inversion (supination)
- midfoot stiffness
- increased ant. tib., post. tib., soleus activity
- varus contracture
- PF contracture (in SLS)
- decreased selective control of dorsis
- weak peroneals
what are the effects of excessive ankle inversion (supination)
- Poor positioning for IC/LR
- decreased stability in single leg stance
- decreased foot clearance in swing
- Rigid foot results in decreased shock absorption and increased IR ROM ipsi hip
- Flexible foot takes more stance time to complete pronation ROM
what are the causes of excessive ankle eversion (pronation)
- weak post tib (WA & SLS)
- weak soleus (SLS)
- PF contracture (SLS)
- valgus deformity
- weak tib ant (SLA)
- increased peroneal activity (SLA)
what are the effects of excessive ankle eversion (pronation)
- increased rotary strain on ankle then knee
- interferes w rigid lever for forefoot rocker
