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KIN 240 > Foot & Lower Leg > Flashcards

Foot & Lower Leg Flashcards

1
Q

Lower extremity chronic & overuse injuries have a number of contributing biomechanical factors including….

A

…mechanics at the foot and ankle (=major contributor!)

-start for lower extremity kinetic chain

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2
Q

2 phases of normal gait

A

Stance phase
&

Swing phase

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3
Q

Stance phase:

A

Accounts for 60% of gait cycle

Involves weight bearing in closed kinetic chain (=force imparted to non moving object)

Has 5 periods

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4
Q

5 periods of stance phase:

A 
5 periods:
Initial contact= double limb support
Loading response =double limb support 
Midstance= single limb support
Terminal stance =single limb support (transitioning through & prep to propel pressing)
Pre swing
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5
Q

Swing phase:

A

=the period of non-weight bearing
(ie while other leg in stance)

3 periods:
Initial swing
Mid-swing
Terminal swing

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6
Q

How does the foot serve as shock absorber?

A

It serves as shock absorber at heel strike and then adapts to uneven surfaces during stance phase

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7
Q

How/when does the foot act as a rigid lever?

A

Foot transitions to serve as rigid level to provide propulsion at toe off

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8
Q

Kinetic chain:

A

Tibia externally rotates with supination on initial contact
(with push off—-when first heel strike/supinate …the tibia slight ext. rot. To allow for more supination)

Internal rotation of rubia occurs as foot moves through pronation.
(And then internally roasters to allow for more pronation)

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9
Q

Supination:

Vs.

Pronation:

A

sole coming up ie. Big toe side

(Plantarflexion, inversion, adduction)

Sole going down and pinky toe side out

(Dorso flexión, eversion, abduction)

(Happen in 3 planes of movement!!!)

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10
Q

Pronation role in gait:

A

-it allows unlocking of mid foot and shock absorption (even distribution) (=to have a bigger base to push off from for more solid push)

-subtalar joint in pronation 55-85% of stance phase
(not supinate!) **if there is =easy way to look for biomechanical problems (look posterior)

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11
Q

Excessive Pronation:

A

Major cause of STRESS INJURIES
—overload structures during extensive stance phase
—prolonged pronation in propulsive phase
(WATCH VIDEOS)

Results in a hyper mobile/loose foot
=results in MORE MIDFOOT MOTION
=more pressure then on metatarsals and more tibial rotation

(Structures that otherwise wouldn’t be absorbed by the foot that much now are (ie TIBIA b/c drops into pronation right away (the transfer btw supination and pronation is gone!)

Won’t allow foot to resupinate to provide that rigid lever for toe off

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12
Q

Excessive Supination:

A

Cause foot to remain rigid/hypomobile
——decreased mobility of calcaneocubiod joint

Decreased mobility in first Ray
——-causes weight absorption on 1st and 5th metatarsals and poor absorption
(Ie. kind of skips mid-stance phase : starts way too lateral too longs and then drops right to medial)

Limits tibial internal rotation (Kinetic chain)
——knee—hip—low back —-shoulder
……..

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13
Q

Excessive supination leads to ….

A

Inversión ankle sprains
Medial tibial stress syndrome
Iliotibial band friction syndrome
Tronchanteric bursitis

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14
Q

Reducing foot injuries:

A

-proper footwear
-orthotics?
-appropriate footwear for activity
(Ie runners need to replace approx 4 months)

Hygiene

  • toenails
  • clean socks and shoes
  • avoid long lasting moisture to avoid athletes foot
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15
Q

Foot assessment

A

HOPS!!!

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16
Q

Foot assessment: history

A

(Questions specific to the foot)

Location of pain. -heel, toes, arches?

Training surfaces or changes in footwear

Does footwear increase to decrease comfort?

ANY MAJOR CHANGES IN VOLUME OF TRAINING, FOOTWEAR, or TRAINING SURFACES (if not then like more acute than biomechanical issue)

17
Q

Foot assessment: Observations

A

Does athlete favour foot, antalgic gait, or unable to bear weight?

How is arch shaped?
Static and dynamic alignment of foot?
Structural deformities?

Look @ their gait sitting, standing, and walking

18
Q

Foot assessment: Palpation

Basic landmarks we should be able to identify are:

A

Medial malleolus

Navicular tubercle (May tell how much pronating)

Lateral malleolus

Cuboid bone (May tell how much supination)

Style is process of the 5th metatarsal

Plantar fascia

19
Q

Fracture of the Talus: etiology

A

Laterally—-Severe eversión and Dorsiflexion force

Medially——inversion and plantar flexion forcé with tibial external rotation

(Pretty uncommon takes a lot of force)

20
Q

Fracture of the Talus:

Signs and symptoms

A

History of repeated ankle trauma

Pain with weight bearing

Catching or clicking with plantar/dorsiflexion

Talar dome is tender upon palpating (palpating this fab help tell if pain is coming directly from bone)

21
Q

Fractures of the calcaneus:

Etiology

A

Occurs from jump or fall from height

Often results in avulsion fractures anteriorly or posteriorly

(Or landing in an excessive dorsiflexion at high velocity could pull achillies and cause avulsion fracture)

22
Q

Fractures of the calcaneus:

Signs and symptoms

A

Immediate swelling, pain, and inability to bear weight

Can often be mistaken for a heel fat pad contusion (more common in many sport) when less severe. (MOI IMPORTANT HERE///if report abnormal fall then likely fracture)

23
Q

Management

Of fractures of the Talus and Calcaneus

A

Refer for x Ray for diagnosis

For non displaced fracture, immobilization (air cast or plaster)
and early ROM exercises when pain and swelling go down

Rehab focus on strengthening and gaining full ROM

if conservative treatment unsuccessful (or significant avulsion fracture) =surgery

24
Q

Apophysitis of the Calcaneus:

A

Aka severa disease (often in children and adolescents)

Etiology:
Traction injury at apophysis of Calcaneus where Achilles attaches (=weak point of Calcaneus) -overuse/chronic:overtime

Signs and symptoms:
Kids/youth b/c growth plate not full/secure
Pain @posterior heel below Achilles attachment
Pain during vigorous activity and stops after

Management:

  • POLICE
  • heel lift could relive some stress off Calcaneus (less muscle pull on it)
  • manage a oft tissue restrictions (roll our hamstrings, gastric and right plantar fascia)
25
Q

Retrocalcaneal Bursitis:

A

Etiology:

  • inflammation of Bursa beneath Achilles’ tendon
  • from pressure and rubbing
  • chronic condition dev. Over time and takes extensive time to resolve
  • Haglund’s deformity (EXOSTOSIS) May develop

Signs and symptoms:

  • pain with palpation above& ant. To Achilles insertion
  • swelling in Both sides of heel chord
  • shoe wear patterns

Management:

  • reduce stress and donut pad to reduce pressure
  • modify footwear to remove pressure points
26
Q

Cuboid subluxation:

A

Etiology:

  • pronation and trauma injury (quick aggressive inversion movement/sprain….can pull Cuboid out of place)
  • often confused with plantar fasciitis
  • puts stress on FIBULARIS LONGUS when foot is pronated=primary reason for pain

Signs and Symptoms:

  • displacement of the cuboid causing pain along 4th & 5th metatarsals and over cuboid (esp. base of the 5th)
  • May refer pain to heel area
  • pain may increase after prolonged non-weight/bearing period

Management:

  • (refer to chiropractor) dramatic results can come from cuboid manipulation
  • orthotics can be used to help keep cuboid in position
27
Q

Tarsometatarsal fracture/dislocation:

A

Aka Lisfranc injury

Etiology:
MOI=foot hyper-plantar flexed With foot already plantar flexed and rear foot locked (ie steps on foot and turn to get away from it so torsion on it)
-dorsal displacement of the proximal end of the metatarsals

Signs and Symptoms: (May take a few days to localize)

  • pain & unable to bear weight, swelling, tenderness localized to DORSUM of the foot
  • May be bruising (often shiny on surface of food and abnormal bruising on bottom (and middle of foot)

Management

  • KEY= recognition (refer to physician), realignment, and maintain stability
  • generally requires open reduction (surgery) with fixation (screws etc.)
28
Q

Pes planus foot:

A 
=flat foot  (is more of a condition that LEADS TO INJURY)
Etiology:
-ass. with excessive pronation
-weak supportive structures 
-consistent high impact activity 
(Hyper mobility of the foot)

Signs and symptoms:

  • pain & weakness or fatigue in MEDIAL LONGITUDINAL ARCH
  • bulging NAVICULAR (it’s dropping significantly =suggest excessive pronation=problematic)
  • flattening to medial longitudinal arch

Management:

  • if not causing athlete pain or symptoms—just leave it!
  • orthotics or tape job could be used to help if it is tho
  • strengthening intrinsic foot muscles
29
Q

Pes Cavus

A

=High arch foot

Etiology:
( Very rigid =bad force distribution )
-higher arch than normal = associated with excessive supination
-accentuated high medial longitudinal arch

Signs and Symptoms:

  • poor shock absorption
  • heavy calluses on ball and heel of foot and big toe too
  • high probability of Medial Tibial Stress Syndrome

Management:

  • if no symptoms-just leave it!
  • orthotics can be used (help put pressure into arch to help distribute that force)
  • release Achilles/gastric complex and plantar fascia
30
Q

What is plantar fasciitis??

And what are plantar fascia?

A

=general term to talk about pain existing btw toes and heels

Plantar fascia=dense, broad ban for connective tissue attaching proximally to the medial surface of Calcaneus and fans out over the plantar aspect of the foot

—-> works to maintain stability of foot and bracing the longitudinal arch

31
Q

Plantar Fasciitis:

E, S&S, M

A

Etiology:

  • Increased tension and stress in fascia (esp. during push off of running phase)
  • Change from rigid supportive footwear to flexible footwear
  • common with excessive pronation (b/c constant pronation puts plantar fascia on stretch=more likely to dev. this)

S&S:

  • pain in ant. medial heel
  • increased pain in MORNINGS
  • increased pain with forefoot dorsiflexion

Management: =conservative

  • soft orthotic with deep heel cup
  • arch taping and night splint to maintain position of static stretch
  • vigorous stretching and exercises of Gastroc/Achilles that increase great toe dorsiflexion
  • NSAIDs and occasionally steroidal injection (only inject when other method unsuccessful!)
32
Q

Metatarsal Stress Fractures:

A

Aka “March Fracture” b/c common in soldiers

Etiology: overuse-change in AMOUNT, FOOTWEAR, SURFACE
2nd metatarsal =most common (re: March fracture )
5th metatarsal fracture @ insertion of peroneus brevis
Change in running pattern

S&S: dull ache when weight bearing, progressing to pain @ rest
Progresses from diffuse to localized pain
Symptoms usually come after increase in duration/intensity/type of training

M: bone scans may be needed (not just X-ray)
Partial weight bearing until asymptomatic at rest
Initial immobilization (aircast) until full weight bearing with no pain

Return to running must be Gradual
Special attention given to biomechanics throughout R2S

Evaluate footwear

33
Q

Bunion:

A

=Hallux Valgus deformity

E: exostosis of 1st metatarsal head
-bursa becomes inflamed and thickens, enlargers joint, and causes lateral MALalignment of great toe

S&S: tenderness, swelling, & enlargement of joint &redness!

  • as inflam. continues, angulation (Abnormal shape) increased causing painful ambulation (movement)
  • tendinitis in great toes flexors may develop

M:early recognition and care!!!
Wear good fittings how’s, appropriate orthotics, place pad over 1st metatarsophalangeal joint, tape splint btw 1st and 2nd toes
-engage in foot exercises for intrinsic and extrinsic muscles
-BUNIONECTOMY May be needed

34
Q

Sprained toes:

A

Etiology:
Usually kicking a non-moving object
Pushes beyond normal ROM and imparting twisting motion on toe—-disrupting ligamientos and joint capsule

S&S: pain immediate and intense BUT short

  • swelling & discolouration in 1-2 days
  • stiffness and residual pain for several wks

M: precautionary X-ray May be needed

  • buddy taping toes to immobilize (ie. middle ones)
  • begin weight bearing as tolerable
35
Q

Great toe hyper extension:

Or Turf Toe

A

Etiology: acute or repetitive trauma from hyper ext. of the first metatarsophalangeal joint

S&S: pain & swelling —-which increase during push off phases (will worsen as they go on)

M: increase rigidity of forefoot region in shoe

  • tape toe to prevent dorsiflexion
  • rest and discourage activity until pain free

(Tape job easy —-actor and tape distal to próx)

Or get orthotic steel thing for toes (might last longer than tape!)

36
Q

Subungual Hematoma:

A

Etiology:

  • direct pressure, dropping an object on toe, or kicking another object
  • repetitive shearing forced on toenail

S&S:

  • accumulation of blood under toe nail
  • extreme pain and eventually loss of nail

m:
Apply ice immediately to reduce swelling
Relive pressure within 12-24 hrs (drill sterilized nail or medicentre for athletes. )

KIN 240 (1 decks)

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