Foot Mechanics Chart Flashcards
Coupling mechanism-
Pronation= unlocked/loose packed position Supination= locked/close packed position
Tibial Alignment
Tibial alignment
Typical 2-3deg varum
If you think about it when you’re walking you transfer your weight over to the side and hive a tibia varus. Usually you have about a 4-7 deg varus angulation as you walk thats normal. That is why doing a lot of things single leg is so critical in your rehab, replicates gate cycle.
Clinical manifestations of pronation- (when you’re watching your patient walk)
- Forefoot- abduction (Main component of pronation)
- Arch- depressing down
- Mid-foot- pronated (we will measure these with longitudinal arch measurement, drop test, and phys’ line)
- Rearfoot or STJ(remember where pronation occurs)- eversion or calcaneal going into valgus (frontal plane component of the tri-plane motion of pronation)
- Ankle- PF towards DF
- when going from heel strike to forfoot loading going to the midstance phase of gate. You should be at the neutral position of the ankle at the 90 deg angle.
- Tibia- IR
- Patella- IR
- LE- IR
Bergman’s position
Birdmen’s position- plantar flexion inversion how the foot normally falls when relaxed. Also used in slipper casting for developing orthotics
Figure 8
- pt in long sitting position start medially
- Start at the anterior tib > navicular > plantar surface > cuboid groove > back to the anterior tib > distal to the medial malleolus > superior calcaneal dome > distal to the lateral malleolus
- About 54 cm.
- 7 mm is the minimal detectable change. If they haven’t changed by 7 mm it is not enough to really be clinically important difference
Tests indicated if supspect a DVT (3)
- Circulatory tests-Buerger’s test
- Homan’s Test
- Well’s CPR-DVT
Plantar Surfaces evaluation
Plantar Surfaces evaluation= dynamic pedograph (look at callus indicae weight bearing)
- Pt. supine or long sitting on table (he said here where you would see the callouses for pronation and supination, but the recording skipped so I couldn’t make it out)
- you can look at the bottoms of the older models and see where it is wearing down
- Should be on the posterior-lateral corner and goes along the lateral aspect, then goes to the center mid stance and then towards the first metatarsal as it is re-supinating. you can see this on the bottoms of shoes.
Mulder’s Sign
Mulder’s Sign (not that great best that we have)
Morton’s neuroma
- Most commonly between 3 and 4
- pt will present complaining of neurological symptoms into the toes.
- Hand over the dorsum of the foot, squeeze everything together, push up with your finger from the plantar side between the 3rd and 4th toe
- Compresses the neuroma Mulder’s sign or squeeze test
- you put your bottom hand between MTP of 3 and 4 the other hand squeezes over the dorsum of the foot pain over bottom of foot would be a positive of a Morton’s neuroma
- push with your finger first then squeeze
Haglund’s Deformities
Haglund’s Deformities-eccestosis usually soft tissue first then it goes on to cause boney response
- usually occurs on Superior lateral dome of the calcaneus
- can be caused by a lot of things old term Pump bumps (reaction to the back of pumps rubbing on heals)
Homan’s Text- DVT
Homan’s Text- DVT (not a good test but it’s a good quick screening test well’s cpr best way to ID a DVT)
- complaining of exquisite Pain in the back of the leg and usually have some swelling there and leg is Hard feeling and red
- Dorsiflex and press in the center of the calf do it gently
- If there is exquisite pain- DVT
- Good to use as a screen for a post surgical patient
- No research to back it also no research to prove that it can or has dislodge a DVT
Longitudinal Arch angle
- Use a gonio axis is the navicular bisect first MTP with stationary arm and moveable arm to medial malleolus (measure the angle)
- Between 100-130= low medial longitudinal arch (similar to a third degrees feiss’ line)
- 130-150= (second degree Feiss’ line) Medium medial arch
- 150-180= (1st degree of feiss’ line)high medial arch
Knee Posture
Knee posture- you eyeball posture and keep all of the following possibilities in mind for future treatment. taking your time with this is one of the more critical things because it is all eyeballing.
- Genu varum
- Genu valgum
- Knee flexion contracture
- Knee recurvatum
- Knee is the patella IR/ER High low (alta baja)
4 Reasons you want the foot to pronate (Refered to as Dynamic Functions of the foot during Gate Cycle) (**** Know this***)
- Becomes a loose adapter at heel strike so it can accommodate to the terrain
- Shock absorber so all of the force is not transmitted up the body
- The pronation absorbs the transverse plane rotation (foot internally rotates but doesn’t slide on the ground into more IR)
- Foot needs to re-supinated to become a rigid lever for propulsive push off
- really supination not pronation
Helbing’s Sign
- observe again
- Medial bowing in the achilles corelates with STJ pronation/calcaneal valgus
Circulatory- pulses
Posterior tib (primary blood supply) Dorsalis Pedis is absent in 12-15% of people don't use as primary distal pulse. it is on the dorsum of the foot at the level of the navicular
Tests indicated if “Foot/LE pain” is present (3)
- NWB-STJ Neutral
- Midtarsal joint mobility
- NWB- forefoot position
Tibial Torsion
Tibial torsion (complicated not getting too bogged down now eye ball it)
- Looking for tibial rotations
- Normal is 13*-18* Q angle
- If the tibial tuberosity in the center, lateral, or medial there are ways you can..(the recording skipped)
Measuring Q Angle (from physiopedia):
Position: Patient supine with knee extended. The therapist stands next to patient. (or can do in standing)
Application: When measuring ensure that the lower extremity is at a right angle to the line joining each ASIS. The foot should be placed in a neutral position relative to supination and pronation with the hip in neutral position relative to medial and lateral rotation. Draw a line from ASIS to the midpoint of patella and then from the midpoint of the patella to the tibial tubercle. The resultant angle formed by the crossing of these two lines is called the Q angle.
Positive sign: Normal Q angle score for females is between 13-18° with values greater than and lesser considered abnormal and may indicate the patient is at risk of developing chondramalacia patella, patella alta or mal tracking of the patella. http://www.physio-pedia.com/’Q’_Angle
From wheeless’ textbook of orthopaedics:
q angle is increased by:
- genu valgum
- increased femoral anteversion
- external tibial torsion
- laterally positioned tibial tuberosity
- tight lateral retinaculum
http: //www.wheelessonline.com/ortho/q_angle_of_the_knee
Weight bearing leg lenght measures
Weight bearing leg length measurements this way the measurement can account for any genu varum/valgum etc. that is present in weight bearing. there are good studies supporting this using radiographs.
Foot biomechanics during the gait cylce (KNOW THIS******)
- When you first hit the ground, the foot is in a supinated position in most cases. Can tell by looking at shoes as dynamic pedograph. Most shoes worn on post lat corner.
- Instantaneously goes through neutral to pronation (25% of gait cycle)
- Pronation is normal- shock absorber first 25% of stance phase (loosey goosey to absorb ground reaction forces)
- Neutral (midstance phase)
- Push off the foot needs to be a rigid lever so it re-supinated
- Think of it as Close packed position, loose packed position, close packed