Foot Orthotics Flashcards
Rearfoot Varus
Amount and speed of pronation during the contact period is abnormal
Compensation
- partial STJ pronation
- MTJ pronation
- 1st ray plantarflexion
Rearfoot - Varus Callus Formation
Compensated
- 2nd met head
- lesser on 3rd and 4th met heads
- not under 1st due to instability (unless 1st ray plantarflexion incompensation)
- pinch callus- medial side of hallux due to propelling off abducted forefoot
Callus Formation (uncompensated) -5th met head
Rearfoot Varus - Symptoms/Outcome
Plantarfascitis
Metatarsalgia
Stress fracture of 2nd metatarsal
Hallux abductovalgus
Strain on Tibialis posterior
- at insertion, tendon sheath (med. mal.), at origin on lower leg (shin splints)
Excessive medial rotation = valgus stress on knee
Forefoot Varus
Amount and timing of pronation is abnormal during midstance and propulsive period
Compensation
- partial STJ pronation
- MTJ pronation
- 1st ray plantarflexion
Forefoot Varus Callus Formation
Compensated
- 2nd met head
- lesser or 3rd 4th met head
- not under 1st due to instability (unless 1st ray plantarflexion compensation)
- pinch callus - medial side of hallux due to propelling off abducted forefoot
Callus Formation (uncompensated) -5th met head
Forefoot Varus Symptoms/Outcome
Plantarfasciitis
1st ray hypermobility
Stress fracture 2nd metatarsal
Metatarsalgia
Hallux abductovalgus
Proximal affects
- pirformis muscle (hip external rotators)
- failure to attenuate shock if uncompensated
Forefoot Valgus
Amount and timing of pronation is abnormal during contact and propulsive period
Compensation
- STJ supination or inadequate STJ pronation (contact period)
- STJ pronation (propulsive period)
- MTJ not adaptable to uneven terrain
Forefoot Valgus Callus Formation
1st and 5th metatarsal heads
More callus formation under 1st met head if plantarflexed 1st ray
Forefoot Valgus Symptoms/Outcomes
Lack of shock absorption = increased forces proximally
- central patellofemoral pain
- sacral and low back dysfunction
- varus stress on knees
- problems around the lateral aspect of knee
1st MTP joint motion compromised
Ligamentous damage/ankle sprain
Plantarflexed 1st ray
similar to forefoot valgus
Forefoot Equinus
Plantarflexed position of forefoot to rearfoot
Ankle must dorsiflex more than normal through midstance period
Compensation
- adequate ankle joint motion, no additional compensation needed
- MTJ dorsiflexion (via oblique axis pronation) if insufficient ankle joint motion
- STJ has little dorsiflexion in sagittal plane, however STJ must pronate to allow MTJ to be more mobile and therefore dorsiflex
- max dorsiflexion (10 deg) just after heel lift when STJ should be supinated
Forefoot Equinus (Symptoms/Outcome)
- clinical symptoms similar to compensated forefoot varus
- may be seen in rigid forefoot valgus
- lack of STJ pronation so compensation occurs more proximal in the leg
- hyperextension force at the knee
- talar exostosis due to repetitive contact on the neck of the talus as tibia move forward
Combined Rearfoot and Forefoot Deformities
Rearfoot varus and forefoot varus
Rearfoot varus and flexible forefoot valgus
Rigid forefoot varus and rearfoot varus
Rearfoot varus and forefoot varus
Abnormal compensatory pronation at STJ throughout stance phase
“Too rapid” in contact phase = rearfoot
“Too much” in midstance = rearfoot
“Wrong time” in midstance = forefoot
Distal and proximal effects
Proximal dysfunction is more likely to occur with both than either one alone
Rearfoot Varus and Flexible Forefoot Valgus
Forefoot valgus is secondary to partially compensated rearfoot varus
Pronation during stance at STJ and MTJ
Slight callus on 1st but more pronounced on 2nd met head
