Forefoot deformity Flashcards
Forefoot deformities
The forefoot appears inverted or everted relative to forefoot when the STJ is in Neutral position and MTJ is maximally pronated
if no rearfoot deformity is present , the forefoot will be inverted or everted relative to?
the floor when the STJ is in neutral position and the MTJ is maximally pronated
forefoot deformity is measured with the pt in what position?
Prone position
How do they measure forefoot deformity?
The plane of metatarsal heads is compared to the perpendicular of the calcaneal bisection
plane of metatarsal heads is the representation of
midtarsal joint
forefoot varus
The forefoot is inverted in relation to the forefoot when the STJ is in neutral position and MTJ is maximally pronated
Forefoot varus may be a result of
abnormal frontal ontogeny
or lack of adequate valgus torsion of the talar head of the neck
Other deformities that will function similarly to forefoor varus
-FF supinatus
-Dorsiflexed 1sr ray
-plantarflexed lateral column
plantarflexed 5th metatrsal
Plantarflexed cuboid
FF supinatus is a secondary deformity what does that mean?
It means that it is there due to other deformities
FF supinatus
soft tissue adaptation as a result of the FF functioning in a chronically inverted position
FF supinatus can happen as a result of
-FF varus with subtalar pronation to end ROM
-Flexible FF valgus
-STJ pronation to end of range of motion as a result of other deformities
_Rearfoot valgus ( because the LMJA is supinating)
forefoot varus
- congenital
- bony-primary
FF supinatus
- acquired
- soft tissue
- secondary
clinical appearance of FF varus
- The lesser tarsus appears flattened from lateral to medial ( when viewed dorsally)
- The lessee tarsus has a longer radius of curvature which makes the foot look wider ( when viewed dorsally)
- The malleoli appear lower ( b/c of the relative dorsiflexion of the forefoot on the rear foot)
- when standing in NCSP, the 1st metarsal head will not bear weight
- There is a rigid resistance to the additional MTJ pronation when the STJ is in neutral position and the MTJ is maximally pronated
Cleanical appearance of FF supinatus
- Normal frontal plane curvature of the lesser tarsus
- Normal dorsal plantar thickness when viewed from the medial side of the foot
- A plantarflexory force at the navicular will reduce/eliminate the inverted forefoot position
Dorsiflexed first ray aka metatarsus primus elevatus is a ——-plane deformity
sagittal
sagittal plane 1st ray deformities are defined by
their ROM
dorsiflexed 1st ray is a deformity in which
the first ray has more dorsiflexion than plantar flexion available so that the neutral position of the first ray is dorsiflexed
Dorsiflexed 1st ray can be
rigid
flexible
Congenital
Rigid
Rigid dorsiflexed 1st ray
unable to plantar flex below the plane of the lesser metatarsal heads
A flexible dorsiflexed 1st ray is
able to plantaflex below the level of the lesser metatarsal heads
A congenital dorsiflexed 1st ray has
normal or greater than normal ROM (10º), but it is dorsally displaced
An acquired dorsiflexed 1st ray has
less than normal ROM and is dorsally displaced
A dorsiflexed 1st ray tends to compensate in a manner similar
to the other inverted forefoot deformities
plantarflexed 5th ray
lateral side of the foot becomes relatively lower than the media side -again putting the forefoot in an inverted position
plantarflexed 5th ray compensation
similar to that of the inverted forefoot deformities
IN FF varus when no other deformity present
the medial side of the forefoot will be off the ground (generally by the amount of forefoot deformity) when the pt is standing in NCSP
Compensation for the FF varus
Pronation of STJ until GRF is equal across the plantar aspect of the foot
Compensation for FF varus when the deformities is less than 5º
STJ pronate to the same degree as deformity
ex: if the deformity is 4º varus , STJ will pronate 4º in order to get the medial side of the foot to the ground.
Compensation for FF varus when the deformity is greater than 5º
for FF deformities greater than 5º, the talus will be so far adducted and plantarflexed relative to the calcaneous that the STJ will go to end range of pronation
if we have 6º FF varus:
it will require 6º pronation to get the medial side to the ground. However once he calcaneous goes beyond 5º everted, the STJ will maximally pronate and goes to the end of range of pronation. In this case the RCSP will be 10º everted-maximally pronated for a normal rear foot
FF valgus
The FF everted to the rearfoot when the STJ is in neutral position and the MTJ is maximally pronated
The plane of metatarsal heads 2-4 or 5 is everted to the rearfoot when the STJ and the MTJ is locked
the first metatrsal head may be in the plane of metatrsal heads 2-4
the first metatarsal head may be plantarflexed relative to the plane of 2-4 which is common
the fist metatrsal head may be dorsiflexed relative to the plane of metatrsal heads 2-4 which is uncommon
Everted FF deformities
- FF valgus
- plantarflexed 1st ray
- dorsiflexed cuboid
Compensation of FF valgus in order
- LMJA for the first 5º
- STJ for the next 5º
- OMJA for the following 5º
- STJ for the remainder
Flexible FF valgus
This deformity is compensated completely by supination at the LMJA ( a FF valgus deformity of 5 or less than 5º)
Rigid FF valgus
This deformity requires additional compensatory supination at the STJ ( and possibly OMJA) a FF valgus deformity of greater than 5º
What are some additional compensations before STJ is required to supinate?
- dorsiflexion of the 1st ray to raise the 1st metatarsal head up to the level of the second metatarsal head
- Dorsiflexion at the 3 cuneiform-navicular articulation to raise the medial column up to the level of 4th metatarsal head
- plantarflexion of the 5th ray
FF valgus compensation , LMJA
will most likely go to end range of supination ( a form of overcompensation)
A person with 3º FF valgus ,where/how is the compensation
LMJA will go to the end range of supination putting teh forefoot 5 degrees inverted from it maximally pronated position so the RCSP will be at 2º EVERTED now!
When the FF valgus requires STJ pronation
the FF valgus is said to be rigid
Plantarflexed 1st ray
- Range of motion is greater in the direction of plantarflexion compared to dorsiflexion
- 1st ray neutral position is plantar flexed
- congenital vs acquired
- flexible vs Rigid
Plantarflexed first ray may occur
- as an isolated deformity
- with a concomitant FF valgus ( will act like a FF valgus)
- with a concomitant FF varus ( will most likely act like a FF varus
isolated plantarflexed !st ray
initial compensation will occur by dorsiflexion of the 1st ray
If the first ray can dorsiflex up to the level of lesser metatarsal heads,
the plantarflexed first ray (PFFR) is said to be flexible. and no other composition will be required
If the First ray ROM does not provide dorsiflexion up to level of the lesser metatarsal heads, what kind of compensation do you get?
LMJA will be required to supinate
This is alos referred to as rigif PFFR
LMJA supination will occur to end range of motion which may result in STJ pronation
FF valgus compensation is similar to
RF valgus
