Gait Cycle, IPJ Conditions, STJ, Statistics Flashcards
Why is muscle testing important?
- To assess whether muscles acting as supposed to.
- Weak muscles affect gait & stance, can be strengthened if recognized.
What are the 9 principles/guidelines of muscle testing?
- Knowledge of muscle origin & insertions, lever arms & position relative to foot axes to understand function
- Pt & tester comfortable as possible
- Fixate proximal to area being tested for specificity
- Apply pressure directly against muscle’s action
- Apply pressure gradually
- One joint muscle tested at end ROM
- Two or more joint muscle tested mid range (most foot muscles)
- Muscles tested 3 times & compared to opposite side
- Isolate muscle being tested
What is the name of the grading system used?
Kendall’s System
Describe pre-heel contact phase of gait (5)
- Limb internally rotates
- knee extended
- Ankle slightly dorsiflexed
- STJ & MTJ slightly supinated (tib anterior)
- 1st Ray & Hallux dorsiflexes (tib anterior & EHL)
Describe Contact phase of gait
- Limb continues to internally rotate
- Ankle joint begins to plantar flex
- Knee starts to flex
- STJ pronates to absorb leg rotations & foot becomes mobile adaptor, adjusting to terrain & absorbing shock
- Tib post, soleus, gastrocs, FHL & FDL decelerate STJ pronation
- MTJ remains pronated at oblique axis & starts to pronate at LA with forefoot loading. (GRF & Tib Ant)
Describe end of contact phase
- Limb externally rotate
- Knee extends to accept weight from contralateral leg
- AJ starts to dorsiflex
- STJ begins to supinate
- MTJ remains pronated at the oblique axis
- 1st ray dorsiflexes
Describe Midstance of gait
- Leg externally rotate
- Knee extended
- AJ dorsiflexion as the trunk moves over the foot until 10 degrees of dorsiflextion
- STJ supination
- MTJ pronated & achieves max pronated position
Describe Heel lift
- forward trunk momentum (COG has passed over foot) & deceleration of the tibia by the calf muscles
- Continuing gastroc contraction which flexes knee & Pf ankle & flexes the hip indirectly
Describe Propulsion
- Leg externally rotate
- knee flexed
- STJ supinates past neutral= rigid lever position, stabalise forefoot joints
- MTJ remains maximally pronated & OA starts to supinate, inc ach heigh & foot stability
- 1st ray plantarflexion allows 90 degrees of dorsiflexion at MPJ. Propel of hallux
- dorsiflexion of the toes post heel lift, plantar fascia is tightened, pulling forefoot to rear foot- ‘windlass mechanism’
Describe swing phase
- Leg internally rotates
- Knee flexed for ground clearance, then extending for heel strike
- STJ pronates in 1st half to allow ground clearance, supinates for heel strike
- AJ rapidly dorsiflexes to 5 degree position at heel strike
Note: Running has ‘airborne (float) phase’ & shorter times
Name 4 specific gait conditions
- Abductory twist: ffoot abd, heel add at HL if foot pronation occurs longer in midstance
- Too many toes: occurs due to excessively abd gait pattern or excess STJ pronation causing inc ffoot abd
- Resupination: lack of notes by midfoot collapse, heel ev in late midstance, ffoot splay & rolling off hallux
- Propulsion: (lack of) noted by not pushing off hallux & hip lift
What are the 7 causes of Claw Toes?
What is the pathology of claw toes?
- Forefoot adductus (phalanges offline with metatarsals)
- Plantarflexed 1st ray (rigid) - OA supination occurs during midstance due to rearfoot inversion compensation increasing forefoot adduction
- Arthritis (joints unstable, flexors overpower)
- Spasm of digital flexors (constant flexed position, i.e, thongs)
- Weakness of gastrocnemius muscle
- Forefoot supinatus - addiction & plantarflexion of forefoot to toes (upset alignment= joint instability)
- Congenital plantarflexed foot (sagittal plane alignment incorrect)
- Instability in transverse plane
- Flexors greater pull & ROM
- Usually mets 2-5 affected
- Bending at both proximal & distal interphalangeal joints (flexion at joints)
- Joint unstable, flexor digitorum longus & flexor hallucis longus working harder than intrinsic muscles holding phalanges
What are the 8 causes of Hammer Toes?
What is the pathology of hammer toes?
- Plantarflexed met
- Loss of lumbrical function (main stabilisers of phalanges)
- Imbalance between medial/lateral interossei (also stabilisers)
- Flaccid paralysis of extensor digitorum brevis & extensor digitorum longus (injury to top of foot)
- Short metatarsal - plantarflexion of met (to try & reach ground)
- Forefoot valgus- grasping of toes or plantarflexion of 4th & 5th in prop (lateral side of footinverted to ground
- Abd pressure of hallux (HAV, 2nd met unstable)
- Trauma (fractured joints are unstble)
*Affects single toes, 2nd most common
Mallet toe is seen clinically as?
Normal proximal interphalangeal joint &
flexed distal interphalangeal joint
Claw toes is seen clinically as?
MTP hyperextension, Flexion at PIP (proximal interphalangeal joints) & DIP (distal phalangeal joints)
(middle & end joints in the toe)
Hallux rigidus & limitus is seen clinically as?
Restricted dorsiflexion of hallux & degenerative changes within first MPJ
Pain & stiffness of hallux
What is Hallux Limitus?
Pathology of hallux, reduced dorsiflexion (sagittal plane motion) at first MPJ during propulsive phase of gait
- 60 degrees or less of dorsiflexion at MPJ
What is Hallux Rigidus?
Total absence of dorsiflexion at first MPJ of hallux
- 5 degrees or less of dorsiflexion at MPJ
What is the normal ROM of hallux dorsiflexion?
65-70 degrees
Hallux Limitus/ Rigidus causes? (6)
- Dorsiflexed 1st ray
(can’t contact ground properly, cant Pf enough & glide on sesamoids) - Ankylosed 1st ray (joined to medial cuneiform)
- Metatarsal parabola variations (2nd toe longer/shorter than 1st= doesn’t achieve proper plantar flexion)
- Ankylosed sesamoid/ met head (ppl with bunion have hallux out of alignment with metatarsals. Causes sesamoids to get stuck & doesn’t move freely, slliding motion doesn’t occur= joint jamming)
- Ankylosed 1st MPJ (could be why 1st MPJ not moving properly in first place) could be due to gout, joint restricted for period of time
- Eversion in propulsion (eversion walking= pronation of foot, 1st ray pushed into ground)
*Easiest to control if pain in MPJ can control forces & minimise pain using shoe inserts etc
How is the Subtalar Joint a mobile adaptor during pronation? (in gait)
Opens the medial column of the foot, to adapt to uneven terrain.
How is the Subtalar Joint a mobile adaptor during supination? (in gait)
Foot becomes rigid & more stable.
Becomes a rigid lever for propulsion
Describe the Subtalar Joint Axis
- Triplanar axis, with triplanar motion (large individual variation in ROM)
- Average 42° from Transverse Plane & 16° from Sagittal Plane
- Recent literature suggest axis not fixed
[Lundberg 1989] - 10° rotation= 7.1 FP, 6.7 TP & 2.0 SP
- > the angle between the axis & plane of motion=
the motion - More vertical the axis (> angle to TP) >TP motion
(More further away from TP= more TP movement)
-More medial axis (< angle to SP)=
Discuss Subtalar Joint Neutral
- Theorised position where the STJ is neither pronated or supinated & there is a 2:1 ratio of motion of inversion to eversion (supination:pronation)
- Neutral is where the foot functions at its greatest efficiency
- Varies from person to person
