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
Discuss pros vs cons of 2:1 ratio
Pros:
Cons: Low reproducibility amongst ppl, everyone diff.
What is the aim of biomechanical (orthotic) treatment of STJ?
Aim of orthotics is to align STJ as close to neutral as possible
What is the motion of the STJ during gait?
- STJ pronates at heel contact (to absorb shock & transverse plane motion) & supinates at propulsion.
- Root suggests foot achieves neutral postn at MTJ & into heel lift.
What is the difference between an experimental group & a control (non-experimental) group?
- Experimental group (treatment group) receives the variable being tested in an experiment.
- One variable is tested at a time.
- The experimental group (treatment group) is compared to a control group (did not receive treatment) which does not receive the test variable.
What is an ICC & what does it measure?
- Intraclass Correlation Coefficient measures the reliability of numerical data
- The reliability of raters
- The reproducibility of numerical measurements made by different people measuring the same thing
- ICC ranges from 0-1
- It is calculated in SPSS software as a respective 95% Confidence Interval
What does a a high Intraclass Correlation Coefficient (ICC) close to 1 indicate?
High similarity between values from the same group
What does a low Intraclass Correlation Coefficient ICC close to zero mean?
Values from the same group are not similar.
Name the levels of evidence in Lloyd Smith’s
‘Hierarchy of Evidence’ (6)
- Meta-analysis of RCTs (& other studies in a systematic review)
- RCT
- Well designed non-randomised controlled study (Rolf’s never found one of these)
- Well designed quasi experimental study (Commonly seen, non controlled group RCT)
- Non experimental descriptive study- case study, comparative study (measures groups of ppl, collecting data, making comparisons, no intervention/ not experiment)
- Respectable opinion
