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Biomechanics > Inverted and Everted FF Deformities > Flashcards

Inverted and Everted FF Deformities Flashcards

1
Q

What are the 5 inverted FF deformities?

A 
forefoot varus (bony or rigid)
forefoot supinatus (soft tissue)
metatarsus primus elevatus
plantarflexed cuboid
plantarflexed 5th metatarsal
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2
Q

What is the most common inverted FF deformity?

A

osseous forefoot varus

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3
Q

What will you see with an osseous FF varus?

A

inverted position of plantar surface of all mets relative to plantar surface of calcaneus, if all mets are inverted on same plane, you cant plantarflex the 1st met during exam

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4
Q

What is the etiology of forefoot varus?

A

during nl development, there is a valgus rotation to the talar head and neck which creates a valgus curvature to the lesser tarsus-if this fails to occur=FF varus

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5
Q

What is the rule of compensation for FF varus?

A

the heel will evert past vertical the same number of degrees as the FF varus deformity to get medial aspect of forefoot on the ground

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6
Q

What happens with uncompensated FF varus?

A

most people will have adequate ROM at MTJ or w/in the 1st rays ROM to allow forefoot to touch ground-mets 2-5 will be in varus with the 1st met flexibly plantarflexed (can dorsiflex 1st met to level of 2nd met)

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7
Q

What skin and osseous findings will there be with uncompensated FF varus?

A

callus sub 4th and 5th met heads

retrocalcaneal exostosis, tailor’s bunion

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8
Q

What type of gait and foot type would you expect with uncompensated FF varus?

A

gait: apropulsive, pronated throughout

foot type: stable cavus

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9
Q

What skin and osseous changes would you expect with a partially compensated FF varus?

A

callus sub ball of foot and hallux

genu valgum, tailor’s bunion

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10
Q

What foot type would you expect with partially compensated FF varus?

A

stable mild cavus

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11
Q

What skin and muscle-fascia pathology would you expect with fully compensated FF varus?

A

medial calcaneal callus, callus sub 2nd and 3rd metaheads

plantar fasciitis, posterior tibial strain

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12
Q

What osseous pathology and foot type would you expect with fully compensated FF varus?

A

sinus tarsi syndrome

hypermobile flatfoot

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13
Q

What kind of abnormality is forefoot supinatous?

A

soft tissue or positional

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14
Q

What is the orientation of the metatarsals with forefoot supinatous? What happens when you push down on the 1st met?

A

all the mets are in varus on the same inverted plane, the 1st met will plantarflex if pushed down

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15
Q

Describe the significance of the heel eversion in forefoot supinatous.

A

If the heel everts past 3 degrees, which it does in FF supinatous, it keeps moving until it reaches the end range of STJ eversion which is a RCSP of 6 degrees

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16
Q

Describe the mechanism of FF supinatous.

A

The RF overcompensates for a FF varus deformity, but only when the FF varus is greater than 3 degrees

17
Q

What is the max amount that the heel can evert?

A

13 degrees, navicular then hits the ground preventing further eversion

18
Q

A true FF varus always includes a _____ component. How do you detect if a soft tissue component is present?

A

osseous

push down on 1st meta head-if it moves, you have some component of soft tissue forefoot varus

19
Q

What type of abormality is metatarsus primus elevatus? How is it acquired?

A

structural (osseous)

acquired by soft tissue (ruptured PL tendon) or osseous (dislocation) abnormality

20
Q

What is the cuboids position on the calcaneous with plantarflexed cuboid?

A

cuboid is inverted on calcaneous which brings 4th and 5th mets closer to ground resulting in inverted forefoot

21
Q

What are the everted FF deformities?

A

forefoot valgus, plantarflexed 1st ray, dorsiflexed cuboid

22
Q

What is the etiology of FF valgus?

A

over valgus rotation during development

23
Q

What is the cutoff between a flexible and rigid total FF valgus?

A

less than 7 degrees is flexible, greater than 7 is rigid

24
Q

What is the compensation of a flexible FF valgus?

A

LAS of LASSO

longitudinal axis of midtarsal joint supination

25
Q

What is the compensation of a rigid FF valgus?

A

LASSO

Longitudinal axis of midtarsal joint supination, STJ supination, Oblique axis of midtarsal joint supination

26
Q

What is the heel position in flexible FF valgus? What does flexible FF valgus lead to?

A

vertical in RCSP
leads to severe MTJ instability during propulsion-it is a hypermobile foot because the MTJ is supinated (unstable position of MTJ)

27
Q

What are the skin sx and foot type of flexible FF valgus?

A

medial heel callus, callus sub 2 (<5 degrees), callus sub 1,5 (>5 degrees)
severe flatfoot

28
Q

What position is the heel in with rigid FF valgus?

A

heel is in varus in RCSP

29
Q

What skin and osseous sx would you expect with rigid FF valgus?

A

lateral heel callus, callus sub 1 and 5

retrocalcaneal exostosis

30
Q

What type of foot would you expect with rigid FF valgus?

A

stable cavus

31
Q

Describe the foot type, heel position and general facts about rigid (structural) plantarflexed 1st ray.

A

cavus foot, RCSP of varus (just like rigid FF valgus)

difficult to dorsiflex 1st met head to level of 2nd met head, lesser metaheads are on same parallel plane

32
Q

What are the lesser metaheads in with flexible plantarflexed 1st ray? What is the foot type?

A

lesser metaheads in varus

foot type: mild cavus with vertical calcaneus in RCSP

33
Q

What risk factors are increased d/t rigid or flexible plantarflexed 1st met?

A

increased incidence of tibial sesamoid pain and ankle sprains

34
Q

How do you acquire dorsiflexed cuboid?

A

chronic subluxation of the OMTJ from a tight gastroc-soleus complex-compensates for equinus by STJ pronation which unlocks OMTJ and dorsiflexes OMTJ causing dosiflexion of FF on the RF

Biomechanics (7 decks)

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