Inverted and Everted FF Deformities Flashcards
What are the 5 inverted FF deformities?
forefoot varus (bony or rigid) forefoot supinatus (soft tissue) metatarsus primus elevatus plantarflexed cuboid plantarflexed 5th metatarsal
What is the most common inverted FF deformity?
osseous forefoot varus
What will you see with an osseous FF varus?
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
What is the etiology of forefoot varus?
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
What is the rule of compensation for FF varus?
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
What happens with uncompensated FF varus?
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)
What skin and osseous findings will there be with uncompensated FF varus?
callus sub 4th and 5th met heads
retrocalcaneal exostosis, tailor’s bunion
What type of gait and foot type would you expect with uncompensated FF varus?
gait: apropulsive, pronated throughout
foot type: stable cavus
What skin and osseous changes would you expect with a partially compensated FF varus?
callus sub ball of foot and hallux
genu valgum, tailor’s bunion
What foot type would you expect with partially compensated FF varus?
stable mild cavus
What skin and muscle-fascia pathology would you expect with fully compensated FF varus?
medial calcaneal callus, callus sub 2nd and 3rd metaheads
plantar fasciitis, posterior tibial strain
What osseous pathology and foot type would you expect with fully compensated FF varus?
sinus tarsi syndrome
hypermobile flatfoot
What kind of abnormality is forefoot supinatous?
soft tissue or positional
What is the orientation of the metatarsals with forefoot supinatous? What happens when you push down on the 1st met?
all the mets are in varus on the same inverted plane, the 1st met will plantarflex if pushed down
Describe the significance of the heel eversion in forefoot supinatous.
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
Describe the mechanism of FF supinatous.
The RF overcompensates for a FF varus deformity, but only when the FF varus is greater than 3 degrees
What is the max amount that the heel can evert?
13 degrees, navicular then hits the ground preventing further eversion
A true FF varus always includes a _____ component. How do you detect if a soft tissue component is present?
osseous
push down on 1st meta head-if it moves, you have some component of soft tissue forefoot varus
What type of abormality is metatarsus primus elevatus? How is it acquired?
structural (osseous)
acquired by soft tissue (ruptured PL tendon) or osseous (dislocation) abnormality
What is the cuboids position on the calcaneous with plantarflexed cuboid?
cuboid is inverted on calcaneous which brings 4th and 5th mets closer to ground resulting in inverted forefoot
What are the everted FF deformities?
forefoot valgus, plantarflexed 1st ray, dorsiflexed cuboid
What is the etiology of FF valgus?
over valgus rotation during development
What is the cutoff between a flexible and rigid total FF valgus?
less than 7 degrees is flexible, greater than 7 is rigid
What is the compensation of a flexible FF valgus?
LAS of LASSO
longitudinal axis of midtarsal joint supination
