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6 Orthopedics > L14 Hallux Valgus and PTT > Flashcards

L14 Hallux Valgus and PTT Flashcards

1
Q

Hallux Valgus

A

chronic progressive deformity of first ray

lateral deviation of 1st toe, medial deviation of first metatarsal with some rotation

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2
Q

Causes of Hallux Valgus

A

genetic component

arthropathy: RA, gout, psoriatic arthritis

high heels and/or tight toe box (men who wear shoes w/wide toe box w/out high heel have HV, females wear high heels with tight toe box do not have HV)

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3
Q

Prevalence of HV

A

23% of population from 18 to 65
36% adults >65yo
more common in females

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4
Q

Hallux Rigidus

A

chronic progressive OA of the 1st MTP Joint. often shows up as bilateral

2.5% of persons > 50 yo
most common in females
most common form of arthritis in foot

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5
Q

Causes of HR

A

idiopathic
2/3 cases have family hx
trauma, RA

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6
Q

What will the exam include for HR and HV?

A

squat, stairs
observation
history
gait
AROM/PROM
balance

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7
Q

Goal for treatment of the midfoot

A

improve muscle performance for MLA dynamic stability and power generation

power is generated in midfoot

muscle atrophy accelerates after age 50 so it is important to address muscle weakness

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8
Q

Severe angles of foot

A

HVA = over 40°
Intermetatarsal angle = over 20°

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9
Q

Moderate to severe HV is associated with

A

reduced hallux plantar pressures and strength measures

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10
Q

Women with mild HV showed

A

significantly higher pressure under the hallux than controls

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11
Q

There is ____ force under the hallux for HV

A

reduced

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12
Q

Plantar Loading Post-op

A

remains altered 12 mo post-surgically

even with decreased pain and sufficient first MTP joint ROM

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13
Q

Loading in Hallux Rigidus

A

had significantly less push off
increased forefoot supination

no significant differences in plantar loading

1st MTP ROM did not improve post-op level. Exercising should being immediately post op

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14
Q

Overall summary of HV and HR plantar pressures

A

conflicting literature
assess relevance in each individual

maladaptive compensatory patterns may lead to increased pain

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15
Q

recruitment of peroneals

A

seated, lift lesser toes from floor while increasing plantar pressure under 1st met head
“keep arch up”

progress to BIL and SL heel rise, and with perturbations

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16
Q

Posterior Tibial Tendon Dysfunction

A

collapse of medial longitudinal arch of foot with continued progressive deformity of foot/ankle

most common cause of adult acquired flatfoot

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17
Q

Causes/RF of PTTD

A

idiopathic
obesity
age > 50 yo
inflammatory conditions-RA, psoriatic arthritis, spondylosing arthropathy

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18
Q

S/S of PTTD

A

insidious onset of edema/pain along post tib tendon

pain aggravated by standing, walking
pain is worse w/standing, high impact
unable to run
inability to push off, raise heel

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19
Q

What is the biomechanical reason for altered gait in PTTD?

A

inability to lock midtarsal joint and achieve rigid propulsion

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20
Q

Observation of PTTD

A
  1. asymmetric flat foot
  2. flattened medial longitudinal arch
  3. hindfoot valgus
  4. abduction of the midfoot on the hindfoot
  5. too many toes sign
  6. antalgic gait pattern
  7. decreased stride length, poor heel off
  8. tenderness along the distal aspect of post tib tendon
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21
Q

What compensates in PTTD?

A

anterior tibialis
toe extensors try to lift foot up by splaying toes

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22
Q

ROM of PTTD

A
  1. limited DF
  2. Subtalar and transverse tarsal jts are mobile in early stages
  3. loss of motion, midfoot becomes fized in late stages
23
Q

MMT of PTTD

A

pf and inversion are still strong because of ant tib contribution

inability to perform a single leg heel rise, which is indicative of PTTD

24
Q

Stage 1 of PTTD

A

tendon synovitis
no foot deformity, no arch collapse

25
Q

Stage 2 PTTD

A

tendon pathology with or w/out synovitis
flat foot deformity
damage to spring lig and soft tissues
hypermobility

26
Q

Stage 3 of PTTD

A
  1. tendon pathology with or w/out synovitis
  2. damage to spring, deltoid ligaments and soft tissues of foot
  3. fixed deformity w/forefoot abd and hindfoot valgus
27
Q

Stage 4 PTTD

A
  1. tendon pathology with or without synovitis
  2. damage to spring, deltoid ligaments and soft tissues
  3. fixed deformity w/complete ankle valgus
28
Q

Modifications for PTTD

A

weight loss, improving footwear, decrease repetitive loading

orthoses to decrease pain as an early intervention, also use eccentric strengthening

goal in stage 2 is to support arch and decrease valgus

29
Q

Target muscles for Medial Long Arch for HV

A

hallux pf, abduction, increased M/L sway
less strength in abductor hallucis, FHB

30
Q

Greater Abductor Hallus EMG activity during

A

short foot > toe curl
single leg standing > sitting
toe spread out > short foot

31
Q

Activation of plantar intrinsic foot muscles increased as

A

task difficulty increased

32
Q

Enhancing Recruitment for abductor hallucis

A

highest force production occurs when 1st MTP joint is positioned between 10-15°of dorsiflexion

33
Q

Enhancing recruitment in intrinsics/extrinsics

A

ABDH, FHB, FDB more active during 1st MTP flexion without IP Flexion

FHL and FDL are greater with IP flexion

toe flexion is important for training of intrinsic muscles

34
Q

Short foot exercises is effective in reducing

A

foot pronation, foot pain, disability in subjects with pes planus

35
Q

Results of barefoot weight bearing study

A

significant increase in CSA of abductor hallucis

significant increase in force during paper grip test

significant improvement in repetition and height

improved strength, balance, fatigue, foot awareness, less pain. increased compliance

36
Q

Interventions in weightbearing with bare feet

A

weight bear without shoes
foot exercises bilaterally
short foot
trunk rotation with short foot
post tib
TSO

37
Q

Pre/Post Intervention Testing for WB in barefeet

A

plantar pressure in different functional mobility

paper grip test

heel rise

foot muscle structure

38
Q

Minimal shoe

A

no motion control
no cushioning
zero drop
no arch support
no midsole
no flares

39
Q

Minimal shoes vs Foot exercise

A

minimalist shoe walking is as effective as foot strengthening exercises in increasing foot muscle size and strength

either intervention provides sufficient stimulus to increase muscle strength significantly

40
Q

Conventional shoes vs Minimal Shoes

A

wearing minimal shoes for six months, even for non-intensive activities, may increase toe-flexion strength

41
Q

Minimalist shoes impact on plantar intrinsic foot muscle size and strength

A

wearing minimalist shoes resulted in increases in IFM size and strength

helpful because it is convenient and there isn’t a time burden

42
Q

Summary of foot exercise interventions

A
  1. short foot, toe spread both benefit HV, HR, PTTD
  2. Activity and force production of plantar intrinsic muscles is enhanced in standing versus sitting, more so in SLS
  3. arch and balance mechanisms will benefit from interventions
  4. barefoot or wearing minimalist shoes increase foot muscle strength
43
Q

Knee OA and minimal footwear

A

increases knee function, decreased pain, increased distance during 6 MWT, decreased knee edema

44
Q

Falls and minimal shoes

A

improves stability and mobility
movement of center of pressure
improves TUG and STAR tests

45
Q

Transitioning to Minimal Footwear

A
  1. Remove orthotics one hour/day and increase each day. add in orthotic towards end of day with fatigue
  2. go from high cushion and supportive shoe to low cushion and less support
  3. Shorter walks in minimal shoes, progress to long walks
  4. Try walking barefoot
46
Q

Women face ageism

A

make clothing choices to conceal or diminish physical markers that would identify them as old

not being able to wear desired footwear and clothing altered women’s body image, with negative impacts on psychological well-being

HV and HR significantly impact confidence, QOL, emotional status, social engagement

47
Q

Patient’s footwear

A

more than 70% was defined as being poor

only 5% pts wore their therapeutic footwear

majority selected shoes for fit and comfort

48
Q

Findings/Conclusions for Foot problems and footwear

A
  1. shoes narrower than foot are associated with corns, HV, foot pain
  2. Women wear shoes that are shorter, narrow, smaller vs men
  3. Short shoes are associated with lesser toe deformity
  4. Heel elevation > 25 mm was associated with HV and plantar calluses
49
Q

How to evaluate fit of shoe

A
  1. Length = 10 to 20 mm from longest toe to front of shoes
  2. Width = grasping of upper over metatarsal, should bunch
  3. Depth = toes/joints move freely, examine for pressure on toes and nails
  4. Motion control
50
Q

Motion of control of foot

A

fixation of upper to the foot
heel counter stiffness
longitudinal sole rigidity

51
Q

HV and Orthoses

A

low level of effectiveness
does improve pain when HV angle improves

52
Q

HR and Orthoses

A

morton’s extension if footplate doesn’t work

47% of cases were treated with orthoses

53
Q

Shoe mods for HR

A

low heels
stiff sole
rocker bottoms
metatarsal bars
increase in heigh of toe box

54
Q

Goal of manual therapy interventions

A

address arthrokinematic impairments that relate to force production

6 Orthopedics (17 decks)

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