Lecture 1

Question 1

Frontal plane motion of the forefoot mostly occurring in the

Answer 1

LMTJ

Question 2

Transverse plane motion of the forefoot mostly occurring in the

Answer 2

OMTJ

Question 3

How does the forefoot function on the rearfoot?

Answer 3

through the Mid-Tarsal Joint Complex, which permits a dependent range of motion to occur in the forefoot, relative to the rearfoot

Question 4

What is the main compensator of Forefoot-Rearfoot Deformities

Answer 4

Frontal plane
LMTJ

Question 5

What does OMTJ do for ankle joint compensation?

Answer 5

Pronates for ankle joint compensation

Question 6

What is the effect of the peroneus longus on the first ray?

Answer 6

peroneus longus has a plantarflexory vector on the first ray
-pronation of the subtalar joint alters the muscle function

Question 7

Purchase theorem

Answer 7

The foot will always try to be flat on the ground

Question 8

Rearfoot perpendicularity theorem

Answer 8

The rearfoot will always attempt to compensate perpendicularly with the weight bearing surface

Question 9

Equinus theorem (compensated)

Answer 9

If the rearfoot is unable to purchase with
normal dorsiflexion of the ankle joint, the Midtarsal Joints will offer additional dorsiflexion to the foot by unlocking and maximally pronating against a maximally everted rearfoot. Therefore, equinus results in pronation of the entire foot if the heel contacts the ground.

Question 10

Equinus theorem (uncompensated)

Answer 10

If an equinus deformity is so severe that
the heel does not contact the ground at all during Stance phase, Supination of the foot will occur.

Question 11

Forefoot loading theorem

Answer 11

Forefoot loads under the lateral column and compensates in the medial

Question 12

Forefoot compensation theorem

Answer 12

The Forefoot compensations in the order of LA- SOS
* Long axis midtarsal joint supinates
* Early subtalar joint mobilization
* Oblique midtarsal joint axis pronation
* Late subtalar joint supination

Question 13

Metatarsal Splay

Answer 13

The metatarsal splays in predictable position
however the 4th metatarsal remains in a fixed position
- Pronation= distal splay
- Supination= proximal splay

Question 14

Relative to the ground, how does the foot always want to be?

Answer 14

foot always wants to get to a perpendicular bisection of the heel
relative to the ground (flat on the ground). If it gets pushed past a few degrees, it wants to evert all the way to its end ROM.

Question 15

Inverted Forefoot Varus

Answer 15

-rigid
A true structural deformity most likely due to inadequate frontal plane torsion of the head and neck of the talus during normal development.

Question 16

Inverted Forefoot Varus characteristics

Answer 16

Physical Characteristics:
– Thin Looking Midfoot
– 1st Ray not really “Hypermobile” – Irreducible!
– Calcaneal eversion required

Question 17

Inverted Forefoot Supinatus

Answer 17

-Flexible
A positional deformity due most often to developmental compensation. Developed over time

Question 18

Inverted Forefoot Supinatus characteristics

Answer 18

Physical characteristics
– Fat, Floppy Looking Midfoot
– 1st Ray seems “Hypermobile”
– Reducible with Functional Control

Question 19

Everted Forefoot Valgus (Flexible) Etiologies

Answer 19

Flexible
-Excessive supination at the STJ accompanied by external rotation of the leg with resultant lateral instability of the knee, ankle and Sub Talar Joint

Question 20

Everted Forefoot Valgus (Rigid) Etiologies

Answer 20

Rigid
-Excessive supination at the STJ accompanied by external rotation of the leg with resultant lateral instability of the knee, ankle and Sub Talar Joint

Question 21

Everted Plantarflexed First ray Etiologies

Answer 21

Rigid
- Chronic Spasm of Peroneus Longus
- Dorsiflexion contracture with Ankylosis of the Hallux
- Trauma on the plantar aspect of the growth plate of the 1st ray
- Partially Compensated RF Varus
- Weak Soleus

Question 22

Everted Forefoot Valgus (Flexible) info

Answer 22

• Compensation occurs via normal LA-SOS sequencing)
• 5-7o available from MTJ’s
• Beyond 7o
• 1o eversion Forefoot
• 1o inversion Rearfoot
• Unstable gait
• Lateral instability Lesions on bottom of foot:
• Less stable forefoot
• Postural fatigue
• Keatoma sub 2nd, 4th and/or 5th
• Tailor’s bunion
• Adducto varus 4th and 5th H.T.s

Question 23

Everted Forefoot Valgus (Rigid) info

Answer 23

A true structural relationship due to excessive frontal plane torsion of the head and neck of the talus.
- Lesion pattern similar to Rigid Plantarflexed 1st Ray

Question 24

Everted Plantarflexed first ray info

Answer 24

A rigid deformity in which eversion is imposed on the forefoot by a medial column abnormality.
- 2 planes = difficult to control in orthotic
- Clinical correlation= Coleman Block Test