Lecture 1 Flashcards
Frontal plane motion of the forefoot mostly occurring in the
LMTJ
Transverse plane motion of the forefoot mostly occurring in the
OMTJ
How does the forefoot function on the rearfoot?
through the Mid-Tarsal Joint Complex, which permits a dependent range of motion to occur in the forefoot, relative to the rearfoot
What is the main compensator of Forefoot-Rearfoot Deformities
Frontal plane
LMTJ
What does OMTJ do for ankle joint compensation?
Pronates for ankle joint compensation
What is the effect of the peroneus longus on the first ray?
peroneus longus has a plantarflexory vector on the first ray
-pronation of the subtalar joint alters the muscle function
Purchase theorem
The foot will always try to be flat on the ground
Rearfoot perpendicularity theorem
The rearfoot will always attempt to compensate perpendicularly with the weight bearing surface
Equinus theorem (compensated)
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.
Equinus theorem (uncompensated)
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.
Forefoot loading theorem
Forefoot loads under the lateral column and compensates in the medial
Forefoot compensation theorem
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
Metatarsal Splay
The metatarsal splays in predictable position
however the 4th metatarsal remains in a fixed position
- Pronation= distal splay
- Supination= proximal splay
Relative to the ground, how does the foot always want to be?
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.
Inverted Forefoot Varus
-rigid
A true structural deformity most likely due to inadequate frontal plane torsion of the head and neck of the talus during normal development.
Inverted Forefoot Varus characteristics
Physical Characteristics:
– Thin Looking Midfoot
– 1st Ray not really “Hypermobile” – Irreducible!
– Calcaneal eversion required
Inverted Forefoot Supinatus
-Flexible
A positional deformity due most often to developmental compensation. Developed over time
Inverted Forefoot Supinatus characteristics
Physical characteristics
– Fat, Floppy Looking Midfoot
– 1st Ray seems “Hypermobile”
– Reducible with Functional Control
Everted Forefoot Valgus (Flexible) Etiologies
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
Everted Forefoot Valgus (Rigid) Etiologies
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
Everted Plantarflexed First ray Etiologies
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
Everted Forefoot Valgus (Flexible) info
- 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
Everted Forefoot Valgus (Rigid) info
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
Everted Plantarflexed first ray info
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
