Lecture 1 Flashcards
Foot Progression Angle evaluates
Limb position during gait
Foot progression Angle is the angular different between
Foot axis (line through heel and 2nd metatarsal) and progression of gait
Gait requires the interaction of what systems
Neuromuscular and skeletal
Dysfunction in either or both neuromuscular and skeletal systems results in
Gait deviation
Gait can involve single or multiple
Segments and/or joints
Treatment of gait ranges from
Conservative to surgical
Gait analysis identifies
Gait deviation and causes of abnormalities
Track neuromuscular disease progression, surgical/conservative treatment planning and postoperative outcomes
Muscle Weakness
Abnormal muscle tone, contracture
Abnormal joint motion and range
Joint movements are effected by
Movements and positions of other joints (joints do not function in isolation)
Since joints do not function in isolation, what can occur at other joints
Adaptions
Rotational deformities occur in the __ plane
Transverse
Intoeing gait (pigeon toed)
Femoral anteversion
Internal tibial torsion
Metatarsal adductus
Out-toeing gait
Femoral retro version
External tibial torsion
Pes planovalgus
Tight hip external rotators
Angular deformities (coronal/frontal plane)
Genu varum and genu valgus
What are indicators of a potential torsional deformity
In toeing and out toeing
Angular deformities noticed typically in
Young children
How do most angular deformities resolve
Over time as part of development
Compensations can develop that
Mask abnormalities
At birth
The tibia more internally rotated and femoral head/neck is anteverted
Conditions that can cause rotational abnormalities
Hereditary, rickets, neurological disorders
Pes planovalgus
- decreased medial longitudinal arch
- hindfoot valgus
- forefoot abduction
Angle of Femoral Torsion (Angle of Declination)
Angle b/w long axis of femur head/neck and coronal plane of condyles (bicondylar plane, transcondylar axis)
Angle of femoral torsion view from
Transverse plane
The angle of femoral torsion is __ at birth
40 degree and decreases with age
Normal range of angle of femoral torsion is
Between 8-15 (20)
Increase angle of femoral torsion (>15)
Anteversion (increased hip IR and decreased hip ER)
Deceased angle of femoral torsion (<8)
Retroversion
Femoral Anteversion
increased medial hip rotation/decreased lateral hip rotation
with femoral anteversion patient commonly sits
in W position, hips flexed, internaly rotated
squinting patella
faces medially (anteversion of femor)
eggbeater running pattern common with
femoral anteversion
craig test
Trochanteric prominence angle test
Craig/Trochanteric prominence angle test determines
the amount of anteversion (8-15⁰ is normal)
Craig/Trochanteric prominence angle test patient is
prone, knee positioned in 90 degrees flexion
how to preform the craigs test
- Patient prone, knee is positioned in 90⁰ flexion
- Hip is rotated by the examiner medially & laterally while palpating the greater trochanter
- Stop at the position in which the greater trochanter is most prominent laterally (parallel to table)
- Measure the hip angle using the long axis of the tibia
at birth tibial torsion is
normally internally rotated and externally rotates with age
Normal Tibial torsion
dependent on age. in infants and children there can be a wide range of normal
evaluating transmalleolar axis or thigh/foot angle helps to determine
internal tibial torsion
intoeing
metatarsus adductus
adduction of the forefoot in the transverse plane at the tarsometatarsal joint (Lisfranc) - bean shaped sole
metatarsus adductus __ lateral border
convex
metatarsus adductus __ medial border
concave
convex lateral border
prominent tuberosity of 5th metatarsal
concave medial border
Vertical skin crease at 1st metatarsocuneiform joint in more severe cases
abnormal heel bisector line (blecks classification) line SHOULD pass through
2nd/3rd web space
what will determine treatment of metatarsaus adductus
if flexible or rigid. 80-95% resolve on their own
metatarsus angle
angle between longitudinal axis of 2nd met and longitudinal axis of tarsal
congenital metatarsus adductus foot deformity attributed to
intrauterine position
congenital metatarsus adductus can be seen with
other foot deformities. evidence of family history
treatment of metatarsus adductus depends on
severity and age
treatments of metatarsus adductus
stretching, corrective casting
surgery (tarsometatarsal capsule release, osteotomy)
uncorrected metatarsus adductus can result in
other functional anatomical problems such as, 5th metatarsal fracture, lateral foot pain, hallux valgus, development of skewfoot
dislocation
displacement of bone from its natural position, 2 bones that form a joint are not congruent
subluxation
partial dislocation
traumatic (acute) dislocations can be either
anterior or posterior (posterior more common)
posterior dislocation axial load on femur with a
flexed, adducted, internally rotated hip
anterior dislocation
occurs with hip abducted and externally rotated
anterior superior dislocation
pubic
anterior inferior dislocation
obturator
dislocation can be associated with
acetabular wall and femoral head fracture and ligament disruption
non traumatic (non acute) dislocation
repetitive microtrauma, connective tissue disorders, dysplasia of bony surfaces
joint capsule is stronger __ because of ___
anteriorly; ligament support
posterior dislocation 10-20% can have ___ injury
sciatic nerve
common cause of posterior dislocation
motor vehicle accident
in a posterior dislocation the affected limb is
shortened, adducted, internally rotated, flexed.
anterior dislocation __ injury against an abducted leg
hyperextension
in an anterior dislocation the affected limb is
abducted and externally rotated
posterior: femoral head is
superimposed on acetabular roof, lesser trochanter less visible (b/c of rotation)
anterior: femoral head is
located medial or inferior to acetabulum
Developmental dysplasia of the hip
abnormality in the size, shape, orientation of the femoral head, acetabulum or both
Developmental dysplasia of the hip can cause
congenital hip dislocation or subluxation
which hip is more commonly effected in a developmental dysplasia of the hip
left hip but can be bilateral
factors contributing to DDH
intrauterine position (breech position, left occiput anterior positions left limb against moms spine.
DDH is more common in
females, those with a family hx, first borns
evaluation of DDH
- Asymmetric skinfolds
- Unequal leg length,femoral shortening (Galeazzi sign/Allis sign)
- Affected side lower than normal
- Limited hip abduction
- If child is walking, Trendelenburg’s sign/gait may be present (poor mechanical adavantage of gluteus medius and minimus)
- Ortolani and Barlow maneuvers
Ortalani and Brlow maneuvers are only useful
before 3rd month
Ortalani and Barlow maneuvers infant is __
supine, hips flexed to 90 degrees
Ortalani and Brlow maneuvers the physicians places index and middle fingers over
greater trochanter
Ortalani
- Gently abduct hip while exerting upward force through trochanter
- Palpable clunk is positive, dislocated hip is reduced
Barlow
- Infants hips are adducted and a gentle downward force is exerted
- Attempting to produce dislocation
Ultrasound can be used in infants
under 6 months
Radiographs are useful in infants
after 6 months
Hilgenreiner line
Horizontal line through triradiate cartilages
Perkin line
Line perpendicular to Hilgenreiner line, intersecting lateral most aspect of acetabular roof
Shenton line
Curved line along inferior border of superior pubic ramus and along the inferomedial border of femur neck
Acetabular index
- Angle between Hilgenreiner line and line passing through triradiate cartilage and lateral acetabular margin
- Can show acetabular dysplasia or overcoverage
Femoral head should lie within the inferomedial quadrant formed by
Hilgenreiner and Perkin lines
__ line should be uninterrupted
Shenton
acetabular index angel depends on
age
