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AFAB I-II > lecture 13 - exam 3 > Flashcards

lecture 13 - exam 3 Flashcards

1
Q

what type of structure is the medial arch?

A

primary load bearing and shock absorbing

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2
Q

what bones make up the medial longitudinal arch?

A

calcaneus, talus, navicular, cuneiforms, 3 medial metatarsals

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3
Q

what would happen without the medial arch?

A

the large/rapid forces of running would exceed physiologic weight bearing capacity of bones

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4
Q

what are the structures that assist load absorbing?

A

fat pads
sesamoid bones (plantar base of great toe)
plantar fascia attaches to overlying thick dermis (reduce shear forces)

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5
Q

muscular forces required for quiet standing is _______ and is _______ compared with support from _________ tissues

A

variable
small
connective

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6
Q

what are examples of high level forces needed when stresses on arch?

A

on tip toes
jumping
running

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7
Q

plantar fascia:
- primary passive support for _____
- ______ connective tissue in superficial and deep layers
- _________ thick
- ______ and _______ collagen rich fibers
- extremely ________
- blends with ______

A
  • arch
  • dense
  • 2-2.5 mm
  • longitudinal and transverse
  • strong
  • first layer intrinsic muscles
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8
Q

plantar fascia:
central bands into metatarsal heads blend with ____

A

plantar plates/ligaments of MTP joints
flexor tendon sheath
fascia of toes (plantar surface)

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9
Q

plantar fascia:
extension of the toes stretches the ______ adding ________ to the medial arch

A

central fibers of the deep fascia
tension

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10
Q

in normal stance, BW goes through ______ and spreads out to _____ and ______ over metatarsal heads and heel

A

talonavicular joint
fat pads and thick dermis

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11
Q

rearfoot ______ compressive force as forefoot

A

2x

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12
Q

what is pes planus?

A

flatfoot
abnormally dropped medial longitudinal arch

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13
Q

what can pes planus be a result of?

A

joint laxity within midfoot or proximal forefoot and/or combined with overstretched, torn, or weak plantar fascia, spring ligament, or posterior tibialis

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14
Q

what is the result of pes planus?

A

excessive subtalar pronation (calcaneal eversion or valgus position)

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15
Q

What causes rubbing against the inside of foot wear to create a callus (in someone with pes planus)?

A

forefoot abduction
depressed talus and navicular

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16
Q

what can you do if someone has a flexible pes planus?

A

orthosis
foot wear changes
exercises

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17
Q

Subtalar joint drives the ______
the capacity to ______ is essential

A

foot
repeatedly transform from a rigid lever to a flexible shock absorber structure

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18
Q

gait cycle is mediated via ? (3)

A

Subtalar
transverse tarsal
medial arch

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19
Q

______ lifts and lowers cyclically throughout the gait cycle:
- during the first 30-35% of cycle the ST joint _______ adding flexibility to the foot
- late stance the arch ________. ______ adds stability to midfoot

A

medial arch
pronates (everts)
rises sharply; supination

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20
Q

what happens immediately after heel contact?
- ______ in TC joint
- _______ in ST joint
- rapidly _____ and ______ 4-9 deg

A
  • DF
  • slightly supinated
  • PFs and pronates
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21
Q

what does the calcaneus do in pronation?

A

tips into eversion/pronation in response to GRF just lateral to midpoint of calcaneus

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22
Q

what does the talus do in pronation?

A

pushed medially (horizontal - add) and inferior (sagittal PF)

23
Q

what does the ST joint do in pronation?

A

abduction
DF
everted

24
Q

what does the tibia and fibula do after heel contact in pronation?

A

internally rotates

25
Q

what happens with overpronation in stance?

A

the center of pressure falls more medially on the sole of the foot and after many repetitions during the gait cycle the tissue can show signs of the stress (local inflammation and pain) to the fascia, talonavicular joint and posterior tibialis tendon

26
Q

where may you experience weakness at with excessive pronation?

A

LE muscles
medial arch structures
abnormal shape/mobility of tarsal bones

27
Q

may have excessive _______ in horizontal/frontal planes with overpronation

A

ST motion

28
Q

how does rearfoot or forefoot fixed varus lead to overpronation?

A

trying to get foot to contact ground ST joint pronates

29
Q

what are some dysfunctions that can happen as a result of overpronation?

A

medial knee pain
Patellofemoral dysfunction
PFPS/instability
overuse syndromes (ITB, shin splints, achilles/patellar tendinopathy)
low back and pelvis pain
stress fractures

origins from hip and knee or foot

30
Q

at about _______ into gait cycle the entire stance limb begins to _____ its horizontal plane motion from _______ rotation to ______ rotation

A

15-20%
reverse
internal to external
(swing phase of contralateral LE)

31
Q

at ______ of gait cycle the pronated STJ moves towards supination
by ______ ____ the medial and longitudinal arch are lifted and the mid and forefoot move into supination

A

30-35%
late stance

32
Q

orthosis controls ______
______ to bring the floor to the foot

A

excessive pronation
medial wedging

33
Q

what is the reasoning behind orthotics? (5)

A

optimizes mid stance alignment to reduce demand on musculature (post tib)
optimizes alignment of bones/joints
changes kinematic sequencing
support to medial tissues

34
Q

what does the Lisfranc’s joints separate? where?

A

midfoot to forefoot
at base of metatarsals and cuneiforms/cuboid

35
Q

the least amount of motion/stability at the Lisfranc’s joints is at the ______

A

2nd and 3rd metatarsals

36
Q

in early midstance the medial column ______ 5 deg
the cuneiform depresses and forces 1st ray ______
it ________ before push off

A

DF
upward
reverses

37
Q

what ligaments make up the intermetatarsal joint?

A

plantar ligaments
dorsal ligaments
interosseous ligaments

38
Q

which intermetatarsal joints are synovial joints?

A

3-5
(1st & 2nd not)

39
Q

metatarsophalangeal joint:
______ head of metatarsal to shallow _______ of phalanx
(______ mm proximal to web space of toes)

A

convex
concavity
2.5 mm

40
Q

what is at the metatarsophalangeal joint?

A

capsule
collateral ligaments
plantar plate
(grooved passage for flexor tendons)

41
Q

how many degrees of freedom are at the metatarsophalangeal joint?

A

2
flx/ext and abd/add

42
Q

what is hallux limitus or rigidus or turf toe?

A

marked limitations of motion
pain at MTP (<55 deg)
may adapt to walking on the outside of the foot

43
Q

how does hallux limitus happen?

A

frequently forceful hyperextension

44
Q

hallux limitus can fracture what?

A

sesamoids

45
Q

what is hallux valgus?

A

progressive lateral deviation of great toe and adduction of metatarsal

46
Q

what promotes greater deformity of hallux valgus?

A

tendons displaced relative to the joint

47
Q

what are some things that could lead to hallux valgus?

A

tightness of achilles
incorrect footwear
excessive rearfoot valgus
instability of 1st ray
can get hammer 2nd toe
metatarsalgia
bursitis at bunion

48
Q

what can be done for hallux valgus?

A

orthotic support
surgery

49
Q

interphalangeal joint:
- _____ head and ______ base of more distal one
- what is at the joint?
- DOF?

A
  • convex; concave
  • ligaments, capsules, plates
  • 1: flx/ext
50
Q

what is the windlass mechanism?

A

fascia transmits force from calcaneus to base of toes for push off

51
Q

windlass mechanism in normal foot:
toe ______ –> _____ tension in fascia –> ______ arch in foot & strengthens the midfoot and forefoot –> bones of foot become ________ –> leads to ______

A

DF
increased
raises
tightly packed
propulsion

52
Q

windlass mechanism in pes planus (flat foot):
** remember pes planus has poorly supported medial arch
forefoot _____ under load of body weight
reduced extension of metatarsophalangeal joints _____ usefulness of of windlass effect
arch remains _______ and midfoot and forefoot are ______

A

sags
limits
flattened; unstable

53
Q

how do you check the windlass effect?

A

have patient stand on tiptoes

AFAB I-II (23 decks)

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