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OPP exam 3 > Mechanics of the foot > Flashcards

Mechanics of the foot Flashcards

1
Q

what is the shape of the ankle

A

Tibia forms a concave surface and fits into the body of the talus

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2
Q

what stabilizes the joint of the ankle

A 
capsule
deltoid ligament (medial)

anterior talofibular (ATF-always tear first!), 
posterior talofibular (PTF) & 
calcaneofibular ligaments
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3
Q

what is the deltoid ligament and what does it attach to

A

medial ligament

very very strong

attaches to the medial malleolus, tuberosity of navicular, the sustentaculum tali of the calcaneus and the medial tubercle of the talus

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4
Q

what is the first ligament to tear in an inversion ankle sprain and what does this ligament attach to

A

anterior talofibular

this attaches to the lateral malleolus and to the neck and lateral articular facet of the talus

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5
Q

where does the PTF attach

A

Attaches to the lateral malleolus & to the lateral tubercle of the post process of the talus

LATERAL ligament. can be hurt in inversion sprain

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6
Q

where does the calcaneofibular ligament attach

A

attaches to the lateral malleolus and the tubercle of the lateral surface of the calcaneus

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7
Q

what are the major motions of the tibiotalar joint many degrees is normal in each

A

plantar flexion (50)

dorsiflexion (20)

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8
Q

what are the major players in plantar flexion

A

gastrocnemius and soleus

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9
Q

what are the minor players in plantar flexion

A

plantaris
tibialis posterior
flexor hallucis longus
flexor digitorum longus

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10
Q

what are the major players in dorsiflexion

A

tibialis anterior

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11
Q

what are the minor players in dorsiflexion

A

extensor digitorum longus

extensor hallucis longus

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12
Q

in which position is the ankle most stable ?

A

dorsiflexion (with posterior glide of the talus)

when you sprain your ankle toes are usually down

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13
Q

what are the accessory motions of the ankle

A

Side-to-side glide,
rotation,
abduction and adduction only if the joint is plantar flexed.

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14
Q

what is the subtalar joint

A

talus on the calcaneus

two separate concave-convex articulations

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15
Q

what are the major motions of the subtalar joint

A

abduction (valgus)
adduction (varus)
this is in relationship to a fixed talus (so the heel deviates in and out)

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16
Q

what other foot bone does the talus articulate with

A

navicular

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17
Q

what other foot bone does the calcaneus articulate with

A

cuboid

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18
Q

motion of the hind foot is the combined motion of what two joints

A

subtalar

navicularcuoid

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19
Q

what occurs in inversion of the foot

A

medial rotation of the calcaneus and navicular
increases height of the medial arch
cuboid rotates down on calcaneus
plantar flexion of the ankle

So inversion is calc adduction + navicular rotation + glide on talus
These raise the medial portion of the foot and depress the lateral portions

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20
Q

what muscles are used in inversion of the foot

A

tibialis anterior and posterior

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21
Q

what occurs during eversion of the foot

A

lateral rotation of the calcaneous and navicular

Lateral rot of calc & nav
Decreases the height of the medial arch
Cuboid rotates up on calcareous
Dorsiflexion of ankle

So eversion is calc abduction + navicular rotation + glide on talus
These raise the lateral portion of the foot and depress the medial portions

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22
Q

what are the muscles used in eversion of the foot

A

fibularis longus and brevis

exterior muscles

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23
Q

what is pronation of the foot

A

eversion, dorsiflexion, abduction

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24
Q

what is supination of the foot

A

inversion, plantar flexion, adduction

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25
what is the primary motion of the tarsometatarsal jts
flexion and extension
26
what is the primary motion of the intermetatarsal jts
sliding
27
what are the motions of the MTP's
flexion extension abduction adduction they also slide, rotate and provide long axis traction
28
what is the motion of the interphalange jts
flexion and extension
29
what is the lateral arch for mostly
weight bearing and elasticity built to transmit weight and thrust to the ground limited mobility type of LONGITUDINAL arch has osseous support
30
what makes up the lateral arch
calcaneus, cuboid, 4th and 5th metarsals
31
what is the medial arch for
for mobility changes to adapt to terrain does NOT have firm osseous support helps control gait
32
what makes up the medial arch
``` calcaneus talus navicular the cuneiforms 1-3 Metatarsals ```
33
what controls the medial arch
``` plantar ligament plantar fascia tibialis posterior flexor digitalis longus flexor hallucis longus intrinsic muscles of the foot ```
34
what causes high medial arch
adduction of foot and VARUS calcaneus
35
what causes dropped medial arch
caused by abduction of foot and valgus calcaneus and dorsiflexion of the ankle (basically extreme pronation)
36
do muscles support the medial arch of the foot?
NO | they help control it for balance and gait
37
what are the 3 transverse arches
anterior posterior tarsal arch
38
what makes up the anterior transverse arch | what is its function
made up of the MT heads transmits weight to the ground flattens with weight bearing
39
what makes up the posterior transverse arch
MT bases
40
what makes up the tarsal arch | what is its function
made up of navicular, cuboid, cuneiforms assists is flexibility of foot as well as rotation
41
what happens with loss of the transverse tarsal arch
pes planus (flat feet)
42
what is the difference between functional flat feet and structural flat feet
Functional flat feet- when standing and walking and foot becomes flat, can treat with an orthotic Structural flat feet- when patient is sitting and their feet are rigid and flat and they are stuck, these people usually have lots of other pain
43
what are high arches called | what happens with high arches
pes cavus there can be gait problems
44
if the feet are pronated what else will be observed
the achilles on the pronated side will bow
45
what happens with hammer toes
DIP is extended | PIP is flexed
46
what happens with claw toes
flexion of both DIP and PIP
47
what are bunions what else can this be caused by
A bunion is the medial deviation of the 1st MTP with lateral deviation of the proximal phalanx of the hallux (great toe) The MTP can be very tender, erythematous and swollen Gout can also do this This is actually a problem usually with the 2nd MTP pushing on the 1st MTP
48
how far can you adduct the subtalar joint
20 degrees
49
how far can you abduct the subtalar joint
10 degrees
50
how do you motion test the subtalar (calcaneal) joint | how many degrees of motion are expected
The patient actively moves the foot first Then the doctor passively moves the foot by gripping the calcneus in one hand and locking the talus by gripping the forefoot with the other. Then invert and evert the foot Inversion/eversion 5 degrees of motion
51
how do you motion test the MT's
grasp the MT next to it and lock it out
52
what are the motions of the hallux and how many degrees in each is expected
flexion 45 degrees | extension 70-90 degrees
53
what happens in the stance phase of gait
heel strike Foot rolls to lateral edge Weight should roll back to ant transverse arch The great toe should push (toe) off
54
what is a common ankle injury and what are the ligaments involved
acute inversion ankle sprain anterior talofibular (always tears first) calcaneofibular posterior talofibular (rare to see this except with fracture/dislocation)
55
what is a grade 1 ankle inversion sprain
microtears with the ligament | Swelling and disability but no instability (no laxity)
56
what is a grade 2 ankle inversion sprain
partial tear of the ligament Severe swelling over the ankle, mild instability, antalgic(limp) gait, mild ligamentous laxity, laxity is noted with a good end point, decreased ROM (swelling, pain)
57
what is a grade 3 ankle inversion sprain
complete tear marked loss of function and complete instability, no endpoint noted on provocative testing
58
what is the mechanism of injury of an acute inversion sprain
inversion and plantar flexion | generally from stepping on an uneven surface
59
what are the symptoms of acute inversion ankle sprain
``` Sx Swelling Eccymosis TTP (tenderness to palpation) depending on degree of injury Decreased ROM Antalgic gait Poor lower extremity propreoception Assessed with one leg standing test ```
60
what do you do in diagnosis of acute inversion sprain
x-ray anterior drawer test talar tilt test arches of the foot
61
what will an X-ray reveal in anterior inversion sprain? anterior drawer? talar tilt?
negative x-ray anterior drawer --> positive in 2nd and 3rd degree tears only talar tilt test is positive assesses the ATF ligament and calcaneofibular
62
what does it mean if the arch of the foot is flat after a sprain? what is the next step
IF the arch is acutely flat; this may indicate tear of tibialis posterior tendon (a stabilizer of the foot) If Tib Post tendon is torn—it must be surgically corrected within 14 days for optimal outcome to prevent degeneration of the foot ORDER MRI
63
who can the ottawa rules be used on?
patients over the age of 18
64
what are the ottawa rules
ankle x-ray is required if bony tenderness at posterior edge of medial or lateral malleolus or if inability to bear weight both immediately and in ED foot x-ray required if bony tenderness at the base of the 5th metatarsal or the navicular or if inability to bear weight immediatley or in the ed
65
how do you do the anterior drawer test and what does a positive test tell you
Pt is sitting with legs dangling off table Foot is in a few degrees of plantar flexion Doc grabs front of tibia with the other hand cupping the calcaneus Gently pull the calcaneus anterior as you push the tibia posterior If normal the talus will not move on the tibia If abnormal the talus slides anteriorly—this is a positive test tells the status of the anterior talofibular ligament
66
how do you do the talar tilt test what is a positive test
Pt is sitting with legs dangling off table Doc inverts the calcaneus If the talus gaps or rocks in the ankle mortise, the ATF & calcaneofibular ligs are torn and the test is positive
67
effects of a sprain on the body
The ankle inverts The fibular head moves posterior, the lateral malleolus moves anterior This could impinge the common fibular (peroneal) nerve and cause a foot drop The tibia externally rotates The femur internally rotates Ipsilateral anterior innominate Anterior torsion of the sacrum facing the side of the ankle sprain So for a right ankle sprain, a Right on Right sacral torsion L5 will rotate opposite of the sacrum
68
treatment of acute ankle sprain grade 1 and 2 tears
Conservative treatment PRICE (protection, rest ice, compression, elevation) NSAIDs once Fx has been ruled out (anti-inlammatory) Other pain medication Crutches if needed OMT
69
what do you treat grade 3 tears with
PRICES (protection, rest, ice, compression and elevation) and SURGERY
70
when can you start physical therapy for acute ankle sprain
once acute inflammation is over 48-72 hours
71
how long do you continue ankle proprioception exercises (one leg standing or wobble board) for?
full 10 weeks to prevent recurrent sprains
72
pectus excavatum
sunken chest
73
pectus carnii
pigeon breast
74
pseudoarthorsis
multiple joints

OPP exam 3 (11 decks)

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