Midterm Flashcards
Toe spring does what/affects what phases of gait ? Also what pathology would you use it with (1 example)?
Toe spring facilitates advancement & affects swing phase & toe off phases of gait. Useful for hallux arthritis & other pathologies that inhibit MTP mobility
Why would you use an extra depth toe box?
Either post surgically or for a pt w DM who developed hammer toes as a result of peripheral neuropathy
Rocker bottom sole does what?
Advances foot during late stance BUT inhibits MTP DF & windlass mechanism
Standard heel height =
1-2 cm; usually add 1 cm if want more ht
Wearing heels increases what forces ?
The vertical forces on the met heads x2
High heels increase demand on what muscles?
Peroneals and knee musculature
Types of lasts
Slip, board or combination
Point of using a flare/disadvantage? Where would you want to put a flare (and why)?
Use a lateral flare to relate stance stability (decr. Chance of lat ankle sprain) BUT it increases pronation forces. Want to out it in forefoot because most ankle sprains are PF/INV
If you want added midsole stiffness could add..
A shank (in athletic shoes, rubber of a higher density)
Difference in gait when barefoot running =? What injuries do you become more prone to getting?
Initial contact is different; more muscle-tendon strain on the forefoot (increased chance of Achilles tendonitis)& on the rear foot more impact & joint loading forces (incr chance of stress fx)
What would you use to unweight metatarsal heads (ie with metatarsalgia)?
Metatarsal cookie & cut outs
For minor bunions (ie <stage 3) use…
Spacers
Which closure design is better for AFO usage?
Blucher
Advantage of using high tops=?
Reduce inversion in lab conditions BUT didn’t reduce ankle Sprains in basketball players
When is glut Max activation peaked?
During loading response
When does the iliopsoas activation peak? (2 times)
During terminal stance & initial swing
What muscles control the PF moment at the ankle during IC & LR?
Tib ant, EHL & EDL
During IC & LR, —- are activated to control the — moment at the hip and promote —- movements
Glut max& hamstrings activated to control the flexion moment at the hip and promote hip control and extension
ROM of hip during gait=? Peak flexion occurs during.. Peak ext during..
10 ext to 30 flexion; peak flexion : IC, peak ext : PSw
Max DF occurs during – phase
Midstance as tibia moves over foot
How many degrees of pronation/supination are normally required during gait?
4-6 deg of each
Peak pronation occurs during ..
Midstance
Peak supination occurs during ..
Pressing
When does peak MTP ext occur? How many degrees ?
Preswing; 55•
What is activated during IC to restrain the hip flexion moment?
Hamstrings and glut max
During loading response, the critical events are ..
Hip stability & controlled knee flexion & PF for shock absorption
When Does the GRF vector change? What does it change to?
Changes from the end of LR to end of MSt ; hip - flex to ext; knee - flexion to ext ; ankle - PF to DF
What is the critical event in midstance?
Controlled tibial advancement, which is done by the gastroc ; this control inherently controls knee extension
What two muscles are active during midstance to prevent the swing leg pelvis from dropping?
Glut min & med
What muscles initiate the forward rotation of the pelvis during midstance to assist in the swing limb advancement?
TFL, glut med & glut min (all do ER?)
What is the foot doing during midstance? And what muscles are activated in the leg/foot?
Foot begins to supinate (still pronated) ; peroneus longus is activated to stabilize the first ray on the ground while the rest of the foot supinates
What ms helps restrain the hip ext moment during terminal stance?
TFL
During IC, what types of moments/forces are acting on the knee? What controls/stabilizes the knee?
Ext moment & valgus thrust; the quads and hamstrings both contract to stabilize the knee during wt acceptance & the gracilis, Vastus medialis & semitendinosis contract to control the valgus thrust
What happens at the midtarsal jt when the STJ is in pronation?
Pronation is the loose packed position of the STJ so when it’s pronated, the midtarsal joint is free to supinate/pronate to adjust to the ground surface in loading phase
Why does the adductor Magnus fire during terminal swing?
To control the body’s fall toward the opposite limb
In preswing, what muscles work to counter the extension moment at the hip to initiate hip flexion?
Adductor longus and rectus femoris
When is the tibia released to advance over the foot? What muscle reduces its contraction to allow for this?
During preswing; the gastroc
During preswing, what occurs as a result of tibial advancement over the foot?
The vector at the knee moves posteriorly, creating passive knee flexion (which is then controlled by the rectus femoris)
What is the critical event in terminal swing?
Knee ext to prepare for a stable landing
At what phases of the gait cycle are the pelvis/femur/tibia externally rotating?
Midstance thru preswing
What might you see as a result of weak posterior tibialis?
Excessive pronation in loading response and midstance
Weakness of the peroneals results in — during the gait cycle
Excessive varus at the STJ ( usually holds first ray to ground as foot supinates in midstance)
Evidence for using insole to prevent LBP?
Strong evidence AGAINST it
Should you use a FO to prevent PFPS?
Weak evidence
People w PFPS have more RF ___
Varus
Mod evidence supports —- usage for medial knee OA
Lateral wedge
Mod evidence supports —- usage for knee valgus pain reduction
Medial wedge
Poor shock absorption of GRFs during LR can result in —- at the foot
Insufficient pronation & excessive jt loading forces
Poor dampening of internal torque & reversal of limb IR during LR can result in —- at the foot
Excessive pronation
If you have a R Achilles’ tendon rupture, what type of orthotic should you use?
B heel lift to reduce stress on Achilles without introducing a LLD
If a pt has a LLD, what type of orthotic would you recommend?
Heel lift (internal 1cm)
If pt has MP OA/hallux rigidus, what type of lift would you prescribe?
Sulcus length lift
How do you determine the ESTIMATED amount Of STJ motion a patient has ?
Degrees of motion between RF position in STJ neutral and in relaxed calcaneal stance
A deep heel seat reduces —-
Pronation by 1 deg
Using semi rigid material reduces —-
Pronation by 2 deg
If a pt incr in RF varus in stance, most likely are — or — type pt
PF 1st ray or FF Varus
If have compensated FF valgus, will see — at loading ; should use — as orthotic
STJ inversion ; lateral FF wedge post
To reduce shock , may use .. (3)
Heel plug, additional soft material, or 1st ray cut out
Dual density may reduce — by —
Reduce pronation by 1 degree
To correct for RF varus, use — post , — length
RF medial wedge; 3/4 length
If someone is an excessive supinator, may compensate by .. (2)
FF valgus or PF 1st ray
If pt excessively pronates, may compensate by ..(2)
RF or FF varus
If pt compensates for FF varus by excessively pronating, use — orthotic — length
Use FF medial wedge and RF medial wedge , sulcus length
