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Lower Extremity > Midterm Notes > Flashcards

Midterm Notes Flashcards

1
Q

Open kinetic chain

A

When one end of a chain is free to move

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2
Q

In the lower extremity - when the foot is not in contact with the groung.

A

Open kinetic chain

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3
Q

Allows shared movement for close packed position and non-weight bearing stresses on articular surfaces

A

Open kinetic chain

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4
Q

Closed kinetic hain

A

Both ends of the chain are not free to move

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5
Q

When contact with the ground surface anchors the lower extremity, putting into action the subtalar joint, locking and unlocking mechanisms of the mid-foot across the trans-tarsal joint, load bearing of the arches, internal rotation of the tibia and glide of the fibula

A

Closed kinetic chian

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6
Q

Describe closed kinetic chain

A 
Subtalar joint in action
Locking and unlocking of mid-foot across trans-tarsal joint
Load bearing of arches
Internal rotation of tibia
Glide of fibula
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7
Q

General foot/ankle info

A

26 bones

2 sesamoids

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8
Q

Work distal to proximal in ____ and proximal to distal in ____

A

Lower extremity

Upper extremity

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9
Q

Three major sections of the foot

A

Forefoot
Midfoot
Rearfoot/hindfoot

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10
Q

Forefoot

A

Metatarsals and phalanges - 5 rays

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11
Q

Midfoot

A

Navicular
Cuboid
Cuneiforms 1,2,3

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12
Q

Rearfoot/hindfoot

A

Calcaneus

Talus

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13
Q

Three arches of the foot

A

Lateral
Medial
Transverse

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14
Q

If keystone drops, so does

A

The arch

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15
Q

Lateral arch keystone

A

Cuboid

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16
Q

Medial arch keystone

A

Navicular

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17
Q

Transverse arch keystone

A

Second metatarsal head

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18
Q

Normal weight bearing and subsequent callus formation usually occurs at three sites

A

Calcaneus
1st and 5th metatarsal heads
Plantar surface of big toe

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19
Q

Calluses appear where

A

Constant friction

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20
Q

Abnormal weight bearing

A

Pes planus

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21
Q

Abnormal weight bearing occurs at

A

Calcaneus

2,3,4 metatarsal heads

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22
Q

Create forces which may lead to morton’s neuroma

A

Abnormal weight bearing

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23
Q

Patient may have pinch calluses on the lateral and/or medial edges of foot from

A

Hypersupination
Hyperpronation

Abnormal weight bearing

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24
Q

Pronation of the foot =

A

Abduction (external rotation) + eversion + dorsiflexion (anterior translation) - non weight bearing subtalar motion/calcaneal primary motion

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25
Q

Supination of the foot =

A

Adduction (internal rotation) + inversion + plantarflexion (posterior translation) - non weight bearing subtalar motion/calcaneal primary motion

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26
Q

There are no muscular attachments

A

Talus

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27
Q

If subluxated, the talus will block ___ due to altered weight distribution and the affect upon the locking and unlocking mechanisms of the foot and may lead to numerous foot complaints

A

Normal motion in the mortise (dorsiflexion)

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28
Q

Altered position of the talus that affects the ankle will cause

A

Whole body effects from tibia up

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29
Q

Altered position of talus may stress tibia/fibula interosseous ligament adding to or causing

A

Shin splint pain

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30
Q

Altered position of ____ may affect leg length

A

Talus

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31
Q

Altered motion of talus may affect ankle proprioception altering

A

Afferent signal

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32
Q

Components of a medial collapsing arch

A

Anterior talus
Inferior navicular and cuneiforms
Superior cuboid
Everted calcaneus

Possible spreading of metatarsal heads
Possible splay foot

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33
Q

Most common position of ankle injury

A

Plantarflexion/inversion

Open packed position/closed kinetic chain

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34
Q

Typically fracture or dislocation are caused by

A

Dorsiflexion/eversion

Closed packed position

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35
Q

May all relate back to the same underlying mechanical problem of a collapsing arch and hypo-tonicity in the muscularity of the lower leg

A

Interdigital neuritis (morton’s)
Plantar fascitis
Hallux valgus
Tarsal tunnel

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36
Q

An intact motor system can adapt via ____ and _____. The adaptations of the motor system are represented by ____

A

CNS control
Muscle system activity
Muscle imbalances

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37
Q

Primary shock absorbers for the spine

A

Foot and ankle

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38
Q

Foot and ankle conform to the ground surface for ___ and then become ___ for propulsion

A

Contact

Rigid lever

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39
Q

The foot and ankle conforming to the ground surface for contact and then becoming rigid lever for propulsion occurs via

A

Locking and unlocking process, which occurs at the trans-tarsal joint aka midtarsal joint

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40
Q

Trans-tarsal joint

Midtarsal joint

A

Talus/navicular and calcaneus/cuboid

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41
Q

Articulations between talus/navicular and calcaneus/cuboid are usually subluxated/misaligned in a

A

Mid-foot sprain or ankle injury

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42
Q

Classic area of investigation if the patient experiences pain in the mid foot upon weight bearing not associated with obvious edema or extreme point tenderness

A

Midtarsal joint

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43
Q

The function of the fibula during dorsiflexion above 90degrees will create

A

A palpable rising of the fibular head

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44
Q

The function of the fibula during dorsiflexion above 90degrees is essential for

A

Proper ankle function and stability

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45
Q

Fibular movement plantarflexion

A

Fibular head anterior, inferior, medial

46
Q

Fibular head movement dorsiflexion

A

Posterior, superior, lateral

47
Q

The best exercise for feet is

A

Walking in soft sand

Towel gathering may be substituted

48
Q

Pt for exercise of feet

A

3 sets of 20 repetitions, 3 times per day

49
Q

What can be substitued exercise for feet for walking in soft sand

A

Towel gathering

50
Q

Cryotherapy and motion is easy to accomplish with the use of

A

A plastic soda bottle - 12 oz size

51
Q

Fill 12 oz water bottle with water and freeze
Use anytime exercises are being done or when the foot is painful
Roll foot over frozen bottle for 3-5 minutes then perform the exercises

If the foot is painful, ____

A

Cryotherapy and motion

Ice between each set if foot is painful

52
Q

If all attempts for the body to correct the foot problem have failed or if time is critical

A

Orthotics may be used

53
Q

Understand the differences between custom and generic

Posting

A

Orthotics

54
Q

A modified hinge joint at the connection of 2 long bones (levers)

A

Knee

55
Q

Least stable joint in the lower extremity when the foot is in contact with the ground surface (closed kinetic chain)

A

Knee joint

56
Q

Largest joint held together by soft tissue

A

Knee joint

57
Q

Coupled motion of knee joint

A

Flexion with tibia on femur internal rotation

Extension with tibia on femus external rotation (screw home)

58
Q

Quadriceps angle

A

ASIS - center of patella/tibial tuberosity - center of patella

Men <10 degrees
Women >10 degrees
20 degrees is unstalbe for all

59
Q

Shin splints

A

Symptoms
Differential
Preventative
Rehabilitation

60
Q

Pain behind the knee cap medial side while walking or running up hill or up steps usually associated with a weak vastus lateralis

A

Medial patellar tracking syndrome

61
Q

Pain behind knee cap lateral side while walking or running down hills or down steps. Usually associated witha weak vastus medialis (VMO)

A

Excessive lateral patellar syndrome

62
Q

For medial weakness exercise the joint during the last 15-20 degrees of

A

Knee extension

63
Q

For lateral weakness, exercise should exclude

A

The last 15-20 degrees of knee extension

64
Q

Taping and straps across patella tendon

A

May be hlepful

65
Q

Impact at the fibular head may affect directly or indirectly

A

The common peroneal nerve

66
Q

The fibular head is an insertion site for the

A

Biceps femoris

67
Q

A slip of the IT band and the lateral collateral ligament with biceps femoris

A

Fibular head

68
Q

Fibular mus have normal motion to allow

A

Normal biomechanics at knee and/or ankle

69
Q

Semi-weight bearing sub-talar neutral casting

Orthotics

A

Fucntional orthotics
Accommodative orthotics
Generic
Normal foot

70
Q

Functional orthotics requirements

A

Support the foot so that the subtalar joint will function around neutral position
Allow normal motions in the proper sequence and eliminate abnormal/compensatory motions
Conform to all contours of the foot that help function
Be comfortable within a 2 week period
Be capable of being adjusted

71
Q

Accommodative orthotics

A

Any orthotic device that does not attempt to establish foot function around the neutral subtalar position (of restraicts motion from proper sequence)

72
Q

Generic orthotics

A

The term used to indicate an off-the-shelf product
Aren’t specifically fitted to your feet and may or may not fit foot properly
Usually made at 4 degrees of varus correction

73
Q

Normal foot

A

A foot that functions around neutral position and adapts well to terrain with normal shock absorption and goes through acceptable pronation and supination

74
Q

Semi-weight bearing sub-talar neutral casting procedure

A

Adjust patient’s feet
Determine forefoot and rearfoot angles
For heel lifts use 1/2 of the measured difference but no more than 6mm inside the shoe
Place one foot on the unopened side of the foam
Place the other directly over the open foam impression box, making sure the knee is directly above the ankle
With your rearward hand, lift the foot into dorsiflexion at the 4-5 metatarsal heads to prepare for finding neutral position
Remove the rearward hand and grasp rear and side of the calcaneus to prevent any lateral movement.

75
Q

Posting forefoot

A

Orthotic will generally have 4-6degrees of intrinsic forefoot varus angulation so you must subtract that anmount from your measurement. Do not post less than 3degrees. Max angle should not exceed 15-18degrees or it will not work in shoe

76
Q

Rearfoot posting

A

Orthotic will have no rearfoot angulation. Therefore post one for one. Max positing is 5degrees

77
Q

Determining sub-talar neutral

A

Adjust foot. 6-8 degree changes are not uncommon
Pt supine - place outside thumb on 4-5 metatarsal heads; place inside thumb and 1st finger into space on either side of talus; place foot into slight dorsiflexion and atttempt to place the foot in a position that is neither inverted nor everted, neither pronated or supinated. Attempt to equalize the holes where your fingers are located then measure angle off tibia
Pt prone - repeat process, measure forefoot angle. Normal is 0-6degree varus; check for functional hallus limitus (FHL)

78
Q

Great toe dorsiflexion normal

A

70-90d

79
Q

Great toe dorsiflexion under load normal is

A

35d

80
Q

Family physicians are frequently called on to evalutae patients who have

A

Acute knee injuries

81
Q

Each year, knee trauma is responsible for an estimated ____ visits to ER departments in the US

A

1.3 million

82
Q

The anatomic characteristics of the knee, it’s exposure to external forces and the functional demands place on the joint may explain

A

The frequency of injury

83
Q

Only ___ of patients with knee trauma have a fracture

A

6%

84
Q

Standard texts imply that radiographs should be routinely obtained for every patient who

A

Presents with knee injury

85
Q

Reasons for the unnecessary use of radiography include

A

Fear of lawsuits
Failure to obtain an adequate history
Expectations on the part of patients

86
Q

Overuse of radiologic studies has become a significant ___ problem int he US

A

Economic

87
Q

Fractures in the knee may occur in

A

The patella
Femoral condyles
Tibial plateua

88
Q

Patellar fractures are divided into

A 
Transverse
Vertical
Upper pole
Lower pole
Comminuted
Osteochondral
89
Q

The 2 main MOI’s of patellar fracture are

A

Direct trauma to the anterior aspect of the knee

A powerful contraction of the quadriceps muscle (transverse, upper pole and lower pole fractures)

90
Q

____ are essential to assess traumatic patellar injury

A

Radiographs

91
Q

In addition to AP, notch, andn lateral views, ___ and ___ views with the knee in 45d of flexion may be necessary to identify an osteochondral fragment

A

Merchant

Infrapatellar

92
Q

Fractures of the femoral condyles involve the

A

Distal 9-15cm of the femur

93
Q

Both the diaphyseal and metaphyseal regions may be involved . Fractures may also show

A

Intra-articular extension

94
Q

Most condylar fractures occur as a result of

A

MVA’s

95
Q

other causes besides MVA of condylar fractures are

A

Falling on a flexed knee or

Falling from a height

96
Q

In young people, higher energy is necessary for a fracture to occur, therefore, more ____ is present

A

Soft tissue damage

97
Q

In older patients with osteoporosis, less energy is needed to produce a fracture; therefore, less associated

A

Soft tissue damage is present

98
Q

Fractures of the tibial plateau are important because of the

A

Weight-bearing areas

99
Q

Fracturs of tibial plateaus may involve

A

Metaphysis
Epiphysis
Articular cartilage

100
Q

MOI fracture of tibial plateau

A

Compression
Valgus force
Combination of both

101
Q

The fractures involve the lateral plateau, medial plateau or both (bicondylar fractures)

A

Fractures of tibial plateau

102
Q

The clinical decision rules created in ____ and ____ are the best known guidelines for appropriate use of radiographs in acute knee injuries

A

Ottawa

Pittsburgh

103
Q

Ottawa knee rules

A 
Age 55 or older
Tenderness at head of fibula
Isolated tenderness of patella
Inability to flex knee to 90d
Inability to walk four weight-bearing steps immediately after the injury andin the ER
104
Q

Pittsburgh decision rules

A

Blunt trauma or a fall as MOI plus either of the following:
Age younger than 12 years or older than 50 years
Inability to walk four weight-bearing steps in the ER

105
Q

Knees of 74% patients evaluated radiographically. ___ were found to have fractures

A

5.2%

106
Q

Logistic regression analysis found fall or blunt trauma MOI knee had sensitivity or __ and specificity of ___ for the presence of knee fraction.

A

92%

57%

107
Q

The prospective part of study for knee found combo of all 3 criteria was ___ sensitive and ___ specific for knee fracture

A

100%

79%

108
Q

Pittsburgh decision rules were ___ sensitive and ___ specific for diagnosis of knee fractures

A

99%

60%

109
Q

Ottawa knee rules were __ sensitive and ___specific

A

97%

27%

110
Q

Ottawa ankle x-ray

A

Only required if there is pain in malleolar zone AND
Bone tenderness at posterior edge or tip of lateral malleolus OR
Bone tenderness at posterior edge or tip of medial malleolus OR
Inability to bear weight both immediately and in the ER

111
Q

Foot x-ray ottawa only required if there is pain in the midfoot zone AND

A

Bone tenderness at base of 5th metatarsal OR
Bone tenderness at navicular OR
Inability to bear weight both immediately and in the ER

112
Q

Ottawa for people

A

19 years and older

Lower Extremity (2 decks)

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