MSK Forefoot and rearfoot deformities

Question 1

What would we use to fix a rear foot valgus deformity?

Answer 1

Medial Wedge (Heel)

Question 2

What would we use to fix a forefoot valgus deformity?

Answer 2

Lateral wedge (Toes - pinkie toe area)

Question 3

What would we use to fix a rear foot varus deformity?

Answer 3

Medial Wedge (Heel)

Question 4

What would we use to fix a forefoot varus deformity?

Answer 4

Medial Wedge (Toes - Big toe area)

Question 5

What do you use to remember the wedges for valgus and varus foot deformities?

Answer 5

L (for lateral) is in Valgus but not Varus. This applies to all the deformities of valgus and varus (all varus are medial wedges)

Question 6

A patient walks with excessive foot pronation during midstance through toe off (preswing). What is the MOST likely cause of the patient’s gait deviation?

1.Compensated rearfoot varus deformity

2.Compensated forefoot valgus deformity

3.Uncompensated lateral (external) rotation of the tibia

4.Uncompensated pes cavus

Answer 6

1. Excessive foot pronation during midstance to toe off is the result of a compensated rearfoot (or forefoot) varus deformity.

Incorrect answers:
2. A compensated forefoot valgus deformity would result in excessive foot supination.
3. Uncompensated lateral (external) rotation of the tibia would result in excessive foot supination.
4. Uncompensated pes cavus would result in excessive foot supination.

Question 7

Which of the following interventions would be MOST appropriate for a child who has Sever disease?

1.Stretch the gastrocnemius and soleus, and use a heel wedge.

2.Stretch the plantar fascia, and use an arch support.

3.Stretch the quadriceps, and use a patellar tendon band.

4.Stretch the tibialis posterior, and use a medial heel wedge.

Answer 7

1. Sever disease is a calcaneal apophysitis and will benefit from stretching to improve flexibility of the gastrocnemius and soleus and use of a heel wedge to decrease the stress and traction of the Achilles insertion.

Incorrect Answers:
2. Sever disease affects the Achilles area, not the plantar fascia.
3. Sever disease affects the Achilles area, not the quadriceps tendon.
4. Sever disease affects the Achilles area, not the tibialis posterior muscle.

Question 8

A patient exhibits swelling and pain in the medial aspect of the ankle. During examination, the patient demonstrates rearfoot pronation in standing position and inability to perform a heel raise on the affected side. The patient demonstrates forefoot abduction when observed from behind. Which of the following conditions is MOST likely present?

1.Eversion ankle sprain

2.Retrocalcaneal bursitis

3.Tarsal tunnel syndrome

4.Posterior tibial tendon dysfunction

Answer 8

4. The main function of the tibialis posterior is to plantar flex and invert the foot as well as support the medial arch. The tendon courses under the medial malleolus, causing pain and inflammation in this area when the tendon is dysfunctional. With a heel raise, the tendon becomes stressed due to its actions of plantar flexion and inversion. Finally, a finding of the “too many toes sign,” which is the hallmark sign of this diagnosis, is due to forefoot abduction and hindfoot valgus.

Incorrect Answers:
1. Although pain and swelling occur about the medial ankle in a patient who has an eversion ankle sprain, the patient would demonstrate pain with eversion stress. Also, the patient would relate this pain to a specific traumatic event. The patient would also not necessarily have rearfoot pronation and forefoot abduction.

2. In retrocalcaneal bursitis, the pain is behind the ankle posterior to the talus, but there is no pain with resistive testing.
3. Although pain occurs in the medial aspect of the ankle with tarsal tunnel syndrome, this condition is associated with paresthesia’s, which are not reported by the patient in the stem.

Question 9

Describe an Eversion ankle sprain and which ligaments are likely to be damaged.

Answer 9

Foot quickly rolls into eversion, placing a medial stress force on the ankle, leading to damage to the deltoid ligament.

Question 10

Describe an Inversion ankle sprain and which ligaments are likely to be damaged.

Answer 10

Foot quickly rolls into inversion, placing a lateral stress force on the ankle, leading to damage of the:
- Anterior talofibular ligament (ATFL)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL).

Question 11

Describe a syndesmosis ankle sprain and which ligaments are likely to be damaged.

Answer 11

A syndesmotic ankle sprain, also known as a high ankle sprain, is a twisting or rotational injury to the ligaments that connect the tibia and fibula in the lower leg. This injury can damage one or more ligaments in the distal tibiofibular syndesmosis, which creates a mortise and tenon joint for the ankle

• Anterior TIBIOfibular ligament
• Posterior TIBIOfibular ligament, including its superficial and deep (transverse) components
• Interosseous ligament; and interosseous membrane