PCS exam revision

Question 1

Discuss the research and clinical applicability of the FPI?

Answer 1

Scharfbillig

• moderate reliability 1-1.5 points on 33 point scale
• Face validity it measured what it purports to measure
• validation against X-ray not well correlated
• not good measure to pick up small changes

Reliability

• Generally good reliability has been shown
• 2008 study showed poor reliability but politics in play
• 2009 good reliability in adolescent population

Validity

• compared valgus index is bad as it isn’t validated
• criterion validation against x-ray not well correlated
• Big differences can be found, smaller movement less so
• Redmond, EMT in static and dynamic showing good correlation

Clinical applicability

• inexpensive and easy measure
• multiplanar
• good reliability
• validity has been studied but not validated well
• consider degree of variability which may influence results and population of the patient

Question 2

what are the signs and symptoms of a compensated equines’ deformity and why does the foot compensate this way?

Answer 2

Signs and symptoms

• excessively pronated
• midfoot collapse/break
• pronation induced pathologies
• HAV
• Neuromas
• postural fatigue

why?

• destructive pathologies
• pronation + lig laxity, destroy foot and get rocker bottom
• diabetic even worse
• orthotics to control pronation

Question 3

what happens when a foot with a flexible forefoot valgus goes through gait?

Answer 3

• compensation for the forefoot valgus will occur from MTJ

- could see collapse

Question 4

what signs and symptoms of flexible forefoot valgus and its pathomechanics?

Answer 4

signs and symptoms

• medium to high arch with slight lowering WB
• callus sub 1-3 MPJ
• HAV
• Tailors bunion
• Neuromas
• Myositis of lateral compartment

Question 5

Describe with reasoning, five features which would make an ideal shoe for a teenager playing basketball competitively, but also wanting to wear this shoe for school?

Answer 5

The ideal shoe:

• heel counter, not collapse
• midfoot, not twist and flex
• weight, should not be heavy
• flex at toes
• outsole traction
• midsole, cushion for shock absorption
• look for air, gel, foam
• is the shoe appropriate for the activity
• Basketball shoes have shank to minimize torsion and roll bar to direct movement

Question 6

what should be considered when purchasing a new shoe and why are each of these important?

Answer 6

-Purchase end of day
foot swells during the day 
-fit both feet 
one foot is bigger than the other 
-measure foot size while standing
feet spread on WB, NWB not correct measure of size
-wear around shop for 5 min
check for rubbing, comfort, shoes don't wear in
-length
thumb width of length from hallux
-wear appropriate socks/hosiery
-cost 
good shoes cost more but not everyone should wear a kayano

Question 7

what are the compensation mechanism for the sagittal plane blockage?

Answer 7

Altered heel lift

• No DF of 1st MPJ DF occurs somewhere else
• DF of midtarsal joint resulting in collapse
• looks excessive pronation

Vertical toe off

• delayed heel lift results foot being lifted before propulsion
• Apropulsive gait

Inverted step

• failure of weight flow from med to lat
• no locking of calcaneocuboid joint
• leads to excessive lateral column loads

Abducted and adducted toe off

• abductory twist most common in propulsion
• compensate to continue moving forward
• body will follow path of least resistance

flexion compensation of the body

• more flexion of knee and hip to move body forward
• chronic postural change (old man kyphosis)

Question 8

A 50 year old female patient comes into your practice complaining of heel pain for the last 4 months with no specific inciting event that she can remember?

Answer 8

answer question related to the scenario

Question 9

What questions would you ask the patient and why?

Answer 9

Questions asked?

• NOLDCAT
• Pt medications/allergies
• what is the patient occupation
• what shoes the patient wears
• activity levels of patient

Why asked?

• Hx of patient
• footwear assessment
• activity and functional assessment
• Current Load

Question 10

What tests would you perform and why?

Answer 10

Tests
-Dorsiflexion range and hamstring range
check for tightness, and equinus 
-stance assessment
check abnormalities, foot type, pain?
-Dynamic gait assessment 
foot position during phases of gait, when pain?
-Active tests
Heel raise, pain = fasciopathy, unable=tib post dysfunction, hop test = ROM

Question 11

What is your diagnosis and DDx at this time?

Answer 11

Dx
-plantar fasciitis, inflammation of fascia

DDx

• plantar fasciosis, degeneration of plantar fascia
• plantar tear, always pain

Question 12

What other signs and symptoms will you look for?

Answer 12

• Pain under heel at medial tubercle of calcaneus and sometimes in arch of foot
• pain of periphery of heel
• pain worse in morning or after sitting long periods
• pain worse when activating platar fascia
• gradual onset
• pain decreases as patient starts to move

Question 13

What are the first line treatments for plantar fasciitis?

Answer 13

• ICE, treating as acute injury ASAP when get to home everyday
• Normal activity levels maintained, we want heal whilst still maintaining normal activity levels
• Footwear, need them in better shoes
• strapping, low dye whenever applicable
• stretching, if any tightness present

Question 14

What is the tissue stress model?

Answer 14

Load deformation curve

• Elastic region - normal range of stress
• Plastic region - excessive load injuring tissue
• Micro failure zone - separating these

Question 15

What is the treatment direction test?

Answer 15

Vicenzino 2004 recreate the diagram