Q3: 1st Ray Insufficiency, Pes Planovalgus, Peroneal Nerve Palsy Flashcards
What is a “Morton’s Toe”
1st Ray Insufficiency
shortened 1st ray which can lead to hypermobility
Etiology
1st Ray Insufficiency
- Shortened 1st Ray
- Compensated deformities
- Ligament Laxity
- PTTD
- Arthritis
Clinical Significance
1st Ray Insufficiency
More weight through other joints; no rigid lever for push off
Clinical Presentation
1st Ray Insufficiency
- Callus under 2nd Met. head
- hypermobile 1st ray
Complications
1st Ray Insufficiency
- stress fx
- hallux valgus
- plantar plate injury
- ulceration
- arthritis
- Plantar Faciitis
- metatarsalgia
- pes planus
Diagnostic Techniques
1st Ray Insufficiency
Considered hypermobile if range > 8 degrees
Dynamic Hicks Test
Modified Klaue Diagnostic Device
1st Ray Insufficiency
Immobilizes all foot/ankle except great toe; be sure to look at first ray
Non-Ox Intervention
1st Ray Insufficiency
Sx to stabalize first ray; distribute force
Ox Intervention
1st Ray Insufficiency
- Morton’s Ext.
- FO (midfoot stability)
- UCBL
Etiology - Pediatrics
Pes Planovalgus
- Toddlers - pronate to learn to walk
- 6 years - develope long. arch
- Influences:
1. shoes
2. weight
3. boys
4. tight achilles
Etiology - Adults
Pes Planovalgus
- Adult Aquired Flatfoot Deformity
- Influences:
1. Int. Rotation (tibia)
2. diabetes
3. paralysis
4. obesity
5. fx (navicular, 1st met, calc.)
6. trauma (PF, spring lig., PTT)
7. Charcot
Etiology - Congenital
Pes Planovalgus
Tarsal Coalition; abnormal connection of 2+ bones
Present at birth but symptoms show later
Result: Rigid Flatfoot
Clinical Significance
Pes Planovalgus
No foot locking (supination) = no rigid lever for propulsion; PTTD
Clinical Presentation
Pes Planovalgus
- Collapsed Med. Long. Arch
- Hindfoot Valgus
- Forefoot Abduction
Too many toes test (should see 2 toes)
Complications
Pes Planovalgus
- Arthritis
- medial ligament sprain
- bunion
- medial ankle pain
- Sinus tarsi pain
- shortened gastroc
- Up the chain pronation (knee valgus/int. rotation and hip adducted/int. rotation)
Diagnostic Techniques - Tip Toes
Pes Planovalgus
looking for hindfoot inversion for correction; indicates a flexible deformity
Diagnostic Techniques - Feiss Line
Pes Planovalgus
Grade I- Nav. falls 1/3 dist. to floor
Grade II- Nav. falls 2/3 dist. to floor
Grade III- Nav. touches floor
Diagnostic Techniques - Long. Arch Angle
Pes Planovalgus
One line from nav. to med. mall. and one from nav. to 1st met. head; measure angle between
<150 degrees = pes planus
Non-Ox Intervention
Pes Planovalgus
- PT to decrease pain
- Sx
Ox Intervention
Pes Planovalgus
- FO
- UCBL - medial heel post
- AFOs (gauntlet or create windows for med. bones)
Common Fibular Nerve
Peroneal Nerve Palsy
Aka Common Peroneal
* branch of sciatic
* innervates DFs
* mononeuropathic
Etiology - Direct Causes
Peroneal Nerve Palsy
- Damage from knee pressure (not enough turning)
- Extended Leg crossing
- Fibular Fx
- Trauma
- Tight Cast
- Sx Injury
Etiology - Risk Factors
Peroneal Nerve Palsy
- Diabetes
- Alcohol use
- CMT
- low BMI/anorexia nervosa (decreased protection)
Clinical Presentation
Peroneal Nerve Palsy
- decreased sensation on top of foot and leg
- foot drop & slap
- toes catch/drag
- gait deviations
- weakness
- loss of muscle mass
Gait Deviations
Peroneal Nerve Palsy
Steppage, vaulting, circumduction, trunk lean
assist in toe clearance
Diagnostic Techniques - Tinel’s
Peroneal Nerve Palsy
tingling when the dorsum of the foot is tapped; tests for nerve entrapment
Diagnostic Technique - EMG
Peroneal Nerve Palsy
Small needles inserted to measure electrical activity in muscle
Diagnostic Techniques - Nerve Conduction and US tests
Peroneal Nerve Palsy
measure the speed and quality of nerve function
Non-Ox intervention
Peroneal Nerve Palsy
- Corticosteroid Injections (swelling/pressure)
- Sx (relieve nerve pressure/tendon transfer/nerve grafting)
- PT (modalities and stretch PF)
Ox intervention
Peroneal Nerve Palsy
AFOs
1
FES (functional electrical stimulation) - walkaide or bioness
