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LL Ox > Q3: 1st Ray Insufficiency, Pes Planovalgus, Peroneal Nerve Palsy > Flashcards

Q3: 1st Ray Insufficiency, Pes Planovalgus, Peroneal Nerve Palsy Flashcards

1
Q

What is a “Morton’s Toe”

1st Ray Insufficiency

A

shortened 1st ray which can lead to hypermobility

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2
Q

Etiology

1st Ray Insufficiency

A
  • Shortened 1st Ray
  • Compensated deformities
  • Ligament Laxity
  • PTTD
  • Arthritis
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3
Q

Clinical Significance

1st Ray Insufficiency

A

More weight through other joints; no rigid lever for push off

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4
Q

Clinical Presentation

1st Ray Insufficiency

A
  • Callus under 2nd Met. head
  • hypermobile 1st ray
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5
Q

Complications

1st Ray Insufficiency

A
  • stress fx
  • hallux valgus
  • plantar plate injury
  • ulceration
  • arthritis
  • Plantar Faciitis
  • metatarsalgia
  • pes planus
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6
Q

Diagnostic Techniques

1st Ray Insufficiency

A

Considered hypermobile if range > 8 degrees

Dynamic Hicks Test

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7
Q

Modified Klaue Diagnostic Device

1st Ray Insufficiency

A

Immobilizes all foot/ankle except great toe; be sure to look at first ray

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8
Q

Non-Ox Intervention

1st Ray Insufficiency

A

Sx to stabalize first ray; distribute force

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9
Q

Ox Intervention

1st Ray Insufficiency

A
  • Morton’s Ext.
  • FO (midfoot stability)
  • UCBL
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10
Q

Etiology - Pediatrics

Pes Planovalgus

A
  • Toddlers - pronate to learn to walk
  • 6 years - develope long. arch
  • Influences:
    1. shoes
    2. weight
    3. boys
    4. tight achilles
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11
Q

Etiology - Adults

Pes Planovalgus

A
  • 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
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12
Q

Etiology - Congenital

Pes Planovalgus

A

Tarsal Coalition; abnormal connection of 2+ bones
Present at birth but symptoms show later
Result: Rigid Flatfoot

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13
Q

Clinical Significance

Pes Planovalgus

A

No foot locking (supination) = no rigid lever for propulsion; PTTD

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14
Q

Clinical Presentation

Pes Planovalgus

A
  • Collapsed Med. Long. Arch
  • Hindfoot Valgus
  • Forefoot Abduction

Too many toes test (should see 2 toes)

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15
Q

Complications

Pes Planovalgus

A
  • 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)
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16
Q

Diagnostic Techniques - Tip Toes

Pes Planovalgus

A

looking for hindfoot inversion for correction; indicates a flexible deformity

17
Q

Diagnostic Techniques - Feiss Line

Pes Planovalgus

A

Grade I- Nav. falls 1/3 dist. to floor
Grade II- Nav. falls 2/3 dist. to floor
Grade III- Nav. touches floor

18
Q

Diagnostic Techniques - Long. Arch Angle

Pes Planovalgus

A

One line from nav. to med. mall. and one from nav. to 1st met. head; measure angle between

<150 degrees = pes planus

19
Q

Non-Ox Intervention

Pes Planovalgus

A
  • PT to decrease pain
  • Sx
20
Q

Ox Intervention

Pes Planovalgus

A
  • FO
  • UCBL - medial heel post
  • AFOs (gauntlet or create windows for med. bones)
21
Q

Common Fibular Nerve

Peroneal Nerve Palsy

A

Aka Common Peroneal
* branch of sciatic
* innervates DFs
* mononeuropathic

22
Q

Etiology - Direct Causes

Peroneal Nerve Palsy

A
  • Damage from knee pressure (not enough turning)
  • Extended Leg crossing
  • Fibular Fx
  • Trauma
  • Tight Cast
  • Sx Injury
23
Q

Etiology - Risk Factors

Peroneal Nerve Palsy

A
  • Diabetes
  • Alcohol use
  • CMT
  • low BMI/anorexia nervosa (decreased protection)
24
Q

Clinical Presentation

Peroneal Nerve Palsy

A
  • decreased sensation on top of foot and leg
  • foot drop & slap
  • toes catch/drag
  • gait deviations
  • weakness
  • loss of muscle mass
25
Q

Gait Deviations

Peroneal Nerve Palsy

A

Steppage, vaulting, circumduction, trunk lean

assist in toe clearance

26
Q

Diagnostic Techniques - Tinel’s

Peroneal Nerve Palsy

A

tingling when the dorsum of the foot is tapped; tests for nerve entrapment

27
Q

Diagnostic Technique - EMG

Peroneal Nerve Palsy

A

Small needles inserted to measure electrical activity in muscle

28
Q

Diagnostic Techniques - Nerve Conduction and US tests

Peroneal Nerve Palsy

A

measure the speed and quality of nerve function

29
Q

Non-Ox intervention

Peroneal Nerve Palsy

A
  • Corticosteroid Injections (swelling/pressure)
  • Sx (relieve nerve pressure/tendon transfer/nerve grafting)
  • PT (modalities and stretch PF)
30
Q

Ox intervention

Peroneal Nerve Palsy

A

AFOs
1
FES (functional electrical stimulation) - walkaide or bioness

LL Ox (24 decks)

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