The foot - Ch.18 Flashcards
what position is the talocrural joint most stable in?
full dorsiflexion due to highest congruency of talus to tibia
how many arches are in the foot? name them
metatarsal arch
transverse arch
medial longitudinal
lateral longitudinal
what forms the metatarsal arch?
distal heads of metatarsals
what forms the transverse arch?
the transverse tarsal bones (primarily cuboid and internal cuneiform)
what forms the medial longitudinal arch?
med. border of calcaneus, navicular, 1st cuneiform, and distal head of 1 st metatarsal
what is the main supporting ligament of the medial longitudinal arch? and it’s supporting tendon
plantar calcaneonavicular ligament - acts as a spring to return back to position after being stretched
supporting tendon: post. tib. tendon
what forms the lateral longitudinal ligament?
lateral calcaneus, cuboid, 5th metatarsal
less flexible
what movements occur at the subtalar joint?
inv.
eve.
pronation
supination
which group of mm allow DF, PF, INV, EVE pronation, supination, abduction/adduction happen at foot?
what group of mm allow phalangeal movement of feet
extrinsic muscles originating in the lower leg
intrinsic mms
name all the muscles that are plantar flexors
gastrocnemius soleus flexor digitorum longus flexor hallucis longus tib post peroneus longus / brevis
name the muscles that are dorsiflexors
tib ant
extensor digitorum longus
peroneus tertius
extensor hallucis longus
which nerve(s) supply the intrinsic muscle of the the foot?
medial and lateral plantar nn (branches of tibial nerve)
which structural abnormality causes over pronation of foot?
fore-foot varus
two special tests that indicates, metatarsalgia or neuroma? demo what the test is.
- Morton’s test: squeeze heads of metatarsals at neutral foot
(+) pain or radiating pain down in the forefoot
- Mulder’s sign: same a/a for morton’s but then you would apply pressure between 3/4 intertarsal space
(+) click or pain radiating down toes
what can the DF-EVE test indicate?
- high ankle sprain
2. tarsal tunnel syndrome or entrapment of the tibial nn
What are the ottawa ankle/foot rules?
Imaging is required if patient displays these signs:
- Bone tenderness at medial and lateral malleoli
- Bone tend. @ navicular
- Bone tend. @ base of fifth
- cannot walk 4 consecutive steps (including limp)
what kind of injury is an apophysitis?
traction injury of the tendon pulling on the bone (esp during adolescents)
what does pump bump refer to ?
haglund’s deformity where there’s excessive rubbing from heel counter - prod. a callus that protudes out of calcaneous
what’s the mx for a lisfranc injury?
hyper-plantar flexion in which the tarsals dissociate from base of metatarsals
metatarsals move dorsally compromising the supporting ligaments - may also be a fracture up in there
describe the “windlass mechanism”
as DF occurs, the plantar fascia tighten up and the longitudinal arch shortens along with toe extension
what is the mx that usually causes sesamoiditis?
repetitive extension of the great toe
how does restricted triceps surae flexibility contribute to metatarsalgia?
decreased midstance during gait due to lack of mobility in calves - causes more emphasis on toe-off phase = more pressure on metatarsal heads
mng technique for sesamoiditis and metatarsalgia
putting a piece of foam as a “metatarsal bar” under behind the heads of the MTs
s/s of a metatarsal arch strain
mng?
obvs: no metatarsal arch - toes are splayed out flat
TOP on region
morton’s test may be (+)
MNG: applying a ‘ metatarsal pad’ underneath the fallen metatarsals + foot control and stability exercises
s/s of morton’s neuroma
mng?
pain and discomfort during wt bearing activities - sensations may radiate to toes
usually reduced pain in non-wt bear
mng: wide toe box
tear drop pad just underneath the 3rd/4th metatarsals allow the heads to splay
mng for turf toe?
putting either a soft piece of foam or taping it to prevent extension of the great toe
what’s the difference between a hammer toe, mallet toe & claw toe ?
hammer toe : flexion contracture of PIP joint
mallet toe: flexion contracture of DIP joint
claw toe: same as mallet but with hyperextension of MTP joint
