The foot - Ch.18

Question 1

what position is the talocrural joint most stable in?

Answer 1

full dorsiflexion due to highest congruency of talus to tibia

Question 2

how many arches are in the foot? name them

Answer 2

metatarsal arch
transverse arch
medial longitudinal
lateral longitudinal

Question 3

what forms the metatarsal arch?

Answer 3

distal heads of metatarsals

Question 4

what forms the transverse arch?

Answer 4

the transverse tarsal bones (primarily cuboid and internal cuneiform)

Question 5

what forms the medial longitudinal arch?

Answer 5

med. border of calcaneus, navicular, 1st cuneiform, and distal head of 1 st metatarsal

Question 6

what is the main supporting ligament of the medial longitudinal arch? and it’s supporting tendon

Answer 6

plantar calcaneonavicular ligament - acts as a spring to return back to position after being stretched

supporting tendon: post. tib. tendon

Question 7

what forms the lateral longitudinal ligament?

Answer 7

lateral calcaneus, cuboid, 5th metatarsal

less flexible

Question 8

what movements occur at the subtalar joint?

Answer 8

inv.
eve.
pronation
supination

Question 9

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

Answer 9

extrinsic muscles originating in the lower leg

intrinsic mms

Question 10

name all the muscles that are plantar flexors

Answer 10

gastrocnemius
soleus
flexor digitorum longus 
flexor hallucis longus 
tib post
peroneus longus / brevis

Question 11

name the muscles that are dorsiflexors

Answer 11

tib ant
extensor digitorum longus
peroneus tertius
extensor hallucis longus

Question 12

which nerve(s) supply the intrinsic muscle of the the foot?

Answer 12

medial and lateral plantar nn (branches of tibial nerve)

Question 13

which structural abnormality causes over pronation of foot?

Answer 13

fore-foot varus

Question 14

two special tests that indicates, metatarsalgia or neuroma? demo what the test is.

Answer 14

1. Morton’s test: squeeze heads of metatarsals at neutral foot

(+) pain or radiating pain down in the forefoot

2. 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

Question 15

what can the DF-EVE test indicate?

Answer 15

1. high ankle sprain

2. tarsal tunnel syndrome or entrapment of the tibial nn

Question 16

What are the ottawa ankle/foot rules?

Answer 16

Imaging is required if patient displays these signs:

1. Bone tenderness at medial and lateral malleoli
2. Bone tend. @ navicular
3. Bone tend. @ base of fifth
4. cannot walk 4 consecutive steps (including limp)

Question 17

what kind of injury is an apophysitis?

Answer 17

traction injury of the tendon pulling on the bone (esp during adolescents)

Question 18

what does pump bump refer to ?

Answer 18

haglund’s deformity where there’s excessive rubbing from heel counter - prod. a callus that protudes out of calcaneous

Question 19

what’s the mx for a lisfranc injury?

Answer 19

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

Question 20

describe the “windlass mechanism”

Answer 20

as DF occurs, the plantar fascia tighten up and the longitudinal arch shortens along with toe extension

Question 21

what is the mx that usually causes sesamoiditis?

Answer 21

repetitive extension of the great toe

Question 22

how does restricted triceps surae flexibility contribute to metatarsalgia?

Answer 22

decreased midstance during gait due to lack of mobility in calves - causes more emphasis on toe-off phase = more pressure on metatarsal heads

Question 23

mng technique for sesamoiditis and metatarsalgia

Answer 23

putting a piece of foam as a “metatarsal bar” under behind the heads of the MTs

Question 24

s/s of a metatarsal arch strain

mng?

Answer 24

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

Question 25

s/s of morton’s neuroma

mng?

Answer 25

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

Question 26

mng for turf toe?

Answer 26

putting either a soft piece of foam or taping it to prevent extension of the great toe

Question 27

what’s the difference between a hammer toe, mallet toe & claw toe ?

Answer 27

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