Treatment of the Foot (1) Flashcards
what do WBing mechanisms do
enhance weight bearing capabilities of the foot
WBing mechanisms
curve beam system
arch system
muscular support
curved beam system
shape of foot as a whole
WBIng through the curved beam
curved beam system has
curved beam
front to back
side to side
curved beam system enhances
support of BW from above
WBing capabilities
fxns like building an arch
where is the curved beam
half of heel
half on met heads
2x on first met head
arches of the foot
anterior transverse arch
lateral longitudinal arch
medial longitudinal arch
medial longitudinal arch
AP arch on the medial side
medial longitudinal arch is a
flexible arch
responsible for mobility of the foot
depresses w/ WB
high point of MLA
navicular tubercle
place of arch support –> MLA
sustentaculum tali
boney prominence on the calcaneus
measuring the MLA
feiss line
Feiss line –> MLA
distance from navicular tubercle to floor in weight bearing
what does the height of the tubercle indicate –> feiss line
if the arch is normal, depressed or excessive
what do we compare –> feiss line
height in WBing and non-WBing to determine the arch
feiss line –> abnormal
if the depressing is excessive
resulting in pes planus
pes planus
flat foot
lateral longitudinal arch
AP arch on the later side
rigid arch
balancing side of the foot
rigid arch –> LLA
stability of the foot
balance side of the foot –> LLA
WB on LLA during MS in gait
transverse arches
transverse metatarsal
transverse tarsal
transverse metatarsal arch
metatarsal heads
flexible arch
roundness of front of foot
high point of transverse MT arch
2 MT head
flexible arch –> transverse MT arch
depressed w/ WB
roundness of front of foot –> transverse MT arch
when excessively depresses –> front of foot flat and splay foot
transverse MT arch is supported by
ligament and muscle support
easily depressed and stretched out
transverse tarsal arch
ML arches across the tarsals
rigid arches
anterior transverse tarsal arch
cuboid and 3 cuneiforms
middle cuneiform = high point/keystone
posterior transverse tarsal arch
navicular and cuboid
longitudinal muscular control
muscular support of the foot as a whole
-abductor hallucis
-flexor hallucis longus
-ABD digiti minimi
-flexor digitorum brevis and longus
-flexor digititorum accessory
muscles support arches –> MLA
posterior tib
fibularis longus
FHL
ABD HL
muscles support arches –> LLA
fibularis brevis and longus
ABD DM
sling of muscles which support the foot
muscles support arches –> TMTA
transverse head ADD hallucis
primary muscular support for this arch
muscles support arches –> TTA
ADD hallucis
fibularis longus
posterior tib
adult acquired flat foot deformity
chronic posterior tib tendonitis
attenuation of posterior tib tendon
breakdown of the arches of the foot
plantar fascia
runs calcaneus to phalanges
what does the plantar fascia support
foot as a whole
ML arch
inflammation of the plantar fascia
plantar fasciitis
causes of plantar fasciitis
flexible foot –> too much motion
rigid foot –> too little motion
weight transfer during gait
heel and ball –> striking part
lateral border –> balancing part
medical side –> stable for push off
heel and ball
HS/PO
lateral border
MS
during HS –> weight transfer during gait
hits heel
during MS –> weight transfer during gait
move to lateral side of foot
PO –> weight transfer during gait
heel off –> move from lateral to medial
toe off –> 1st and 2nd met heads
how is the foot divided
forefoot/hindfoot
divided by midtarsal joints
motions of the foot
ADD
ABD
inversion/eversion
supination/pronation
ADD –> motions of the foot
movement is towards the midline of the foot
ABD –> motions of the foot
movement is away from the midline of the foot
inversion/eversion –> motions of the foot
uniplanar
supination/pronation –> motions of the foot
triplanar
general principles of subtalar movement
rearfoot/forefoot movement could be open chain or close chain
open chain –> subtalar
rearfoot and forefoot move together
follows the calcaneus
talus doesnt move
closed chain –> subtalar
rearfoot and forefoot move opposite to each other
talus moves on a fixed calcaneus due to weight from above
movements of the subtalar joint
supination
pronation
valgus/varus
supination –> open chain –> subtalar
calcaneus inverted, ADD
plantar flexion
supination –> closed chain –> subtalar
calcaneus –> inversion
talus –> ABD, DF
pronation –> open chain –> subtalar
calcaneus: everted, ABD, DF
pronation –> closed chain –> subtalar
calcaneus –> eversion
talus –> ADD and PF
pronation is
LE rotation
mobile adaptor
pronation includes
ankle DF
rearfoot eversion
calcaneal valgus
forefoot ABD
midtarsal ABD
supination is
LE external rotation
rigid lever
supination includes
ankle PF
rearfoot inversion
calcaneal varus
forefoot ADD
midtarsal ADD
what does the subtalar joint do during heel strike
pronates
normal –> heel strike @ subtalar
adaptation to terrain
shock absorption
shock absorption –> normal –> heel strike @ talus
attenuates the forces of HS
abnormal –> heel strike @ talus
insufficient pronation
excessive pronation
insufficient pronation –> heel strike @ talus
decrease shock absorption
forces transmitted up kinetic chain
LBP, SI joint pain
ankle sprains
excessive pronation –> heel strike @ talus
energy sparing spring theory
less effective as shock absorber
energy sparing spring theory –> excessive pronation –> heel strike @ talus
unlocking into pronation
absorbing shock
less effective as shock absorber –> excessive pronation –> heel strike @ talus
pain in patellar femoral joint
push off @ subtalar joint –> normal
propulsion
rigid lever
stable push off
abnormal –> push off @ subtalar joint
insufficient supination
excessive supination
insufficient supination –> abnormal –> push off @ subtalar joint
foot unlocked
unstable for push off
unstable to push off –> push off @ subtalar
hallux valgus
bunions
splay foot
callus
excessive supination –> abnormal –> push off @ subtalar joint
excessive weight on 5th MT head/lateral foot
bunionette
deformity
non-WBing
compensation
what you see in WBing
when does a forefoot valgus occur
forefoot is everted relative to the rearfoot
not common
when does the forefoot varus
forefoot is inverted to the rearfoot
most common cause of excessive pronation
when does rearfoot valgus occur
rearfoot is everted
when does rearfoot varus occur
rearfoot is inverted
can increase maximum pronation
forefoot in varus NWB
medial side of foot off ground in NWB
body compensates by brining medial side of fot to ground
subtalar compensation –> forefoot varus
foot pronation
hind foot in varus NWB
medial side of foot is off ground in NWB
body compensated by bringing medial side of foot to ground
subtalar compensation –> rearfoot varus
foot pronation
forefoot in valgus/PF 1st Ray
lateral side foot off ground in NWB
body compensates by bringing lateral side of foot to ground
subtalar compensation –>forefoot in valgus/PF 1st Ray
foot supination
hind foot in valgus
lateral side of foot off ground in NWB
body compensates by bringing lateral side of foot to ground
subtalar compensation –> hind foot in valgus
foot supination
