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MSK 2 > Week 8 > Flashcards

Week 8 Flashcards

1
Q

What is the function of the foot?

A

To provide stability and mobility

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2
Q

How does the foot provide stability?

A
  1. Stable base of support for WB

2. Act as shock absorber and rigid lever for effective push-off during gait

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3
Q

How does the foot provide mobility?

A
  1. Dampening rotations from proximal joints
  2. Flexible enough to absorb shock
  3. Foot conform to terrain
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4
Q

What are the 3 segments of the LE?

A
  • Leg segment
  • Rearfoot segment
  • Forefoot segment
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5
Q

What are the functional segments of the forefoot?

A
  • Metatarsals

* Phalanges

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6
Q

What are the functional segments of the midfoot?

A
  • Navicular
  • Cuboid
  • Cuneiforms
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7
Q

What are the functional segments of the hind/rearfoot?

A
  • Talus

* Calcaneus

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8
Q

How much dorsiflexion do we have?

A

20º

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9
Q

How much plantarflexion do we have?

A

50º

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10
Q

In what plane and around what axis do we have ankle motion?

A

• DF and PF in the sagittal plane around the coronal axis

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11
Q

What motions of the foot occurs in the frontal plane, around the AP axis?

A

Inversion and Eversion

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12
Q

What is inversion of the foot?

A

Plantar surface towards the midline

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13
Q

What is eversion of the foot?

A

Plantar surface away from midline

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14
Q

In what plane and around what axis does ABD and ADD of the foot occur?

A

Occur in transverse plane around the vertical axis

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15
Q

What is ADD in the foot?

A

Distal segment toward midline of body

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16
Q

What is ABD in the foot?

A

Distal segment away from the midline of body

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17
Q

What joint and axis does supination and pronation occur in?

A

Occur at subtalar joint around a combination of axes

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18
Q

What movement happens during supination and pronation in the open chain?

A

Calcaneus moves on fixed talus/ leg

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19
Q

What movement happens with supination in the open chain?

A

Calcaneus plantarflexes, inverts, adducts

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20
Q

What movement happens with pronation in the open chain?

A

Calcaneus dorsiflexes, everts, abducts

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21
Q

What movement happens with supination in the closed chain?

A
  • IR of tibia & fibula
  • Talar ADD & PF
  • Calcaneal eversion
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22
Q

What movement happens with pronation in the closed chain?

A
  • ER of tibia & fibula
  • Talar ABD & DF
  • Calcaneal inversion
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23
Q

What is a varus motion?

A

Distal segment toward midline

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24
Q

What is a valgus motion?

A

Distal segment away from the midline

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25
Q

What is the composite motion of the ankle?

A

Supination & Pronation

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26
Q

___ is the main ankle joint

A

Talocrural joint is the main ankle joint

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27
Q

What type of joint is the talocrural joint?

A

Synovial, modified saddle or hinge joint

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28
Q

What is the mortise?

A

A rectangular cavity that holds the talus into the talocrural joint

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29
Q

What is the roof of the ankle mortise?

A

Tibia

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30
Q

The anterior portion of the talocrural joint can be referred to as the ___

A

The anterior portion of the talocrural joint can be referred to as the tenon

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31
Q

___ is a projection shaped for insertion into mortise

A

Tenon is a projection shaped for insertion into mortise

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32
Q

What makes up the talocrural joint?

A

The talus sitting in the mortise

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33
Q

In what direction are the talus and mortise wide?

A

They are wide anteriorly

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34
Q

There is a tight fit between the talus and mortise throughout ___

A

There is a tight fit between the talus and mortise throughout ROM

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35
Q

The talocrural joint is the ___ congruent joint in the body

A

The talocrural joint is the most congruent joint in the body

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36
Q

What are the characteristics of the talocrural joint?

A
  • No muscular attachments
  • Limited blood supply
  • Risk for delayed or non union fracture
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37
Q

What are the coupled movements of the talocrural joint when the leg goes through internal rotation in CKC?

A
  • Inward gliding of the talus

- Foot pronation

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38
Q

What are the coupled movements of the talocrural joint when the leg goes through external rotation inc CKC?

A
  • Outward gliding of the talus

- Foot supination

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39
Q

What is the close pack position of the talocrural joint?

A

DF

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40
Q

DF is the position of ___ congruency, joint compression, and stability

A

DF is the position of greatest congruency & joint compression, and stability

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41
Q

What is the open/loose pack position of the talocrural joint?

A

Plantarflexion

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42
Q

What is the capsular pattern of the talocrural joint?

A

Plantarflexion limited more so than DF

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43
Q

What aspect of the foot does the deltoid ligament sit?

A

On the medial aspect of the foot

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44
Q

The deltoid ligament is the primary static constraint to excessive ___

A

The deltoid ligament is the primary static constraint to excessive eversion

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45
Q

The deltoid ligament strongly resists __

A

The deltoid ligament strongly resists *side to side movement or rotation of mortise upon talus

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46
Q

The deltoid ligament has ___ tensile strength

A

The deltoid ligament has great tensile strength

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47
Q

What are the components of the deltoid ligament?

A
  • Tibionavicular ligament
  • Tibiocalcaneal ligament
  • Posterior tibiotalar ligament
  • Anterior tibiotalar ligament
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48
Q

Why are eversion sprains of the ankle rare?

A

Deltoid ligament strength

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49
Q

What are the lateral collateral ligaments of the ankle?

A
  • Anterior talofibular ligament
  • Posterior talofibular ligament
  • Calcaneofibular ligament
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50
Q

What strains of the ankle are the most common?

A

Counter varus/inversion
stresses or lateral ankle joint
distraction

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51
Q

85% of ankle strains are ____ strains

A

85% of ankle strains are inversion strains

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52
Q

Which LCL is the weakest and most commonly injured?

A

Anterior talofibular ligament (ATFL)

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53
Q

When is the stress on the Anterior talofibular ligament the greatest?

A

Stress greatest in combined INV/PF

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54
Q

What kind of instability does the (ATFL) have?

A

Anterolateral rotatory instability

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55
Q

Which LCL is the strongest and least frequently injured?

A

Posterior talofibular ligament

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56
Q

What kind of joint is the Subtalar (Talocacalcaneal) Joint?

A

Functional synovial joint

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57
Q

What bones make up the Subtalar (Talocacalcaneal) Joint?

A

Talus(distally) and calcaneus

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58
Q

What are the articulations of the Subtalar (Talocacalcaneal) Joint?

A

Posterior, (then tarsal canal),

middle, and anterior articulations

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59
Q

Where can the tibiofibular joint be injured?

A

Proximally and distally

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60
Q

What kind of joint is the proximal tibiofibular joint?

A

Synovial

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61
Q

What makes up the proximal tibiofibular joint?

A

FIbular head and fibular articulating facet of the tibia

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62
Q

What motions occur at the proximal tibiofibular joint?

A
  • Superior and inferior fibular gliding
  • Fibular rotation
    (both are of small magnitude)
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63
Q

What makes up the middle tibiofibular joint?

A

Interosseous membrane

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64
Q

What is the function of the middle tibiofibular joint?

A

Supports proximal and distal joints

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65
Q

What kind of joint is the distal tibiofibular joint?

A

Syndesmosis/ fibrous union

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66
Q

What makes up the distal tibiofibular joint?

A

Distal fibula and fibular notch of the tibia

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67
Q

There is ___ motion at the distal tibiofibular joint

A

Not a lot of motion at the distal tibiofibular joint

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68
Q

When is there motion detected in the distal tibiofibular joint?

A

After a significant sprain and a high ankle sprain

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69
Q

What kind of motion does the subtalar joint create?

A

A tri-planar motion

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70
Q

The subtalar joint dampens ___ forces

A

The subtalar joint dampens rotational forces

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71
Q

What is the function of the subtalar joint?

A

Maintains foot contact with

supporting surface and moves the foot to accommodate a changing surface, so the body doesn’t have to move as musch

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72
Q

What does the talar ADD component of the subtalar joint cause?

A

Talar ADD component of pronation causes IR of superimposed tibia/fibula

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73
Q

With the subtalar joint maintained in WB;

pronation imposes IR force on leg that can affect ___ and___

A

With the subtalar joint maintained in WB;

pronation imposes IR force on leg that can affect knee & hip

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74
Q

Hip joint IR may be related to

____ & ____

A

Hip joint IR may be related to

medially facing patellae & patient’s knee pain

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75
Q

What position is the subtalar joint in closed packed?

A

Supination

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76
Q

What happens to the ligamentous tendons of the subtalar joint in the closed pack position?

A

Ligamentous tension draws together or “locks” talocalcaneal joint surfaces

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77
Q

The closed pack position of the subtalar joint is critical for ___, as the foot becomes ___

A

The closed pack position of the subtalar joint is critical for stability, as the foot becomes rigid lever

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78
Q

What position is the subtalar joint in open packed?

A

Midway between supination/pronation, & 10º talar PF

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79
Q

What is pronation of the subtalar joint critical for?

A

Pronation critical for mobility, shock absorption & dampening. WB-imposed rotational forces

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80
Q

What is the capsular pattern of the subtalar joint?

A

Varus limited more so than valgus

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81
Q

___ separates the hind foot from the mid foot

A

The transverse tarsal joint separates the hind foot from the mid foot

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82
Q

What makes up the transverse tarsal joint?

A

Talonavicular Joint and Calcaneocuboid Joint

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83
Q

The talonavicular joint is enhanced by the ___

A

The talonavicular joint is enhanced by the Spring Ligament (plantar calcaneonavicular ligament)

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84
Q

What type of joint is the talonavicular joint?

A

“Ball-Socket” type joint

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85
Q

What is the function of the spring ligament?

A
  • Supports joint

- Supports medial longitudinal arch

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86
Q

What ligament supports the Calcaneocuboid Joint?

A

Long plantar ligament

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87
Q

There is more ___ motion at the calcaneocuboid joint

A

There is more restrictive motion at the calcaneocuboid joint

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88
Q

What is the function of the long plantar ligament?

A
  • Supports lateral longitudinal

arch

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89
Q

What of the joints that make up the transverse tarsal joint is more medially placed and which is more laterally placed?

A

Talonavicular Joint(medial) Calcaneocuboid Joint (lateral)

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90
Q

What is the function of the transverse tarsal joint?

A
  • Transitional link between hind- & forefoot
  • Increases sup/pronation range of subtalar joint
  • Compensates (within forefoot) for hind foot positioning
  • Theoretically enables forefoot to remain flat on ground regardless of hind foot pro/supination
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91
Q

The transverse tarsal joint moves in combination with the ___ joint, to add a bit of a ___ motion to maintain the longitudinal arch

A

The transverse tarsal joint moves in combination with the subtalar joint to add a bit of a pronation/supination motion to maintain the longitudinal arch

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92
Q

What kind of joint is the tarsometatarsal joint?

A

Planar synovial joints

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93
Q

What forms the tarsometatarsal joint?

A

Formed by distal tarsals and bases of metatarsals

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94
Q

The tarsometatarsal joint is also known as the ___

A

The tarsometatarsal joint is also known as the Lisfranc’s joint

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95
Q

The tarsometatarsal joint function augments the ____ function

A

The tarsometatarsal joint function augments the transverse tarsal joint function

96
Q

What happens to the transverse tarsal joint during early to mid stance phase of gait?

A

• During level surface stance, subtalar & transverse tarsal joints each pronate
• Enables foot to absorb WB
• Subtalar & transverse tarsal pronation absorb shock during early stance
• Transverse tarsal then supinates to ensure contact between lateral border of foot & ground
• “Counter movement” enables normal WB thru forefoot while rearfoot
absorbs tibial IR

97
Q

What happens to the transverse tarsal joint during late stance phase of gait?

A

• Subtalar & transverse tarsal supination increase stability of
stance limb
• Bony surfaces congruent & joints locked in closed-pack position
• Locking of joints enables weight transfer to forefoot as foot becomes rigid lever for push off

98
Q

What is the function of the tarsometatarsal joint?

A

Maintain forefoot contact with ground: rotate to adjust forefoot positioning when transverse tarsal joint cannot fully compensate for
rear foot positioning

99
Q

Where does the tarsometatarsal joint impact its function?

A

Position metatarsals & phalanges

100
Q

What motions happen in the 1st and 2nd ray?

A

Invert/extend & evert/flex

101
Q

Which ray is the least mobile, hence the most stable?

A

2nd ray

102
Q

What motion occurs in the 3rd ray?

A

Extends & flexes

103
Q

What motion occurs in the 4th and 5th ray?

A

Evert/extend & invert/flex

104
Q

What kind of joint is the metatarsalpharengeal joints?

A

Condyloid synovial

105
Q

What motions occur at the metatarsalpharengeal joints?

A
  • Extension
  • Flexion
  • ABD/ADD
106
Q

What happens during extension of the metatarsalpharengeal joints?

A

Body passes over foot

107
Q

What happens during flexion of the metatarsalpharengeal joints?

A

Return to neutral from

extension

108
Q

What happens during ABD/ADD of the metatarsalpharengeal joints?

A

• Grasping
• Absorb some of force on MTs as they undergo pro/supination twist at TMT
joints

109
Q

Where are the sesamoid bones in the foot and what maintains them?

A

Maintained by ligamentous masses in grooves along plantar aspect of 1st MT head

110
Q

The sesamoid bones of the foot act as ___

A

The sesamoid bones of the foot act as anatomic pulleys for flexor hallucis brevis

111
Q

What is the function of the sesamoid bones of the foot?

A

Protect flexor hallucis longus tendon from WB trauma, which
passes thru tunnel formed by sesamoids & intersesamoidal
ligament joining their plantar surfaces

112
Q

What are the sources of stability of the foot?

A 
• Wedge-shaped mid-tarsal	bones	
• Inclination of calcaneus & 1st	MT (med	longitudinal arch)	
• Ligamentous support	(incl.	
plantar aponeurosis)	
• Intrinsic	foot	muscles
113
Q

What is the plantar aponeurosis/fascia?

A

Fibrous tissue extending from calcaneus to plantar plates at MTP joints, then via plantar plates to proximal phalanges)

114
Q

What is the function of the plantar aponeurosis/fascia?

A
  • Supports arches

* Increases foot stability during MTP extension in push off (Windlass Effect)

115
Q

What component of the tie rod & strut complex is the plantar aponeurosis/fascia?

A

Tie rod component

116
Q

What is the plantar aponeurosis relaxed and when is it tensioned or stretched?

A
  • Relaxed when non-weight bearing

* Tensioned or stretched when struts compressed during weight bearing

117
Q

What is pes planus?

A

Pronated or flat foot

118
Q

What causes pes planus?

A

Decreased or absent medial

longitudinal arch

119
Q

What happens to the bones during pes planus?

A

Talus depresses navicular &

minimizes potential for transverse tarsal counter rotation to offset subtalar pronation

120
Q

What is pes cavus?

A

Supinated or high arched foot

121
Q

What are the potential effects of pes planus?

A

• Overly mobile or flexible foot
• Foot may require muscular
contraction during stance
• Possible decreased push off
during gait (foot not a rigid lever during push off)
• Potentially altered patellar tracking
• Excessive mobility may stress ligaments, tendons & muscles that control motion of rear foot
• Increased magnitude & rate of pronation

122
Q

What does an increased tibial internal rotation cause?

A
  • Potentially altered patellar tracking

* Increased Q Angle at knee

123
Q

What are the potential effects of pes cavus?

A
  • Increased medial longitudinal arch height
  • Subtalar & transverse tarsal joints excessively supinated
  • Rearfoot varus
  • Potential external rotation stress on leg
  • Rigid or flexible
124
Q

What are the effects of a rigid pes cavus?

A 
• Less effective shock absorption capability:	
     • Greater forces may be 
       imposed	upon foot	 
       and	proximal	structures	
• Increased loading of lateral	
structures
125
Q

What are some injuries associated with pes planus?

A
  • Plantar fasciitis
  • Knee pain
  • Patellar tendinitis
  • Stress fractures (2nd/3rd MTs)
126
Q

What are some injuries associated with pes cavus?

A
  • Plantar fasciitis
  • Ankle INV sprains
  • ITBS
  • Stress fractures (5th MT)
127
Q

What does a medial tibial stress syndrome account for?

A

Accounts for the inflammatory, traction event on the tibial aspect of the leg common in runners.

128
Q

Medial Tibial Stress Syndrome is more accurately named ___

A

Medial Tibial Stress Syndrome is more accurately named medial tibial traction periostitis or just medial tibial
periostitis

129
Q

What are the presentations of a medial tibial stress syndrome?

A

Tightness/tenderness, throbbing along tibial crest that comes on with activity and settles with rest

130
Q

What are the causes of a medial tibial stress syndrome (MTSS)?

A
  • Inappropriate footwear
  • Muscle weakness
  • Poor running mechanics
  • Improper training (hard surfaces, poor dosage)
  • Tight gastrocsoleus
  • Weak tibialis anterior and posterior
  • Hypermobileor pronated feet
  • Excessive supination
131
Q

___ looks very similar to MTSS

A

Tibialis Anterior Tendonopathy looks very similar to MTSS

132
Q

How can a Tibialis Anterior Tendonopathy be provoked?

A

MMT testing should provoke

133
Q

What are the key things to do during the screening for a Tibialis Anterior Tendonopathy?

A
  • Palpation key
  • Be sure to screen lumbar
  • Gait and running analysis key
134
Q

With a tibialis posterior tendonopathy, there will be pain with __ and/or __

A

With a tibialis posterior tendonopathy, there will be pain with AROM and/or MMT

135
Q

What is the usual source of a tibialis posterior tendonopathy?

A

Repetitive stress

136
Q

With a tibialis posterior tendonopathy, there is usually ___ and ___

A

With a tibialis posterior tendonopathy, there is usually pes planus and hypermobile feet

137
Q

There is irritation at insertion on ___ or ___ with a tibialis posterior tendonopathy

A

There is irritation at insertion on navicular or behind medial malleoli with a tibialis posterior tendonopathy

138
Q

Peroneal tendonopathy occurs in ___ behind __

A

Peroneal tendonopathy occurs in sulcus behind lateral malleoli or at cuboid

139
Q

What are the methods of injury of a peroneal tendonopathy?

A

Overuse or friction

140
Q

Peroneal tendonopathy, occurs often after ____

A

Peroneal tendonopathy, occurs often after inversion sprain

141
Q

A rupture of the peroneal tendon at the retinaculum leads to a ___

A

A rupture of the peroneal tendon at the retinaculum leads to a peroneal subluxation

142
Q

What causes a tarsal tunnel syndrome?

A
  • Lesion to posterior tibial nerve in flexor retinaculum

* Indirect trauma

143
Q

Where does the lesion to posterior tibial nerve in flexor retinaculum occur?

A

Behind medial malleoli

144
Q

What are the possible mechanisms of an indirect trauma that leads to a tarsal tunnel syndrome?

A
  • Running on hard surfaces, or poor fitting shoes

* Overpronation

145
Q

What are presentations of a tarsal tunnel syndrome?

A
  • Localized swelling
  • Medial ankle and heel pain
  • Positive sensory loss to medial heel
  • Positive Tinel’s sign
  • Possible adverse neural tension
146
Q

What foot posture should be looked at in reference to a tibialis posterior tendonopathy?

A

Look at resting and dynamic foot posture

147
Q

A lesion to posterior tibial nerve in the flexor retinaculum that causes a tarsal tunnel syndrome can be as a result of a what?

A

Entrapment or traction

148
Q

Where is chronic exertional compartment syndrome typically?

A

Typically anterior

149
Q

In what population is a chronic exertional compartment syndrome usually present?

A

Common in runners and soccer players

150
Q

What are some of the things that a patient will complain of when they have a chronic exertional compartment syndrome?

A

A tingling and parasthesia after an extended period of time

151
Q

____ can be palpated in 40-60% of patients with a chronic exertional compartment syndrome

A

Muscle herniation can be palpated in 40-60% of patients with a chronic exertional compartment syndrome

152
Q

___ and ___ are common in the respective compartment f a chronic exertional compartment syndrome

A

*Neurologic weakness and

numbness* are common in the respective compartment f a chronic exertional compartment syndrome

153
Q

What are the common presentations of a chronic exertional compartment syndrome?

A
  • Pain at predictable periods
  • Excessive pressure
  • Palar
  • Parasthesia (burning, tingling, numb)
  • Pulselessness
154
Q

When should pulselessness be tested for in a chronic exertional compartment syndrome?

A

At rest and after exertion

155
Q

What is the test used for a chronic exertional compartment syndrome?

A

Wick Catheter before and after treadmill test

156
Q

What is a treatment option for a chronic exertional compartment syndrome?

A

Consider transition to forefoot running

157
Q

What does transitioning a patient with a chronic exertional compartment syndrome to forefoot running do?

A
  • Decreases GRF
  • Take load off anterior tibial structure
  • Reduce anterior compartment pressure
158
Q

What are the key principles

when treating anterior shin pain?

A
  • RICE
  • Flexibility program for GS complex
  • Retrain inhibited musculature
  • Restore CKC dorsiflexion
  • Strengthen inhibited musculature
  • Improve intrinsic foot strength
  • Short term use of Low-Dye taping
  • Running evaluation and retraining
  • Address associated trigger points
  • Footwear changes if necessary
159
Q

What is an achilles tendonitis?

A

Inflammation of Achilles tendon

160
Q

What is the mechanism of injury of an achilles tendonitis?

A
  • Overuse/overloaded state

- Gradual onset

161
Q

____ exacerbates in an achilles tendonitis?

A

Decreased flexibility exacerbates in an achilles tendonitis?

162
Q

Achilles tendonosis is ___ in nature

A

Achilles tendonosis is chronic in nature

163
Q

Where does achilles tendonosis typically show up?

A

Hypovascular zone 2-6cm from insertion

164
Q

Achilles tendonosis may present with ___ and often lacks ____

A

Achilles tendonosis may present with crepitus and often lacks CKC DF

165
Q

What are the presentations of an achilles tendonosis?

A
  • Thickening of Achilles tendon
  • Tight, painful gastrocsoleus with TP’s
  • Painful resisted PF
166
Q

What are the treatment methods for an achilles tendonosis?

A
  • IASTM (instrument assisted soft tissue mobilization)
  • Stretching
  • No NSAID’S
  • Eccentric training
167
Q

What is the specifics of the eccentric training that should be done as the treatment option for an achilles tendonosis?

A
  • 3 sets of 15 eccentric heel drops
  • 2x daily
  • 12 weeks
168
Q

What is an achilles tendon rupture?

A

Chronic degeneration due to inflammation

169
Q

What is the mechanism of injury of an achilles tendon rupture?

A

Forceful, sudden contraction

170
Q

What are the risk factors of an achilles tendon rupture?

A
  • Cortisone injection
  • 30-40 year old male
  • Tight gastroc
  • History on tendonosis
171
Q

What are the presentations of an achilles tendon rupture?

A

Palpable and/or visible defect in tendon
• Gait changes: unable to push off
• Swelling and ecchymosis
• Can PF secondary to secondary muscles, albeit weak
• Positive Thompson test
• Most treated surgically

172
Q

How does a Thompson test work?

A

Squeeze the gastroc to see if it has an associated PF, if not the gastroc is not intact

173
Q

What is a hallux abductovalgus (HAV)?

A

Medial deviation of 1st metatarsal head in relation to center of body

174
Q

What is an adolescent HAV?

A

Familial and may require surgical intervention

175
Q

An adolescent HAV is often associated with ___

A

An adolescent HAV is often associated with hyperpronation of the rearfoot

176
Q

What is a degenerative HAV?

A

DJD of 1st metatarsal head and base of proximal phalanx

177
Q

What are the interventions for HAV?

A
  • Strengthen intrinsic muscles
  • Manual therapy of foot and ankle
  • Modify footwear
  • Custom orthotics
  • Splinting
178
Q

What is morton’s neuroma?

A

Pain and paresthesia in interdigital space (typically 2-3 or 3-4) with fibrous entrapment of interdigital nerve

179
Q

What is the management method of morton’s neuroma?

A 
- Decompression vs shoe wear	
modification
- Metatarsal	pads
- MT mobilization
- IASTM
180
Q

What is the diabetic foot?

A

Infection, ulceration or destruction of deep tissues associated with neurological abnormalities & various degrees of peripheral vascular diseases in the lower limb

181
Q

___% of all non traumatic lower limb amputation are due to diabetic feet

A

40% - 60% of all non traumatic lower limb amputation are due to diabetic feet

182
Q

85% of diabetic related foot amputation are preceded by foot ___

A

85% of diabetic related foot amputation are preceded by foot ulceration

183
Q

4 out of 5 ulcers in diabetics are precipitated by ___

A

4 out of 5 ulcers in diabetics are precipitated by trauma

184
Q

What are the motor dysfunctions caused by a diabetic foot neuropathy?

A
  • Limited joint mobility

- Postural and coordination deviation

185
Q

What are the sensory dysfunctions caused by a diabetic foot neuropathy?

A

Decreased protective sensation

186
Q

What does the sensory and motor dysfunctions caused by a diabetic foot neuropathy lead to?

A
  • Foot deformities, stress and shear pressure which leads to
  • Foot ulcer, when injured
    which leads either directly to an amputation or to an infection which will end up in an amputation
187
Q

What are the autonomic dysfunctions caused by a diabetic foot neuropathy and what does it lead to?

A
  • Diminished sweating, altered blood flow regulation, which leads to
  • Skin fissuring and cracks, which leads to a
  • Foot ulcer, which leads either directly to an amputation or to an infection which will end up in an amputation
    OR
  • Microvascular dysfunction which leads to a
  • Foot ulcer, when injured which leads either directly to an amputation or to an infection which will end up in an amputation
188
Q

What are the dysfunctions caused by a diabetic foot angiopathy and what does it lead to?

A
  • Microvascular dysfunction which leads to a
  • Foot ulcer, when injured which leads either directly to an amputation or to an infection which will end up in an amputation
    OR
  • Peripheral arterial occlusive disease, which leads to ischaemia, which then leads to either gangrene or a foot ulcer, which will then result in a
  • Foot ulcer, when injured which leads either directly to an amputation or to an infection which will end up in an amputation
189
Q

___ and ____ are mandatory to diagnose diabetic neuropathy, hence every patient that comes in the clinic with diabetes must have this

A

History & careful foot examination are mandatory to diagnose diabetic neuropathy, hence every patient that comes in the clinic with diabetes must have this

190
Q

____ & _____ neuropathy are major risk factors for

ulcer

A

Sensorimotor & peripheral sympathetic neuropathy are major risk factors for
ulcer

191
Q

What do we start with palpation wise in an assessment of the foot for a diabetic patient?

A
  • Palpation of the dorsalis pedis pulse
  • Palpation of the posterior tibial pulse
  • Palpate the foot for temperature (cool in PVD)
192
Q

What is the most important test done for patient with diabetes?

A

Mono-filament test

193
Q

What is reactive hyperemia?

A

Leg turns bright red when going from an elevated position to declining back to the ground (test for this in diabetic patients)

194
Q

What does a monofilament test do?

A

Test for pressure sensation

195
Q

How is a monofilament test performed?

A
  • Place a 10g nylon Semmes-Weinstein monofilament at a right angle to the skin
  • Apply pressure until the monofilament buckles
196
Q

What is the inability to perceive pressure during the monofilament test indicate?

A

Inability to perceive the 10g of force applied by the monofilament is associated with clinically significant large fibre neuropathy and an increased risk of ulceration

197
Q

What is an at risk foot?

A
  • One with diabetes
  • One with deformities as a result of improper footwear
  • Clawed toes, which causes pressure at the top of the shoebox
  • Prominent metatarsal heads
  • Dry skin and fissure
198
Q

___ is the most important pre-ulcerative lesion in this stage (at risk foot)

A

Callus formation is the most important pre-ulcerative lesion in this stage (at risk foot)

199
Q

How should deformities in an at risk foot be addressed?

A

Deformities should be accommodated in properly fitting footwear.

200
Q

How should clawed toes in an at risk foot be addressed?

A

Clawed toes need a shoe with a wide, deep, soft toe box to reduce pressure on the dorsum of the toes. Extra depth shoes to protect the apices of the toes

201
Q

How should prominent metatarsal heads in an at risk foot be addressed?

A

An extra depth stock shoe with a cushioning insole may suffice

202
Q

How should callus formation in an at risk foot be addressed?

A

It should be regularly and sufficiently remove by a

trained professional with a scalpel

203
Q

How should dry skin and fissure in an at risk foot be addressed?

A

Treat with an emollient, reduce fissure margins with scalpel

204
Q

What is stage 1 of ulcer development?

A

Callus formation

205
Q

What is stage 2 of ulcer development?

A

Subcutaneous hemorrhage

206
Q

What is stage 3 of ulcer development?

A

Breakdown of the skin

207
Q

What is stage 4 of ulcer development?

A

Deep foot infection with osteomyelitis, starting with a soft tissue infection, then progressing to a bone infection

208
Q

What is a charcot foot?

A

A neurogenic arthropathy that affects the joints in the

foot.

209
Q

What is a neurogenic arthropathy?

A

A rapidly progressive degenerative arthritis that

results from damaged nerves (neuropathy)

210
Q

What is severely impaired in a charcot foot?

A

Pain perception, motor function, and proprioception of the foot are severely impaired.

211
Q

The losses sustained in a charcot foot allows ___

A

The losses sustained in a charcot foot allow minor traumas to go undetected and untreated, leading to laxity, dislocations, bone erosion, cartilage damage, and deformity of the foot

212
Q

What is the most common cause of a charcot foot?

A

Diabetes

213
Q

60%-70% of people with diabetes develop ____ that can lead to Charcot foot

A

60%-70% of people with diabetes develop peripheral nerve damage that can lead to Charcot foot

214
Q

When is the onset of charcot foot?

A

Onset occurs after the patient has been diabetic for 15 to 20 years, usually at the age of 50 or older.

215
Q

What is the intervention for a charcot foot?

A

Total Contact Casting

216
Q

What are the ways to prevent foot problems in diabetes?

A
  • Identification of high risk patient
  • Regular inspection & examination of foot & footwear
  • Education of patient, family & health care providers
  • Appropriate foot wear
  • Treatment of non ulcerative pathology
217
Q

What does the total contact casting do?

A

It creates distribution of pressure around the foot and offload the ulcerative area

218
Q

What are the types of total contact casting and which helps offload the wound more?

A
  • Conventional TCC

- Wound-isolation TCC (offloads the wound more)

219
Q

What environment is the TCC in and why?

A

In a moist environment, because it helps promote healing

220
Q

In what gender does Talipes Equinovarus - (Clubfoot) occur the most?

A

Boys

221
Q

In what population does Talipes Equinovarus - (Clubfoot) occur the most?

A

Cerebral Palsy, Cerebral Vascular Accidents and Children (congenital)

222
Q

What is the cause of Talipes Equinovarus - (Clubfoot)?

A

Congenital

223
Q

What occurs in a Talipes Equinovarus - (Clubfoot)?

A

Posterior and medial muscles are unduly short. Capsules of affected joints become thick and contracted on concave side of deformity.

224
Q

What happens in a Talipes Equinovarus - (Clubfoot) as time goes by?

A

The soft tissue contractures become progressively resistant to correction as
weeks go by both before and after birth

225
Q

There are __ deg changes in the shape of actively growing bones and involved joints in a Talipes Equinovarus (Clubfoot)

A

There are 2 deg changes in the shape of actively growing bones and involved joints in a Talipes Equinovarus (Clubfoot)

226
Q

Talipes Equinovarus - (Clubfoot) is frequently associated with ___

A

Talipes Equinovarus - (Clubfoot) is frequently associated with internal tibial rotation

227
Q

How is Talipes Equinovarus - (Clubfoot) diagnosed?

A

Easy with severe cases(observation), mild cases distinguished from “positional equinovarus” due to intrauterine fetal position.

228
Q

What is the intervention for mild Talipes Equinovarus - (Clubfoot)?

A

• Initiation of treatment within the 1st few days of life with gentle passive
correction of the deformities.
• Maintenance of correction for a long period and supervision of the child until the end of the growth period.

229
Q

What is the intervention for moderate Talipes Equinovarus - (Clubfoot)?

A
  • Weekly application of plaster casts for approx 6 weeks.
  • Denis Browne splint with feet fixed to brace and progressively turned outward into valgus for 12 weeks
  • Use of the Denis Browne splint day and night for 3 mos. in the static position after the initial 12 weeks.
  • Straight last or outflare shoes/boots for day wear until 3 years.
  • Semi-rigid orthotics to maintain soft tissue position and length.
230
Q

What is the intervention for severe Talipes Equinovarus - (Clubfoot)?

A
  • Surgical treatment if failure of the non surgical methods.
  • Meticulous soft tissue release of tendons and joint contractions.
  • Post-operatively the non-operative methods are resumed to insure success.
  • Semi-rigid orthotics to maintain soft tissue length.
231
Q

Calcaneal Apophysitis- Sever’s Disease is commonly seen in what population?

A

Commonly seen in skeletally immature

232
Q

What are the causes of Calcaneal Apophysitis- Sever’s Disease?

A
  • Direct trauma (repetitive heel strike during weight bearing activities)
  • Repetitive traction through achilles tendon
233
Q

What is Calcaneal Apophysitis- Sever’s Disease?

A

Inflammation of the apophysis of the calcaneus, and the apophysis may fragment

234
Q

What are the sign and symptoms of Calcaneal Apophysitis- Sever’s Disease?

A
  • Antalgic gait - heel pain during running/walking
  • Swelling
  • Localized pain/tenderness
  • Positive active/passive ROM test for tight achilles tendon
235
Q

What are the management methods of Calcaneal Apophysitis- Sever’s Disease?

A
  • Initial- restricting DF by elevating heel
  • Will resolve when apophysis closes
  • Modification of activity level
  • Non-irritating stretching of GS Complex (manual stretching)

MSK 2 (4 decks)

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