Week 8 Flashcards
1
Q
What is the function of the foot?
A
To provide stability and mobility
2
Q
How does the foot provide stability?
A
- Stable base of support for WB
2. Act as shock absorber and rigid lever for effective push-off during gait
3
Q
How does the foot provide mobility?
A
- Dampening rotations from proximal joints
- Flexible enough to absorb shock
- Foot conform to terrain
4
Q
What are the 3 segments of the LE?
A
- Leg segment
- Rearfoot segment
- Forefoot segment
5
Q
What are the functional segments of the forefoot?
A
- Metatarsals
* Phalanges
6
Q
What are the functional segments of the midfoot?
A
- Navicular
- Cuboid
- Cuneiforms
7
Q
What are the functional segments of the hind/rearfoot?
A
- Talus
* Calcaneus
8
Q
How much dorsiflexion do we have?
A
20º
9
Q
How much plantarflexion do we have?
A
50º
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
11
Q
What motions of the foot occurs in the frontal plane, around the AP axis?
A
Inversion and Eversion
12
Q
What is inversion of the foot?
A
Plantar surface towards the midline
13
Q
What is eversion of the foot?
A
Plantar surface away from midline
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
15
Q
What is ADD in the foot?
A
Distal segment toward midline of body
16
Q
What is ABD in the foot?
A
Distal segment away from the midline of body
17
Q
What joint and axis does supination and pronation occur in?
A
Occur at subtalar joint around a combination of axes
18
Q
What movement happens during supination and pronation in the open chain?
A
Calcaneus moves on fixed talus/ leg
19
Q
What movement happens with supination in the open chain?
A
Calcaneus plantarflexes, inverts, adducts
20
Q
What movement happens with pronation in the open chain?
A
Calcaneus dorsiflexes, everts, abducts
21
Q
What movement happens with supination in the closed chain?
A
- IR of tibia & fibula
- Talar ADD & PF
- Calcaneal eversion
22
Q
What movement happens with pronation in the closed chain?
A
- ER of tibia & fibula
- Talar ABD & DF
- Calcaneal inversion
23
Q
What is a varus motion?
A
Distal segment toward midline
24
Q
What is a valgus motion?
A
Distal segment away from the midline
25
What is the composite motion of the ankle?
Supination & Pronation
26
___ is the main ankle joint
*Talocrural joint* is the main ankle joint
27
What type of joint is the talocrural joint?
Synovial, modified saddle or hinge joint
28
What is the mortise?
A rectangular cavity that holds the talus into the talocrural joint
29
What is the roof of the ankle mortise?
Tibia
30
The anterior portion of the talocrural joint can be referred to as the ___
The anterior portion of the talocrural joint can be referred to as the *tenon*
31
___ is a projection shaped for insertion into mortise
*Tenon* is a projection shaped for insertion into mortise
32
What makes up the talocrural joint?
The talus sitting in the mortise
33
In what direction are the talus and mortise wide?
They are wide anteriorly
34
There is a tight fit between the talus and mortise throughout ___
There is a tight fit between the talus and mortise throughout *ROM*
35
The talocrural joint is the ___ congruent joint in the body
The talocrural joint is the most congruent joint in the body
36
What are the characteristics of the talocrural joint?
* No muscular attachments
* Limited blood supply
* Risk for delayed or non union fracture
37
What are the coupled movements of the talocrural joint when the leg goes through internal rotation in CKC?
- Inward gliding of the talus
| - Foot pronation
38
What are the coupled movements of the talocrural joint when the leg goes through external rotation inc CKC?
- Outward gliding of the talus
| - Foot supination
39
What is the close pack position of the talocrural joint?
DF
40
DF is the position of ___ congruency, joint compression, and stability
DF is the position of greatest congruency & joint compression, and stability
41
What is the open/loose pack position of the talocrural joint?
Plantarflexion
42
What is the capsular pattern of the talocrural joint?
Plantarflexion limited more so than DF
43
What aspect of the foot does the deltoid ligament sit?
On the medial aspect of the foot
44
The deltoid ligament is the primary static constraint to excessive ___
The deltoid ligament is the primary static constraint to excessive *eversion*
45
The deltoid ligament strongly resists __
The deltoid ligament strongly resists *side to side movement or rotation of mortise upon talus
46
The deltoid ligament has ___ tensile strength
The deltoid ligament has *great* tensile strength
47
What are the components of the deltoid ligament?
* Tibionavicular ligament
* Tibiocalcaneal ligament
* Posterior tibiotalar ligament
* Anterior tibiotalar ligament
48
Why are eversion sprains of the ankle rare?
Deltoid ligament strength
49
What are the lateral collateral ligaments of the ankle?
* Anterior talofibular ligament
* Posterior talofibular ligament
* Calcaneofibular ligament
50
What strains of the ankle are the most common?
Counter varus/inversion
stresses or lateral ankle joint
distraction
51
85% of ankle strains are ____ strains
85% of ankle strains are *inversion* strains
52
Which LCL is the weakest and most commonly injured?
Anterior talofibular ligament (ATFL)
53
When is the stress on the Anterior talofibular ligament the greatest?
Stress greatest in combined INV/PF
54
What kind of instability does the (ATFL) have?
Anterolateral rotatory instability
55
Which LCL is the strongest and least frequently injured?
Posterior talofibular ligament
56
What kind of joint is the Subtalar (Talocacalcaneal) Joint?
Functional synovial joint
57
What bones make up the Subtalar (Talocacalcaneal) Joint?
Talus(distally) and calcaneus
58
What are the articulations of the Subtalar (Talocacalcaneal) Joint?
Posterior, (then tarsal canal),
| middle, and anterior articulations
59
Where can the tibiofibular joint be injured?
Proximally and distally
60
What kind of joint is the proximal tibiofibular joint?
Synovial
61
What makes up the proximal tibiofibular joint?
FIbular head and fibular articulating facet of the tibia
62
What motions occur at the proximal tibiofibular joint?
- Superior and inferior fibular gliding
- Fibular rotation
(both are of small magnitude)
63
What makes up the middle tibiofibular joint?
Interosseous membrane
64
What is the function of the middle tibiofibular joint?
Supports proximal and distal joints
65
What kind of joint is the distal tibiofibular joint?
Syndesmosis/ fibrous union
66
What makes up the distal tibiofibular joint?
Distal fibula and fibular notch of the tibia
67
There is ___ motion at the distal tibiofibular joint
Not a lot of motion at the distal tibiofibular joint
68
When is there motion detected in the distal tibiofibular joint?
After a significant sprain and a high ankle sprain
69
What kind of motion does the subtalar joint create?
A tri-planar motion
70
The subtalar joint dampens ___ forces
The subtalar joint dampens *rotational* forces
71
What is the function of the subtalar joint?
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
72
What does the talar ADD component of the subtalar joint cause?
Talar ADD component of pronation causes IR of superimposed tibia/fibula
73
With the subtalar joint maintained in WB;
| pronation imposes IR force on leg that can affect ___ and___
With the subtalar joint maintained in WB;
| pronation imposes IR force on leg that can affect *knee & hip*
74
Hip joint IR may be related to
| ____ & ____
Hip joint IR may be related to
| *medially facing patellae & patient’s knee pain*
75
What position is the subtalar joint in closed packed?
Supination
76
What happens to the ligamentous tendons of the subtalar joint in the closed pack position?
Ligamentous tension draws together or “locks” talocalcaneal joint surfaces
77
The closed pack position of the subtalar joint is critical for ___, as the foot becomes ___
The closed pack position of the subtalar joint is critical for *stability*, as the foot becomes *rigid lever*
78
What position is the subtalar joint in open packed?
Midway between supination/pronation, & 10º talar PF
79
What is pronation of the subtalar joint critical for?
Pronation critical for mobility, shock absorption & dampening. WB-imposed rotational forces
80
What is the capsular pattern of the subtalar joint?
Varus limited more so than valgus
81
___ separates the hind foot from the mid foot
*The transverse tarsal joint* separates the hind foot from the mid foot
82
What makes up the transverse tarsal joint?
Talonavicular Joint and Calcaneocuboid Joint
83
The talonavicular joint is enhanced by the ___
The talonavicular joint is enhanced by the *Spring Ligament (plantar calcaneonavicular ligament)*
84
What type of joint is the talonavicular joint?
“Ball-Socket” type joint
85
What is the function of the spring ligament?
- Supports joint
| - Supports medial longitudinal arch
86
What ligament supports the Calcaneocuboid Joint?
Long plantar ligament
87
There is more ___ motion at the calcaneocuboid joint
There is more *restrictive* motion at the calcaneocuboid joint
88
What is the function of the long plantar ligament?
- Supports lateral longitudinal
| arch
89
What of the joints that make up the transverse tarsal joint is more medially placed and which is more laterally placed?
Talonavicular Joint(medial) Calcaneocuboid Joint (lateral)
90
What is the function of the transverse tarsal joint?
* 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
91
The transverse tarsal joint moves in combination with the ___ joint, to add a bit of a ___ motion to maintain the longitudinal arch
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
92
What kind of joint is the tarsometatarsal joint?
Planar synovial joints
93
What forms the tarsometatarsal joint?
Formed by distal tarsals and bases of metatarsals
94
The tarsometatarsal joint is also known as the ___
The tarsometatarsal joint is also known as the *Lisfranc's joint*
95
The tarsometatarsal joint function augments the ____ function
The tarsometatarsal joint function augments the *transverse tarsal joint* function
96
What happens to the transverse tarsal joint during early to mid stance phase of gait?
• 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
What happens to the transverse tarsal joint during late stance phase of gait?
• 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
What is the function of the tarsometatarsal joint?
Maintain forefoot contact with ground: rotate to adjust forefoot positioning when transverse tarsal joint cannot fully compensate for
rear foot positioning
99
Where does the tarsometatarsal joint impact its function?
Position metatarsals & phalanges
100
What motions happen in the 1st and 2nd ray?
Invert/extend & evert/flex
101
Which ray is the least mobile, hence the most stable?
2nd ray
102
What motion occurs in the 3rd ray?
Extends & flexes
103
What motion occurs in the 4th and 5th ray?
Evert/extend & invert/flex
104
What kind of joint is the metatarsalpharengeal joints?
Condyloid synovial
105
What motions occur at the metatarsalpharengeal joints?
- Extension
- Flexion
- ABD/ADD
106
What happens during extension of the metatarsalpharengeal joints?
Body passes over foot
107
What happens during flexion of the metatarsalpharengeal joints?
Return to neutral from
| extension
108
What happens during ABD/ADD of the metatarsalpharengeal joints?
• Grasping
• Absorb some of force on MTs as they undergo pro/supination twist at TMT
joints
109
Where are the sesamoid bones in the foot and what maintains them?
Maintained by ligamentous masses in grooves along plantar aspect of 1st MT head
110
The sesamoid bones of the foot act as ___
The sesamoid bones of the foot act as *anatomic pulleys for flexor hallucis brevis*
111
What is the function of the sesamoid bones of the foot?
Protect flexor hallucis longus tendon from WB trauma, which
passes thru tunnel formed by sesamoids & intersesamoidal
ligament joining their plantar surfaces
112
What are the sources of stability of the foot?
```
• Wedge-shaped mid-tarsal bones
• Inclination of calcaneus & 1st MT (med longitudinal arch)
• Ligamentous support (incl.
plantar aponeurosis)
• Intrinsic foot muscles
```
113
What is the plantar aponeurosis/fascia?
Fibrous tissue extending from calcaneus to plantar plates at MTP joints, then via plantar plates to proximal phalanges)
114
What is the function of the plantar aponeurosis/fascia?
* Supports arches
| * Increases foot stability during MTP extension in push off (Windlass Effect)
115
What component of the tie rod & strut complex is the plantar aponeurosis/fascia?
Tie rod component
116
What is the plantar aponeurosis relaxed and when is it tensioned or stretched?
* Relaxed when non-weight bearing
| * Tensioned or stretched when struts compressed during weight bearing
117
What is pes planus?
Pronated or flat foot
118
What causes pes planus?
Decreased or absent medial
| longitudinal arch
119
What happens to the bones during pes planus?
Talus depresses navicular &
| minimizes potential for transverse tarsal counter rotation to offset subtalar pronation
120
What is pes cavus?
Supinated or high arched foot
121
What are the potential effects of pes planus?
• 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
What does an increased tibial internal rotation cause?
* Potentially altered patellar tracking
| * Increased Q Angle at knee
123
What are the potential effects of pes cavus?
* Increased medial longitudinal arch height
* Subtalar & transverse tarsal joints excessively supinated
* Rearfoot varus
* Potential external rotation stress on leg
* Rigid or flexible
124
What are the effects of a rigid pes cavus?
```
• Less effective shock absorption capability:
• Greater forces may be
imposed upon foot
and proximal structures
• Increased loading of lateral
structures
```
125
What are some injuries associated with pes planus?
- Plantar fasciitis
- Knee pain
- Patellar tendinitis
- Stress fractures (2nd/3rd MTs)
126
What are some injuries associated with pes cavus?
- Plantar fasciitis
- Ankle INV sprains
- ITBS
- Stress fractures (5th MT)
127
What does a medial tibial stress syndrome account for?
Accounts for the inflammatory, traction event on the tibial aspect of the leg common in runners.
128
Medial Tibial Stress Syndrome is more accurately named ___
Medial Tibial Stress Syndrome is more accurately named *medial tibial traction periostitis or just medial tibial
periostitis*
129
What are the presentations of a medial tibial stress syndrome?
Tightness/tenderness, throbbing along tibial crest that comes on with activity and settles with rest
130
What are the causes of a medial tibial stress syndrome (MTSS)?
* 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
___ looks very similar to MTSS
*Tibialis Anterior Tendonopathy* looks very similar to MTSS
132
How can a Tibialis Anterior Tendonopathy be provoked?
MMT testing should provoke
133
What are the key things to do during the screening for a Tibialis Anterior Tendonopathy?
- Palpation key
- Be sure to screen lumbar
- Gait and running analysis key
134
With a tibialis posterior tendonopathy, there will be pain with __ and/or __
With a tibialis posterior tendonopathy, there will be pain with *AROM and/or MMT*
135
What is the usual source of a tibialis posterior tendonopathy?
Repetitive stress
136
With a tibialis posterior tendonopathy, there is usually ___ and ___
With a tibialis posterior tendonopathy, there is usually *pes planus and hypermobile feet*
137
There is irritation at insertion on ___ or ___ with a tibialis posterior tendonopathy
There is irritation at insertion on *navicular or behind medial malleoli* with a tibialis posterior tendonopathy
138
Peroneal tendonopathy occurs in ___ behind __
Peroneal tendonopathy occurs in *sulcus behind lateral malleoli or at cuboid*
139
What are the methods of injury of a peroneal tendonopathy?
Overuse or friction
140
Peroneal tendonopathy, occurs often after ____
Peroneal tendonopathy, occurs often after *inversion sprain*
141
A rupture of the peroneal tendon at the retinaculum leads to a ___
A rupture of the peroneal tendon at the retinaculum leads to a *peroneal subluxation*
142
What causes a tarsal tunnel syndrome?
* Lesion to posterior tibial nerve in flexor retinaculum
| * Indirect trauma
143
Where does the lesion to posterior tibial nerve in flexor retinaculum occur?
Behind medial malleoli
144
What are the possible mechanisms of an indirect trauma that leads to a tarsal tunnel syndrome?
* Running on hard surfaces, or poor fitting shoes
| * Overpronation
145
What are presentations of a tarsal tunnel syndrome?
* Localized swelling
* Medial ankle and heel pain
* Positive sensory loss to medial heel
* Positive Tinel’s sign
* Possible adverse neural tension
146
What foot posture should be looked at in reference to a tibialis posterior tendonopathy?
Look at resting and dynamic foot posture
147
A lesion to posterior tibial nerve in the flexor retinaculum that causes a tarsal tunnel syndrome can be as a result of a what?
Entrapment or traction
148
Where is chronic exertional compartment syndrome typically?
Typically anterior
149
In what population is a chronic exertional compartment syndrome usually present?
Common in runners and soccer players
150
What are some of the things that a patient will complain of when they have a chronic exertional compartment syndrome?
A tingling and parasthesia after an extended period of time
151
____ can be palpated in 40-60% of patients with a chronic exertional compartment syndrome
*Muscle herniation* can be palpated in 40-60% of patients with a chronic exertional compartment syndrome
152
___ and ___ are common in the respective compartment f a chronic exertional compartment syndrome
*Neurologic weakness and
| numbness* are common in the respective compartment f a chronic exertional compartment syndrome
153
What are the common presentations of a chronic exertional compartment syndrome?
- Pain at predictable periods
- Excessive pressure
- Palar
- Parasthesia (burning, tingling, numb)
- Pulselessness
154
When should pulselessness be tested for in a chronic exertional compartment syndrome?
At rest and after exertion
155
What is the test used for a chronic exertional compartment syndrome?
Wick Catheter before and after treadmill test
156
What is a treatment option for a chronic exertional compartment syndrome?
Consider transition to forefoot running
157
What does transitioning a patient with a chronic exertional compartment syndrome to forefoot running do?
- Decreases GRF
- Take load off anterior tibial structure
- Reduce anterior compartment pressure
158
What are the key principles
| when treating anterior shin pain?
- 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
What is an achilles tendonitis?
Inflammation of Achilles tendon
160
What is the mechanism of injury of an achilles tendonitis?
- Overuse/overloaded state
| - Gradual onset
161
____ exacerbates in an achilles tendonitis?
*Decreased flexibility* exacerbates in an achilles tendonitis?
162
Achilles tendonosis is ___ in nature
Achilles tendonosis is *chronic* in nature
163
Where does achilles tendonosis typically show up?
Hypovascular zone 2-6cm from insertion
164
Achilles tendonosis may present with ___ and often lacks ____
Achilles tendonosis may present with *crepitus* and often lacks *CKC DF*
165
What are the presentations of an achilles tendonosis?
- Thickening of Achilles tendon
- Tight, painful gastrocsoleus with TP’s
- Painful resisted PF
166
What are the treatment methods for an achilles tendonosis?
* IASTM (instrument assisted soft tissue mobilization)
* Stretching
* No NSAID’S
* Eccentric training
167
What is the specifics of the eccentric training that should be done as the treatment option for an achilles tendonosis?
* 3 sets of 15 eccentric heel drops
* 2x daily
* 12 weeks
168
What is an achilles tendon rupture?
Chronic degeneration due to inflammation
169
What is the mechanism of injury of an achilles tendon rupture?
Forceful, sudden contraction
170
What are the risk factors of an achilles tendon rupture?
* Cortisone injection
* 30-40 year old male
* Tight gastroc
* History on tendonosis
171
What are the presentations of an achilles tendon rupture?
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
How does a Thompson test work?
Squeeze the gastroc to see if it has an associated PF, if not the gastroc is not intact
173
What is a hallux abductovalgus (HAV)?
Medial deviation of 1st metatarsal head in relation to center of body
174
What is an adolescent HAV?
Familial and may require surgical intervention
175
An adolescent HAV is often associated with ___
An adolescent HAV is often associated with *hyperpronation of the rearfoot*
176
What is a degenerative HAV?
DJD of 1st metatarsal head and base of proximal phalanx
177
What are the interventions for HAV?
* Strengthen intrinsic muscles
* Manual therapy of foot and ankle
* Modify footwear
* Custom orthotics
* Splinting
178
What is morton's neuroma?
Pain and paresthesia in interdigital space (typically 2-3 or 3-4) with fibrous entrapment of interdigital nerve
179
What is the management method of morton's neuroma?
```
- Decompression vs shoe wear
modification
- Metatarsal pads
- MT mobilization
- IASTM
```
180
What is the diabetic foot?
Infection, ulceration or destruction of deep tissues associated with neurological abnormalities & various degrees of peripheral vascular diseases in the lower limb
181
___% of all non traumatic lower limb amputation are due to diabetic feet
*40% - 60%* of all non traumatic lower limb amputation are due to diabetic feet
182
85% of diabetic related foot amputation are preceded by foot ___
85% of diabetic related foot amputation are preceded by foot *ulceration*
183
4 out of 5 ulcers in diabetics are precipitated by ___
4 out of 5 ulcers in diabetics are precipitated by *trauma*
184
What are the motor dysfunctions caused by a diabetic foot neuropathy?
- Limited joint mobility
| - Postural and coordination deviation
185
What are the sensory dysfunctions caused by a diabetic foot neuropathy?
Decreased protective sensation
186
What does the sensory and motor dysfunctions caused by a diabetic foot neuropathy lead to?
- 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
What are the autonomic dysfunctions caused by a diabetic foot neuropathy and what does it lead to?
- 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
What are the dysfunctions caused by a diabetic foot angiopathy and what does it lead to?
- 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
___ and ____ are mandatory to diagnose diabetic neuropathy, hence every patient that comes in the clinic with diabetes must have this
*History & careful foot examination* are mandatory to diagnose diabetic neuropathy, hence every patient that comes in the clinic with diabetes must have this
190
____ & _____ neuropathy are major risk factors for
| ulcer
*Sensorimotor & peripheral sympathetic* neuropathy are major risk factors for
ulcer
191
What do we start with palpation wise in an assessment of the foot for a diabetic patient?
- Palpation of the dorsalis pedis pulse
- Palpation of the posterior tibial pulse
- Palpate the foot for temperature (cool in PVD)
192
What is the most important test done for patient with diabetes?
Mono-filament test
193
What is reactive hyperemia?
Leg turns bright red when going from an elevated position to declining back to the ground (test for this in diabetic patients)
194
What does a monofilament test do?
Test for pressure sensation
195
How is a monofilament test performed?
* Place a 10g nylon Semmes-Weinstein monofilament at a right angle to the skin
* Apply pressure until the monofilament buckles
196
What is the inability to perceive pressure during the monofilament test indicate?
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
What is an at risk foot?
- 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
___ is the most important pre-ulcerative lesion in this stage (at risk foot)
*Callus formation* is the most important pre-ulcerative lesion in this stage (at risk foot)
199
How should deformities in an at risk foot be addressed?
Deformities should be accommodated in properly fitting footwear.
200
How should clawed toes in an at risk foot be addressed?
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
How should prominent metatarsal heads in an at risk foot be addressed?
An extra depth stock shoe with a cushioning insole may suffice
202
How should callus formation in an at risk foot be addressed?
It should be regularly and sufficiently remove by a
| trained professional with a scalpel
203
How should dry skin and fissure in an at risk foot be addressed?
Treat with an emollient, reduce fissure margins with scalpel
204
What is stage 1 of ulcer development?
Callus formation
205
What is stage 2 of ulcer development?
Subcutaneous hemorrhage
206
What is stage 3 of ulcer development?
Breakdown of the skin
207
What is stage 4 of ulcer development?
Deep foot infection with osteomyelitis, starting with a soft tissue infection, then progressing to a bone infection
208
What is a charcot foot?
A neurogenic arthropathy that affects the joints in the
| foot.
209
What is a neurogenic arthropathy?
A rapidly progressive degenerative arthritis that
| results from damaged nerves (neuropathy)
210
What is severely impaired in a charcot foot?
Pain perception, motor function, and proprioception of the foot are severely impaired.
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The losses sustained in a charcot foot allows ___
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*
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What is the most common cause of a charcot foot?
Diabetes
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60%-70% of people with diabetes develop ____ that can lead to Charcot foot
60%-70% of people with diabetes develop *peripheral nerve damage* that can lead to Charcot foot
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When is the onset of charcot foot?
Onset occurs after the patient has been diabetic for 15 to 20 years, usually at the age of 50 or older.
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What is the intervention for a charcot foot?
Total Contact Casting
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What are the ways to prevent foot problems in diabetes?
* 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
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What does the total contact casting do?
It creates distribution of pressure around the foot and offload the ulcerative area
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What are the types of total contact casting and which helps offload the wound more?
- Conventional TCC
| - Wound-isolation TCC (offloads the wound more)
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What environment is the TCC in and why?
In a moist environment, because it helps promote healing
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In what gender does Talipes Equinovarus - (Clubfoot) occur the most?
Boys
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In what population does Talipes Equinovarus - (Clubfoot) occur the most?
Cerebral Palsy, Cerebral Vascular Accidents and Children (congenital)
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What is the cause of Talipes Equinovarus - (Clubfoot)?
Congenital
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What occurs in a Talipes Equinovarus - (Clubfoot)?
Posterior and medial muscles are unduly short. Capsules of affected joints become thick and contracted on concave side of deformity.
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What happens in a Talipes Equinovarus - (Clubfoot) as time goes by?
The soft tissue contractures become progressively resistant to correction as
weeks go by both before and after birth
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There are __ deg changes in the shape of actively growing bones and involved joints in a Talipes Equinovarus (Clubfoot)
There are *2* deg changes in the shape of actively growing bones and involved joints in a Talipes Equinovarus (Clubfoot)
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Talipes Equinovarus - (Clubfoot) is frequently associated with ___
Talipes Equinovarus - (Clubfoot) is frequently associated with *internal tibial rotation*
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How is Talipes Equinovarus - (Clubfoot) diagnosed?
Easy with severe cases(observation), mild cases distinguished from "positional equinovarus" due to intrauterine fetal position.
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What is the intervention for mild Talipes Equinovarus - (Clubfoot)?
• 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.
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What is the intervention for moderate Talipes Equinovarus - (Clubfoot)?
* 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.
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What is the intervention for severe Talipes Equinovarus - (Clubfoot)?
* 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.
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Calcaneal Apophysitis- Sever’s Disease is commonly seen in what population?
Commonly seen in skeletally immature
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What are the causes of Calcaneal Apophysitis- Sever’s Disease?
* Direct trauma (repetitive heel strike during weight bearing activities)
* Repetitive traction through achilles tendon
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What is Calcaneal Apophysitis- Sever’s Disease?
Inflammation of the apophysis of the calcaneus, and the apophysis may fragment
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What are the sign and symptoms of Calcaneal Apophysitis- Sever’s Disease?
* Antalgic gait - heel pain during running/walking
* Swelling
* Localized pain/tenderness
* Positive active/passive ROM test for tight achilles tendon
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What are the management methods of Calcaneal Apophysitis- Sever’s Disease?
* Initial- restricting DF by elevating heel
* Will resolve when apophysis closes
* Modification of activity level
* Non-irritating stretching of GS Complex (manual stretching)
