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486 Cards in this Set
- Front
- Back
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OSCE Subtalar joint total Range of Motion
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"- place patient in prone
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OSCE Plotting subtalar joint axis
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"- place patient in sitting or supine position with knee extended
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OSCE Neutral Calcaneal Stance Position
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"- patient in standing position
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OSCE Tibial influence
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"- patient in standing position
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OSCE Relaxed Calcaneal Stance Position
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"- patient in standing position
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OSCE Forefoot to Rearfoot Relationship MTJ
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"Goniometric measurement
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OSCE First Ray Range of Motion
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"- pateint in either supine or prone
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OSCE Ankle Dorsiflexion
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"- patient in supine position with knee extended
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OSCE Malleolar Position
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"- patient in supine position
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The MTJ functions to:
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"a) accomodation to terrain
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b) smooth transition from lateral to
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c) maintenance of forefoot loading
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The talonavicular joint is similar to a _____ joint with almost limitless ROM.
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a) ball and socket
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that is _____ in the saggital plane and _____ in the frontal plane.
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"
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saddle type, concave, convex
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The calcaneo-cuboid joint has motion in
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) all three planes
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: Which ligament does not contribute to limit the pronation and supination of the MTJ?
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transverse cuboidal
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The MTJ motion occurs around two independent axes which are both oriented in an _____ direction.
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anterior medial dorsal
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The longitudinal axis of the MTJ is oriented _____?
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"15 degrees from transverse plane
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8-9 from sagittal plane
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The longitudinal axis is more closely aligned to the ___ and ___ planes. The motion is predominantly _____.
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transverse, sagittal, frontal
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Frontal plane motion of the MTJ long axis allows?
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midfoot to respond to variations in rearfoot
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The oblique axis is oriented?
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"52 degrees from transverse
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57 degrees from sagittal
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: The oblique axis is oblique to both ___ and ____ planes.
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transverse, sagittal
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oblique axis motion is coupled with
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"dorsiflexion, abduction
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plantarflexion, adduction
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The oblique axis allows compensation for?
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equinus
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Oblique axis ROM is?
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22 degrees
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ROM of the MTJ is controlled by the position of the _____?
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STJ
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what decreases MTJ ROM because the axes are more oblique to each other?
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b) STJ supination
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Locking mechanism of the MTJ occurs with MTJ?
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pronation
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Locking mechanism is assisted by action of which three muscles.
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posterior tibial, peroneus longus & brevis
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Motions in the “grounded” segment (MTJ) are seen as ____ in the proximal segment (STJ).
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equal and opposite
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Appropriate motion of MTJ in gait facilitates smooth ____ of rearfoot?
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eversion and inversion
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During the contact period, MTJ ROM increases with ______.
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) STJ pronation
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The MTJ longitudinal axis _____ as the tibialis anterior fires to control plantarflexion
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supinates
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The MTJ oblique axis _____ as the long extensors and peroneus terius fire.
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pronates
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In midstance, MTJ ROM decreases with _____ of STJ. (both LAMTJ and OAMTJ pronate).
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supination
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In the propulsive period, a supinated STJ maintains a?
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locked MTJ (rigid lever)
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In the propulsive period, the LAMTJ is ____ allowing the peroneals to shift weight from the laterl to medial side of the foot.
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pronated
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In the propulsive period, the windlass mechanism causes the forefoot to be?
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adducted and plantarflexed
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The windlass affect is attributed to?
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plantar aponeurosis
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In the swing phase, the oblique axis is ____ by pull of the long extensors and the longitudinal axis is ____ by pull of tibialis anterior.
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pronated, supinated
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A structural abnormality in which the plantar plane of the forefoot is inverted to the rearfoot.
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forefoot varus
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Which is not a possible etiology of forefoot varus?
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dorsiflexed cuboid
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A structural abnormality in which the plantar plane of the forefoot is everted to the rearfoot?
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forefoot valgus
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A relatively fixed supinated position of the forefoot relative to the rearfoot caused by soft tissue adaptation?
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supinatus
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A forefoot compensation where the forefoot is completely on the ground?
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completely compensated
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: If the forefoot varus is 3 degrees or less the STJ will compensate?
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by 3 degrees or less
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if the forefoot varus is greater than 3 degrees the STJ will compensate?
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to its end range of motion.
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Forefoot valgus compensation is by
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inversion
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What happens first in forefoot valgus compensation? (remember LASOS)
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longitudinal axis of MTJ inverts
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What happens second in forefoot valgus compensation? (remember LASOS)
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STJ supinates
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What happens third in forefoot valgus compensation? (remember LASOS)
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Oblique axis of the MTJ supinates
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What happens fourth in forefoot valgus compensation? (remember LASOS)
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STJ supinates more
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In both fully and partially compensated forefoot varus the STJ remains _____ during the entire gait cycle.
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pronated
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The above question causes an “apropulsive gait” which means?
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no active propulsion of the digits
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signs or symptoms of a completely compensated forefoot varus?
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"a) tailors bunion
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b) callus of submet 2
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c) muscle fatigue
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d) hallux abducto valgus
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sign or symptom of a partially compensated forefoot varus?
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"a)callus of submet 4 & 5
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b) knee strain medially
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c) knee strain laterally
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when watching a person with forefoot valgus in gait, the first half of midstance the foot is?
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supinated
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when watching a person with forefoot valgus in gait, at the end of midstance there is ______ of the STJ.
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pronation
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when watching a person with forefoot valgus in gait, in late propulsion the foot?
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supinates
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A forefoot valgus with MTJ longitudinal axis compensation may show all of the following signs and symptoms?
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"a) contracture of lesser digits
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b) callus of submet 1&5
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c) lateral knee strain
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: First ray motion _____ with STJ pronation and _____ with STJ supination
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increases, decreases
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In the stance phase, starting in late midstance and ending in late propulsion, the first ray motion is ______?
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plantarflexing
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In the stance phase, starting in late midstance and ending in late propulsion, the first ray motion is plantarflexing, the first ray positions in gait are?
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plantarflexed, everted
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The 1st ray position in gait in the swing phase?
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dorsiflexed, inverted
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Abnormal STJ pronation in propulsive phase of gait results in?
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"hypermobility of 1st ray leading to 1st
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1st Ray hypermobility in the transverse plane can lead to?
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"a) forefoot adductus
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b) halux abductovalgus
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1st ray hypermobility in the sagittal plane can cause?
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"a) forefoot rectus
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b) hallux limitus/rigidus
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characteristics of a plantarflexed 1st ray?
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"a) 1st ray abnormal motion
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b) STJ pronation in propulsion
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c) forefoot is everted to rearfoot
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d) 1st ray is hypermobile
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e) apropulsive gait
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f) (LA S.O.S) compensation
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g) unstable hallux, MPJs, lesser digits
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h) structural abnormality of 1st ray
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characteristics of forefoot valgus?
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"a) 1st ray normal range of motion
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b) STJ pronation in propulsion
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c) forefoot is everted to rearfoot
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d) 1st ray is hypermobile
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e) apropulsive gait
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f) (LA S.O.S) compensation
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g) unstable hallux, MPJs, lesser digits
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h) structural abnormality of MTJ
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characteristics of metatarsus primus elevatus?
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"a) structural abmormality – 1st ray is elevated
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b) metatarsal head is prominent dorsally
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c) STJ slightly pronated or neutral in propulsion
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d) 1st ray unstable, MPJs not well stabilized
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e) excessive weight is borne on 2nd metatarsal head
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f) apropulsive gait
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: If the forefoot (1st ray) is unstable during the propulsive period (apropulsive) then the muscle of the foot and leg?
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work harder to stabilized the foot causing muscle fatigue
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A plantarflexed 1st ray, forefoot valgus, and metatarsus primus elevatus have the following in common?
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"a) STJ pronation during propulsion
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b) 1st ray unstable – hallux limitus/rigidus
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c) MPJs and lesser digits unstable
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d) apropulsive gait
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e) muscle fatigue"
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The overall take home message about pathology within the first rays is?
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"it produces and unstable 1st ray
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The 5th ray motion is?
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triplanar
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5th ray total ROM is?
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20º
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5th ray motion is coupled with?
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"a) dorsiflexion with eversion
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MTPJs motion in transverse axis is?
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dorsiflexion, plantarflexion
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MTPJs motion in the verticle axis is?
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abduction, adduction
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____ amount of dorsiflexion is required from the MTPJs during normal walking.
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65º
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For MTPJs, plantarflexion is or is not required for normal walking?
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is not
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the digits dorsiflex in the ______ period of stance to create a stable platform.
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propulsive
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The MTPJs are stabilized by the ______?
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flexor digitorum longus
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Sagittal plane deviation of the MTJ would bring the oblique axis almost parallel to the ankle axis creating?
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almost pure plantar/dorsiflexion
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Sagittal plane medial deviation of the MTJ increases the _____ forces at the oblique axis.
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pronatory
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What occurs as the sagittal plane deviation of the MTJ approaches horizontal?
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midfoot breakdown
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Midfoot breakdown causes?
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the medial arch to be flat
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which is not a sign or symptom of medial deviation from the sagittal plane?
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forefoot valgus
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Superior deviation from the transverse plane of the oblique axis is sometimes referred to as? (most common type of deviation seen)
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vertical oblique axis
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With Superior deviation of the oblique axis, more _____ and ____ is seen
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adduction, abduction
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Midfoot and Talar adduction cause the leg to medially displace over the calcaneus with body weight causing?
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STJ to pronate
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Signs and symptoms of superior deviation from the transverse plane are all of the following...
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"a) medial collateral knee pain
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b) chondromalacia patellae
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c) Patella tendon strain
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d) prominent talar head medially
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e) C-shaped calcaneo-cuboid joint
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A change of structure, position or function of one part in response to forces created by a demand from a preceeding or superseding part.
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compensation
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Motion in which the foot moves to adjust for terrain or deviations in the position of the trunk or lower extremity.
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Normal compensation
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Motion in which the foot moves to adjust for abnormal structure or function of the lower extremity.
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abnormal compensation
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Theorem 1 states that
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"the heel will always attempt to purchase the ground unless prevented by limitation of motion.
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(called PURCHASE)
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: Theorem 2 states
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"states the rearfoot will always try to compensate perpendicular unless influenced by some proximal or distal force.
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(called REARFOOT PERPENDICULAR)
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: Theorem 3 states that if driven to valgus more than 2 degrees beyond perpendicular, the rearfoot will
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"(called REARFOOT FALLTHROUGH)
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In theorem 4, If the rearfoot is unable to purchase with normal ankle dorsiflexion, the MTJs will?
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"unlock and maximally pronate against a
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Theorem 5 states that the forefoot loads under the _____ and compensates by the _______. Therefore the forefoot compensates primarily in the direction of _______ from its fully loaded neutral position.
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"lateral, medial, inversion
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According to theorem 6, which is the correct order of forefoot compensation?
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"Long MTJ axis, STJ, Oblique axis of MTJ, STJ
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: According to theorem 7, the metatarsal parabola will splay in a predictable direction as the foot goes through the motions of supination and pronation. The splay pattern for pronation is?
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"4th met doesn’t move, 1-3 medial, 5th lateral
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According to theorem 7, the metatarsal parabola will splay in a predictable direction as the foot goes through the motions of supination and pronation. The splay pattern for supination is?
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"4th met doesn’t move, 1-3 lateral, 5th medial
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Normal forefoot compensation to when the rearfoot inverts is?
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"forefoot will invert
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Normal forefoot compensation to when the rearfoot everts is?
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"To keep the metatarsal on the ground via long axis of the MTJ (theorem 5)
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Normal rearfoot compensation when the forefoot inverts is?
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"rearfoot will do nothing
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Normal rearfoot compensation when the forefoot everts is?
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"rearfoot will do nothing
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The lateral malleoulus is larger and extends further distally and more posteriorly than the medial malleolus.
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The medial malleoulus determines the position of the ankle joint axis.
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FALSE the lateral malleolus does
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The ___ joint is the most stable joint in the lower extremity.
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ankle
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What makes the ankle joint so stable?
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"ligaments, shape of talus
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ankle plantarflexion is limited by:
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"a) anterior talofibular ligament
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b) deltoid ligament
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c) talus against the tibia
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Ankle dorsiflexion is limited by?
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"a) triceps surae
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b) posterior talofibular ligament
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c) posterior deltoid
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The talar dome is wider posteriorly than anteriorly
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"false
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It is wider anteriorly
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The talar dome being wider anteriorly than posteriorly leads to more stability especially in
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dorsiflexion
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The talar dome is wider ___ and smaller ____.
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laterally medially
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Congruency between the talar dome and the tibial plafond is 90%. How much lateral displacement of the talus can cause a 42% reduction in congruency?
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1mm
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Location of the ankle joint axis is just inferior of the?
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medial & lateral malleoli
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The axis of the ankle joint is directed?
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laterally, posteriorly & plantarly
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The ankle joint axis is
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oblique to all three planes.
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Motion in the ankle joint is
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pronatory/supinatory with dominance in the sagittal plane.
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with regard to ankle joint axis.
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"-axis is different from person to person
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"What is the name of the test used to measure ankle joint ROM (dorsiflexion) called?
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"
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When measuring ROM on the ankle, what can go wrong?
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"pronating the STJ, allowing the knee to flex or hyperextend
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What is the minimum ROM for dorsiflexion and plantarflexion of the ankle joint?
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dorsiflexion 10, Plantarflexion 20
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There is more ROM in the ankle joint as an adult than at birth.
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"false-Birth has 75⁰, adult has 5-10
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In OKC dorsiflexion foot moves toward the tibia. In CKC, dorsiflexion tibia moves ...
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anterior over planted foot
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In OKC plantarflexion tibia moves posterior over planted foot. In CKC, plantarflexion foot moves away from tibia.
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"false
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OKC – foot moves away from tibia
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CKC – tibia moves posterior over planted
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In OKC ankle joint movements are determined by:
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"position of the axis, shape of joint surfaces
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: In OKC, ankle joint motion is controlled by?
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collateral ligaments,integrity and stability of joint surfaces
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In CKC, ankle joint movements are controlled by?
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"position of the axis, shape of joint surface
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In CKC, ankle joint motion is controlled by?
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"ground reactive forces, muscles
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At heel contact, ground reactive force posterior to the ankle joint cause a _______ moment.
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plantarflexory
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At heel contact, muscles anterior to the ankle?
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contract to decelerate ankle plantarflexion
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ankle joint in midstance is characterized by?
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"relative dorsiflexion as the body passes
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n midstance, excessive dorsiflexion of the tibia must be resisted or the person would fall forward. What muscles do this?
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soleus, PT, FDL, FHL, some PL
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In midstance, the femur continues forward as the tibia is decelerated by calf muscles and knee extension results. What to muscles work together to provide knee extension?
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gastroc nemius, soleus
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In terminal stance, ground reactive force anterior to the ankle result in?
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dorsiflexion
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In pre-swing, the ankle rapidly ________ reaching 20 degrees by toe-off.
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plantarflexes
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In the swing phase, muscles dorsiflex the ankle to allow toes to clear ground. What muscle is the major dorsiflexor is this process?
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extensor hallucis longus
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What define equinus?
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"<10⁰ ankle joint dorsiflexion w/ neutral STJ
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The soleus and grastrocnemius act to extend the knee by?
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"soleus pulling on tibia, gastroc pulling on femur
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The most common form of equinus (congenital or acquired) caused by tight gastrocnemius w/ less than 10 degrees of dorsiflexion w/ knee extended.
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gastroc equinus
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Equinus caused by a tight triceps surae and will have less than 10⁰ dorsiflexion w/ knee extended and flexed. Achillies tendon is taught
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Gastrosoleal equinus
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Equinus with an abrupt end to dorsal ROM due to impingement of tibiotalar articulation.
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osseous equinus
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This equinus has 10⁰ of dorsiflexion at ankle but functionally needs more because of a plantarflexed forefoot.
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"pseudo equinus
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A new etiology of ankle equinus is?
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failure of translation of the fibula
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which is not a feature we may see in gait of a person with equinus?
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Genu Varum
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proximal compensation mechanisms for equinus can be?
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"a) hip flexion
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b) genu recurvatum
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c) lordosis
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"
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There is insufficient ROM in ankle, STJ, or MTJ to permitt heel to contact the ground in this equinus (toe walker).
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uncompensated
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: In this equinus, there is sufficient ROM to permit the heel to contact the ground but insufficient motion to allow tibia to angulate 10⁰ to the foot during gait (bouncy gait).
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partially compensated (no, it's not a personality thing!)
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In this equinus, there is sufficient ROM to permit the heel to contact the ground and sufficient motion to allow tibia to angulate 10⁰ to the foot during gait. (arch flattening)
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fully compensated
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Clinical findings for uncompensated equinus include?
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"callus formation under ball of foot
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clinical findings for partially compensated equinus?
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"sheer callus submet 2
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clinical findings for fully compensated equinus?
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"a) HAV 2ndary to hypermobile 1st ray
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b) sever calluses met heads 2,3,4
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c) severe arch fatigue, leg cramps, thigh and lower back pain
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d) forefoot supinatus
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e) hammered 5th digit
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Increasing the resting length of the gastroc-soleus complex through stretching exercises or surgery is the only treatment for equinus.
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"false
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heel lifts to decrease tension on achilles tendon is another method.
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The ankle joint can functionally adapt/remodel overtime to deformities impede normal ROM.
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Subtalar joint motion is
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triplanar
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"
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distal-medial-dorsal to proximal-lateral-plantar (dmd-plp)
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"
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16° from sagittal, 42° from transverse, 48° from frontal
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"
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frontal
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"
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inversion / eversion
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MTJ motion occurs in what plane(s) about the oblique axis?
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sagittal and transverse
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"
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50% dorsiflexion/ abduction with 50% plantar flexion /adduction
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"
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frontal
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"
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sagittal and transverse planes
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"
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frontal and sagittal
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"
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transverse
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"
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increasing motion
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"
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decreasing motion
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"
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triplane motion (pronation, supination)
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"
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STJ
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"
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sagittal plane
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"
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parallel to the transverse and frontal planes
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Motion occurs in the transverse plane about what axis?
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vertical
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Subtalar joint varus
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The heel is inverted to the leg in STJ NP (non-weight bearing)
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Rear foot varus is best described as
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STJ is in neutral position and heel is inverted to the ground (weight-bearing
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"
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Rear foot valgus is
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when the STJ is in NP (weight bearing) and heel is everted to the ground?
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"
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inverted
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"
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everted
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"
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1-4 degrees
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The NCSP measurement is best described as
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Angle between the bisected calcaneus and the ground while in stance
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"
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0-4º inverted
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"
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"a) rear foot deformity
|
|
|
|
b) STJ NP + Tibial Influence
|
|
|
|
c) position of the calcaneous in STJ NP stance
|
|
|
"
|
Tibial influence
|
|
|
"
|
angle between the bisection of the calcaneus and ground while in relaxed stance
|
|
|
"
|
information about the amount of rear foot deformity attributed to the tibia
|
|
|
"
|
relaxed position
|
|
|
"
|
information about the position of compensation
|
|
|
"
|
pronation of STJ
|
|
|
"
|
pronate to perpendicular
|
|
|
"
|
compensated rearfoot varus
|
|
|
"
|
partially compensated rearfoot varus
|
|
|
"
|
lateral column problems (hyperkeratosis)
|
|
|
"
|
hyperpronatory
|
|
|
"
|
|
|
|
"
|
STJ increased pronation
|
|
|
"
|
NCSP = RCSP (everted a little)
|
|
|
"
|
STJ max pronation will occur
|
|
|
"
|
STJ max pronation + 2-3 degrees additional pronation
|
|
|
"
|
"a) STJ axis and relation to adjacent muscles
|
|
|
|
b) muscular dysfunction
|
|
|
|
c) Subtalar varus & valgus
|
|
|
|
d) Rearfoot varus & valgus
|
|
|
|
e) tibial varum & valgus
|
|
|
|
f) tarsal coalition
|
|
|
"
|
pronators
|
|
|
"
|
supinator
|
|
|
"
|
medial, lateral
|
|
|
"
|
") pronate
|
|
|
|
(because the pronators overpower them)
|
|
|
"
|
supinate
|
|
|
"
|
tarsal coalition
|
|
|
"
|
hypermobility and abnormal shearing forces
|
|
|
"
|
joint subluxation
|
|
|
"
|
calluses
|
|
|
"
|
both cause perstistant STJ pronation in contact and midstance with STJ remaining pronated in propulsion
|
|
|
"
|
supination
|
|
|
"
|
NOPE! Massive STJ pronation just before propulsion causing STJ subluxation
|
|
|
OSCE Subtalar joint total Range of Motion
|
- place patient in prone
- rotate leg so longitudinal axis of calcaneus is perpendicular to the ground - place STJ in neutral - bisect the leg -bisect upper 2/3 of calcaneus -dorsiflex ankle to 90° to lock it out when inverting or everting - to invert gra |
|
|
OSCE Plotting subtalar joint axis
|
- place patient in sitting or supine position with knee extended
-rotate leg so longitudinal axis of calcaneus is perpendicular to ground - Place STJ in neutral -lock midtarsal joint by placing your thumb over 4th & 5th metatarsal heads & gently dorsiflex |
|
|
OSCE Neutral Calcaneal Stance Position
|
- patient in standing position
- assure patient is in angle & base of gait (march in place) - assure patients hips & knees extended and torso is straight - be behind leg being examined with eyes level with ankle - place STJ in neutral - bisect upper 2/3 o |
|
|
OSCE Tibial influence
|
- patient in standing position
- assure patient in angle & base of gait (march in place) - be behind leg being examined with eyes at ankle level - put STJ in neutral position - bisect lower 1/3 of leg - measure bisection line versus ground with goniometer |
|
|
OSCE Relaxed Calcaneal Stance Position
|
- patient in standing position
- assure patient is in their angle & base of gait (march in place) - be behind leg being measured with eyes at ankle level - align STJ into its resting or relaxed position - bisect upper 2/3 of calcaneous - use goniometer to |
|
|
OSCE Forefoot to Rearfoot Relationship MTJ
|
Goniometric measurement
- patient in prone position - rotate leg so longitudinal axis of calcaneous is perpendicular to ground - place STJ in neutral - Lock MTJ by applying dorsiflexing, everting, & abducting force on met heads 4 & 5 - one arm of goniometer parallel with planter surface of metheads and other parallel with plantar surface of calcaneous - measure wether patient has forefoot varus or forefoot valgus Forefoot Measuring device - bisects upper 2/3 of calcaneous - handle of device on bisection -base of protractor is placed parallel with met heads - lock out MTJ & take measurement - Read # of °s of forefoot varus or valgus indicated on protractor |
|
|
OSCE First Ray Range of Motion
|
- pateint in either supine or prone
- pateint's knee extended - longitudinal axis of calcaneous is perpendicular to ground - place STJ in neutral - lock MTJ by applying dorsiflexing, everting & abducting force on met heads 4 & 5 - Stabalize metatarsal hea |
|
|
OSCE Ankle Dorsiflexion
|
- patient in supine position with knee extended
- place STJ in neutral - align hinge of goniometer with lateral aspect of calcaneous - one arm of goniometer with fibula and other arm with along 5th ray - pace dorsiflexory force along ENTIRE plantar aspect |
|
|
OSCE Malleolar Position
|
- patient in supine position
- patients knee extended - patients leg is on frontal plane - place STJ in neutral - pateints ankel at 90° - bisect medial malleolus and bring line distal down to plantar surface of foot - bisect lateral malleolus in similar f |
|
|
The MTJ functions to:
|
a) accomodation to terrain
b) smooth transition from lateral to medial in stance phase of gait. c) maintenance of forefoot loading during late midstance while STJ supinates |
|
|
The talonavicular joint is similar to a _____ joint with almost limitless ROM.
|
a) ball and socket
|
|
|
The calcaneo-cuboid joint is a _______ joint
that is _____ in the saggital plane and _____ in the frontal plane. |
saddle type, concave, convex
|
|
|
The calcaneo-cuboid joint has motion in
|
) all three planes
|
|
|
: Which ligament does not contribute to limit the pronation and supination of the MTJ?
|
transverse cuboidal
|
|
|
The MTJ motion occurs around two independent axes which are both oriented in an _____ direction.
|
anterior medial dorsal
|
|
|
The longitudinal axis of the MTJ is oriented _____?
|
15 degrees from transverse plane
8-9 from sagittal plane |
|
|
The longitudinal axis is more closely aligned to the ___ and ___ planes. The motion is predominantly _____.
|
transverse, sagittal, frontal
|
|
|
Frontal plane motion of the MTJ long axis allows?
|
midfoot to respond to variations in rearfoot
|
|
|
The oblique axis is oriented?
|
52 degrees from transverse
57 degrees from sagittal |
|
|
: The oblique axis is oblique to both ___ and ____ planes.
|
transverse, sagittal
|
|
|
oblique axis motion is coupled with
|
dorsiflexion, abduction
plantarflexion, adduction |
|
|
The oblique axis allows compensation for?
|
equinus
|
|
|
Oblique axis ROM is?
|
22 degrees
|
|
|
ROM of the MTJ is controlled by the position of the _____?
|
STJ
|
|
|
what decreases MTJ ROM because the axes are more oblique to each other?
|
b) STJ supination
|
|
|
Locking mechanism of the MTJ occurs with MTJ?
|
pronation
|
|
|
Locking mechanism is assisted by action of which three muscles.
|
posterior tibial, peroneus longus & brevis
|
|
|
Motions in the “grounded” segment (MTJ) are seen as ____ in the proximal segment (STJ).
|
equal and opposite
|
|
|
Appropriate motion of MTJ in gait facilitates smooth ____ of rearfoot?
|
eversion and inversion
|
|
|
During the contact period, MTJ ROM increases with ______.
|
) STJ pronation
|
|
|
The MTJ longitudinal axis _____ as the tibialis anterior fires to control plantarflexion
|
supinates
|
|
|
The MTJ oblique axis _____ as the long extensors and peroneus terius fire.
|
pronates
|
|
|
In midstance, MTJ ROM decreases with _____ of STJ. (both LAMTJ and OAMTJ pronate).
|
supination
|
|
|
In the propulsive period, a supinated STJ maintains a?
|
locked MTJ (rigid lever)
|
|
|
In the propulsive period, the LAMTJ is ____ allowing the peroneals to shift weight from the laterl to medial side of the foot.
|
pronated
|
|
|
In the propulsive period, the windlass mechanism causes the forefoot to be?
|
adducted and plantarflexed
|
|
|
The windlass affect is attributed to?
|
plantar aponeurosis
|
|
|
In the swing phase, the oblique axis is ____ by pull of the long extensors and the longitudinal axis is ____ by pull of tibialis anterior.
|
pronated, supinated
|
|
|
A structural abnormality in which the plantar plane of the forefoot is inverted to the rearfoot.
|
forefoot varus
|
|
|
Which is not a possible etiology of forefoot varus?
|
dorsiflexed cuboid
|
|
|
A structural abnormality in which the plantar plane of the forefoot is everted to the rearfoot?
|
forefoot valgus
|
|
|
A relatively fixed supinated position of the forefoot relative to the rearfoot caused by soft tissue adaptation?
|
supinatus
|
|
|
A forefoot compensation where the forefoot is completely on the ground?
|
completely compensated
|
|
|
: If the forefoot varus is 3 degrees or less the STJ will compensate?
|
by 3 degrees or less
|
|
|
if the forefoot varus is greater than 3 degrees the STJ will compensate?
|
to its end range of motion.
|
|
|
Forefoot valgus compensation is by
|
inversion
|
|
|
What happens first in forefoot valgus compensation? (remember LASOS)
|
longitudinal axis of MTJ inverts
|
|
|
What happens second in forefoot valgus compensation? (remember LASOS)
|
STJ supinates
|
|
|
What happens third in forefoot valgus compensation? (remember LASOS)
|
Oblique axis of the MTJ supinates
|
|
|
What happens fourth in forefoot valgus compensation? (remember LASOS)
|
STJ supinates more
|
|
|
In both fully and partially compensated forefoot varus the STJ remains _____ during the entire gait cycle.
|
pronated
|
|
|
The above question causes an “apropulsive gait” which means?
|
no active propulsion of the digits
|
|
|
signs or symptoms of a completely compensated forefoot varus?
|
a) tailors bunion
b) callus of submet 2 c) muscle fatigue d) hallux abducto valgus |
|
|
sign or symptom of a partially compensated forefoot varus?
|
a)callus of submet 4 & 5
b) knee strain medially c) knee strain laterally |
|
|
when watching a person with forefoot valgus in gait, the first half of midstance the foot is?
|
supinated
|
|
|
when watching a person with forefoot valgus in gait, at the end of midstance there is ______ of the STJ.
|
pronation
|
|
|
when watching a person with forefoot valgus in gait, in late propulsion the foot?
|
supinates
|
|
|
A forefoot valgus with MTJ longitudinal axis compensation may show all of the following signs and symptoms?
|
a) contracture of lesser digits
b) callus of submet 1&5 c) lateral knee strain |
|
|
: First ray motion _____ with STJ pronation and _____ with STJ supination
|
increases, decreases
|
|
|
In the stance phase, starting in late midstance and ending in late propulsion, the first ray motion is ______?
|
plantarflexing
|
|
|
In the stance phase, starting in late midstance and ending in late propulsion, the first ray motion is plantarflexing, the first ray positions in gait are?
|
plantarflexed, everted
|
|
|
The 1st ray position in gait in the swing phase?
|
dorsiflexed, inverted
|
|
|
Abnormal STJ pronation in propulsive phase of gait results in?
|
hypermobility of 1st ray leading to 1st
MTPJ subluxation |
|
|
1st Ray hypermobility in the transverse plane can lead to?
|
a) forefoot adductus
b) halux abductovalgus |
|
|
1st ray hypermobility in the sagittal plane can cause?
|
a) forefoot rectus
b) hallux limitus/rigidus |
|
|
characteristics of a plantarflexed 1st ray?
|
a) 1st ray abnormal motion
b) STJ pronation in propulsion c) forefoot is everted to rearfoot d) 1st ray is hypermobile e) apropulsive gait f) (LA S.O.S) compensation g) unstable hallux, MPJs, lesser digits h) structural abnormality of 1st ray |
|
|
characteristics of forefoot valgus?
|
a) 1st ray normal range of motion
b) STJ pronation in propulsion c) forefoot is everted to rearfoot d) 1st ray is hypermobile e) apropulsive gait f) (LA S.O.S) compensation g) unstable hallux, MPJs, lesser digits h) structural abnormality of MTJ |
|
|
characteristics of metatarsus primus elevatus?
|
a) structural abmormality – 1st ray is elevated
b) metatarsal head is prominent dorsally c) STJ slightly pronated or neutral in propulsion d) 1st ray unstable, MPJs not well stabilized e) excessive weight is borne on 2nd metatarsal head f) apropulsive gait |
|
|
: If the forefoot (1st ray) is unstable during the propulsive period (apropulsive) then the muscle of the foot and leg?
|
work harder to stabilized the foot causing muscle fatigue
|
|
|
A plantarflexed 1st ray, forefoot valgus, and metatarsus primus elevatus have the following in common?
|
a) STJ pronation during propulsion
b) 1st ray unstable – hallux limitus/rigidus c) MPJs and lesser digits unstable d) apropulsive gait e) muscle fatigue |
|
|
The overall take home message about pathology within the first rays is?
|
it produces and unstable 1st ray
segment with an apropulsive gait |
|
|
The 5th ray motion is?
|
triplanar
|
|
|
5th ray total ROM is?
|
20º
|
|
|
5th ray motion is coupled with?
|
a) dorsiflexion with eversion
b) plantarflexion with inversion |
|
|
MTPJs motion in transverse axis is?
|
dorsiflexion, plantarflexion
|
|
|
MTPJs motion in the verticle axis is?
|
abduction, adduction
|
|
|
____ amount of dorsiflexion is required from the MTPJs during normal walking.
|
65º
|
|
|
For MTPJs, plantarflexion is or is not required for normal walking?
|
is not
|
|
|
the digits dorsiflex in the ______ period of stance to create a stable platform.
|
propulsive
|
|
|
The MTPJs are stabilized by the ______?
|
flexor digitorum longus
|
|
|
Sagittal plane deviation of the MTJ would bring the oblique axis almost parallel to the ankle axis creating?
|
almost pure plantar/dorsiflexion
|
|
|
Sagittal plane medial deviation of the MTJ increases the _____ forces at the oblique axis.
|
pronatory
|
|
|
What occurs as the sagittal plane deviation of the MTJ approaches horizontal?
|
midfoot breakdown
|
|
|
Midfoot breakdown causes?
|
the medial arch to be flat
|
|
|
which is not a sign or symptom of medial deviation from the sagittal plane?
|
forefoot valgus
|
|
|
Superior deviation from the transverse plane of the oblique axis is sometimes referred to as? (most common type of deviation seen)
|
vertical oblique axis
|
|
|
With Superior deviation of the oblique axis, more _____ and ____ is seen
|
adduction, abduction
|
|
|
Midfoot and Talar adduction cause the leg to medially displace over the calcaneus with body weight causing?
|
STJ to pronate
|
|
|
Signs and symptoms of superior deviation from the transverse plane are all of the following...
|
a) medial collateral knee pain
b) chondromalacia patellae c) Patella tendon strain d) prominent talar head medially e) C-shaped calcaneo-cuboid joint |
|
|
A change of structure, position or function of one part in response to forces created by a demand from a preceeding or superseding part.
|
compensation
|
|
|
Motion in which the foot moves to adjust for terrain or deviations in the position of the trunk or lower extremity.
|
Normal compensation
|
|
|
Motion in which the foot moves to adjust for abnormal structure or function of the lower extremity.
|
abnormal compensation
|
|
|
Theorem 1 states that
|
the heel will always attempt to purchase the ground unless prevented by limitation of motion.
(called PURCHASE) |
|
|
: Theorem 2 states
|
states the rearfoot will always try to compensate perpendicular unless influenced by some proximal or distal force.
(called REARFOOT PERPENDICULAR) |
|
|
: Theorem 3 states that if driven to valgus more than 2 degrees beyond perpendicular, the rearfoot will
|
(called REARFOOT FALLTHROUGH)
fall to its end ROM in direction of eversion |
|
|
In theorem 4, If the rearfoot is unable to purchase with normal ankle dorsiflexion, the MTJs will?
|
unlock and maximally pronate against a
maximally everted foot. (called EQUINUS) |
|
|
Theorem 5 states that the forefoot loads under the _____ and compensates by the _______. Therefore the forefoot compensates primarily in the direction of _______ from its fully loaded neutral position.
|
lateral, medial, inversion
called FOREFOOT LOADING |
|
|
According to theorem 6, which is the correct order of forefoot compensation?
|
Long MTJ axis, STJ, Oblique axis of MTJ, STJ
called FOREFOOT SEQUENCING) |
|
|
: According to theorem 7, the metatarsal parabola will splay in a predictable direction as the foot goes through the motions of supination and pronation. The splay pattern for pronation is?
|
4th met doesn’t move, 1-3 medial, 5th lateral
called METATARSAL SPLAY) |
|
|
According to theorem 7, the metatarsal parabola will splay in a predictable direction as the foot goes through the motions of supination and pronation. The splay pattern for supination is?
|
4th met doesn’t move, 1-3 lateral, 5th medial
(called METATARSAL SPLAY) |
|
|
Normal forefoot compensation to when the rearfoot inverts is?
|
forefoot will invert
It can’t evert because once the FF is on the ground, it cant evert along the LAMTJ (theorem 5) |
|
|
Normal forefoot compensation to when the rearfoot everts is?
|
To keep the metatarsal on the ground via long axis of the MTJ (theorem 5)
forefoot will invert |
|
|
Normal rearfoot compensation when the forefoot inverts is?
|
rearfoot will do nothing
Unless the wedge(rock..etc) is large enough then it will invert (thereom 1 & 6) |
|
|
Normal rearfoot compensation when the forefoot everts is?
|
rearfoot will do nothing
Unless the wedge(rock..etc) is large enough then it will evert (thereom 1 & 6) |
|
|
The medial malleoulus determines the position of the ankle joint axis.
|
FALSE the lateral malleolus does
|
|
|
The ___ joint is the most stable joint in the lower extremity.
|
ankle
|
|
|
What makes the ankle joint so stable?
|
ligaments, shape of talus
|
|
|
ankle plantarflexion is limited by:
|
a) anterior talofibular ligament
b) deltoid ligament c) talus against the tibia |
|
|
Ankle dorsiflexion is limited by?
|
a) triceps surae
b) posterior talofibular ligament c) posterior deltoid |
|
|
The talar dome is wider posteriorly than anteriorly
|
false
It is wider anteriorly |
|
|
The talar dome being wider anteriorly than posteriorly leads to more stability especially in
|
dorsiflexion
|
|
|
The talar dome is wider ___ and smaller ____.
|
laterally medially
|
|
|
Congruency between the talar dome and the tibial plafond is 90%. How much lateral displacement of the talus can cause a 42% reduction in congruency?
|
1mm
|
|
|
Location of the ankle joint axis is just inferior of the?
|
medial & lateral malleoli
|
|
|
The axis of the ankle joint is directed?
|
laterally, posteriorly & plantarly
|
|
|
The ankle joint axis is
|
oblique to all three planes.
|
|
|
Motion in the ankle joint is
|
pronatory/supinatory with dominance in the sagittal plane.
|
|
|
with regard to ankle joint axis.
|
-axis is different from person to person
-axis is different from non-weight bearing to weight bearing more transverse plane motion in OKC -axis is constantly changing from dorsiflexion to plantarflexion |
|
|
What is the name of the test used to measure ankle joint ROM (dorsiflexion) called?
|
silfverskiold test
|
|
|
When measuring ROM on the ankle, what can go wrong?
|
pronating the STJ, allowing the knee to flex or hyperextend
|
|
|
What is the minimum ROM for dorsiflexion and plantarflexion of the ankle joint?
|
dorsiflexion 10, Plantarflexion 20
|
|
|
There is more ROM in the ankle joint as an adult than at birth.
|
false-Birth has 75⁰, adult has 5-10
|
|
|
In OKC dorsiflexion foot moves toward the tibia. In CKC, dorsiflexion tibia moves ...
|
anterior over planted foot
|
|
|
In OKC plantarflexion tibia moves posterior over planted foot. In CKC, plantarflexion foot moves away from tibia.
|
false
OKC – foot moves away from tibia CKC – tibia moves posterior over planted foot |
|
|
In OKC ankle joint movements are determined by:
|
position of the axis, shape of joint surfaces
|
|
|
: In OKC, ankle joint motion is controlled by?
|
collateral ligaments,integrity and stability of joint surfaces
|
|
|
In CKC, ankle joint movements are controlled by?
|
position of the axis, shape of joint surface
|
|
|
In CKC, ankle joint motion is controlled by?
|
ground reactive forces, muscles
|
|
|
At heel contact, ground reactive force posterior to the ankle joint cause a _______ moment.
|
plantarflexory
|
|
|
At heel contact, muscles anterior to the ankle?
|
contract to decelerate ankle plantarflexion
|
|
|
ankle joint in midstance is characterized by?
|
relative dorsiflexion as the body passes
over the weight bearing foot |
|
|
n midstance, excessive dorsiflexion of the tibia must be resisted or the person would fall forward. What muscles do this?
|
soleus, PT, FDL, FHL, some PL
|
|
|
In midstance, the femur continues forward as the tibia is decelerated by calf muscles and knee extension results. What to muscles work together to provide knee extension?
|
gastroc nemius, soleus
|
|
|
In terminal stance, ground reactive force anterior to the ankle result in?
|
dorsiflexion
|
|
|
In pre-swing, the ankle rapidly ________ reaching 20 degrees by toe-off.
|
plantarflexes
|
|
|
In the swing phase, muscles dorsiflex the ankle to allow toes to clear ground. What muscle is the major dorsiflexor is this process?
|
extensor hallucis longus
|
|
|
What define equinus?
|
<10⁰ ankle joint dorsiflexion w/ neutral STJ
10⁰ are needed as the tibia advance relative to the talus |
|
|
The soleus and grastrocnemius act to extend the knee by?
|
soleus pulling on tibia, gastroc pulling on femur
called a flexion moment |
|
|
The most common form of equinus (congenital or acquired) caused by tight gastrocnemius w/ less than 10 degrees of dorsiflexion w/ knee extended.
|
gastroc equinus
|
|
|
Equinus caused by a tight triceps surae and will have less than 10⁰ dorsiflexion w/ knee extended and flexed. Achillies tendon is taught
|
Gastrosoleal equinus
|
|
|
Equinus with an abrupt end to dorsal ROM due to impingement of tibiotalar articulation.
|
osseous equinus
|
|
|
This equinus has 10⁰ of dorsiflexion at ankle but functionally needs more because of a plantarflexed forefoot.
|
pseudo equinus
forefoot loads earlier due to anterior cavus foot |
|
|
A new etiology of ankle equinus is?
|
failure of translation of the fibula
|
|
|
which is not a feature we may see in gait of a person with equinus?
|
Genu Varum
|
|
|
proximal compensation mechanisms for equinus can be?
|
a) hip flexion
b) genu recurvatum c) lordosis |
|
|
There is insufficient ROM in ankle, STJ, or MTJ to permitt heel to contact the ground in this equinus (toe walker).
|
uncompensated
|
|
|
: In this equinus, there is sufficient ROM to permit the heel to contact the ground but insufficient motion to allow tibia to angulate 10⁰ to the foot during gait (bouncy gait).
|
partially compensated (no, it's not a personality thing!)
|
|
|
In this equinus, there is sufficient ROM to permit the heel to contact the ground and sufficient motion to allow tibia to angulate 10⁰ to the foot during gait. (arch flattening)
|
fully compensated
|
|
|
Clinical findings for uncompensated equinus include?
|
callus formation under ball of foot
,contracted lesser digits |
|
|
clinical findings for partially compensated equinus?
|
sheer callus submet 2
calf, thigh, lower back pain stress on articular surface of ankle joint |
|
|
clinical findings for fully compensated equinus?
|
a) HAV 2ndary to hypermobile 1st ray
b) sever calluses met heads 2,3,4 c) severe arch fatigue, leg cramps, thigh and lower back pain d) forefoot supinatus e) hammered 5th digit |
|
|
Increasing the resting length of the gastroc-soleus complex through stretching exercises or surgery is the only treatment for equinus.
|
false
heel lifts to decrease tension on achilles tendon is another method. |
|
|
Subtalar joint motion is
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triplanar
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The STJ axis runs?
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distal-medial-dorsal to proximal-lateral-plantar (dmd-plp)
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The STJ axis is:
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16° from sagittal, 42° from transverse, 48° from frontal
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MTJ motion occurs primarily in what plane about the longitudinal axis
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frontal
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Frontal plane motion is primarily?
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inversion / eversion
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MTJ motion occurs in what plane(s) about the oblique axis?
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sagittal and transverse
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MTJ motion in sagittal and transverse planes about the oblique axis is coupled how?
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50% dorsiflexion/ abduction with 50% plantar flexion /adduction
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MTJ longitudinal axis is 75 deg from the frontal plane it is essentially perpendicular to what plane?
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frontal
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If MTJ longitudinal axis is essentially parallel to?
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sagittal and transverse planes
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1st ray has equal motion in what planes
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frontal and sagittal
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1st ray axis is parallel to what plane?
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transverse
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STJ pronation affects 1st ray motion by?
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increasing motion
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STJ supination affects 1st ray motion by?
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decreasing motion
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5th ray motion is?
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triplane motion (pronation, supination)
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5th ray axis orientation is similar to?
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STJ
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The central 3 rays and IPJs motion occurs in?
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sagittal plane
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The central 3 rays and IPJs axis is?
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parallel to the transverse and frontal planes
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Motion occurs in the transverse plane about what axis?
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vertical
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Subtalar joint varus
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The heel is inverted to the leg in STJ NP (non-weight bearing)
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Rear foot varus is best described as
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STJ is in neutral position and heel is inverted to the ground (weight-bearing
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Rear foot valgus is
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when the STJ is in NP (weight bearing) and heel is everted to the ground?
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Tibial varum is when the STJ is in NP in stance and the distal aspect of the leg is _____ relative to the proximal aspect.
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inverted
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Tibial valgum (STJ in NP) in stance is when the distal aspect of the leg is ___ relative to the proximal aspect.
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everted
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Normal tibial varum in adults is?
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1-4 degrees
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The NCSP measurement is best described as
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Angle between the bisected calcaneus and the ground while in stance
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Normal NCSP values are?
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0-4º inverted
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What info NCSP will tell us?
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a) rear foot deformity
b) STJ NP + Tibial Influence c) position of the calcaneous in STJ NP stance |
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The angle between the bisection of the distal 1/3 of the tibia and the ground?
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Tibial influence
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RCSP is?
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angle between the bisection of the calcaneus and ground while in relaxed stance
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What does tibial influence tell us?
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information about the amount of rear foot deformity attributed to the tibia
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In RCSP the Subtalar joint is in its?
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relaxed position
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What does RCSP tell us?
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information about the position of compensation
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The compensation mechanism for rearfoot varus is?
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pronation of STJ
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The compensation mechanism in rearfoot varus allows the inverted calcaneus to?
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pronate to perpendicular
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What is the condition in which a person with rear foot varus has enough STJ eversion available to overcome the deformity (calcaneus eversion to perpendicular 0º)?
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compensated rearfoot varus
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What is the condition in which a person with rear foot varus has some STJ eversion available to reduce the deformity?
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partially compensated rearfoot varus
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A partially compensated rearfoot varus often has associated problems?
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lateral column problems (hyperkeratosis)
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If a compensated rearfoot varus has >4º inversion, then the resulting compensation is considered?
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hyperpronatory
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The compensation mechanism for rearfoot valgus is?
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STJ increased pronation
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If the NCSP shows <3 degrees of Rearfoot valgus, then?
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NCSP = RCSP (everted a little)
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If the NCSP shows >3 degrees of rearfoot valgus, then?
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STJ max pronation will occur
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If the NCSP show over 10 degrees of rear foot valgus, then?
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STJ max pronation + 2-3 degrees additional pronation
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factors affecting rearfoot position?
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a) STJ axis and relation to adjacent muscles
b) muscular dysfunction c) Subtalar varus & valgus d) Rearfoot varus & valgus e) tibial varum & valgus f) tarsal coalition |
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Fibularis brevis, longus, tertius and the extensor digitorum longus are considered?
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pronators
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The Tibialis anterior is considered?
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supinator
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Supinators insert on the _______ side while pronators insert on the _______ side.
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medial, lateral
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If the supinators are weak then the foot will?
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) pronate
(because the pronators overpower them) |
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If the pronators are weak, then the foot will?
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supinate
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If the STJ is restricted in motion due to an abnormal union between bones, the condition is called?
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tarsal coalition
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In propulsion an abnormal amount of STJ pronation leads to?
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hypermobility and abnormal shearing forces
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Hypermobility caused by STJ pronation during the propulsive phase leads to?
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joint subluxation
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Abnormal shearing forces caused by STJ pronation during the propulsive phase leads to?
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calluses
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similarities in rearfoot varus and equinus?
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both cause perstistant STJ pronation in contact and midstance with STJ remaining pronated in propulsion
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In rearfoot varus (large degree), the STJ undergoes ____ during propulsion, but remains pronated.
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supination
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In equinus, there is only a slight STJ pronation just before propulsion resulting in STJ subluxation.
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NOPE! Massive STJ pronation just before propulsion causing STJ subluxation
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