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68 Cards in this Set

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Malleolar torsion
13-18 ext rotated
Ankle joint ROM
-10 DF with knee extended
-gastrocs are tight with less then 10 degrees in flex and extension
-20 degrees PF
-note that these degrees are from neutral or past 90 degrees
-total of 30
-20 inversion
-10 eversion
when the STJ is in neutral, the calcaneal bisection should be paralell to what, and perpendicular to what
-parallel to bisection of lower 1/3 of the leg
-perpendicular to the supporting surface
how much dorsal and plantar excursion should the 1st ray (met and cuneiform) have
-equal amounts up and down (5mm) from a level equal with the 2nd met
how much dorsal and plantar excursion should the 5th ray have
-equal excursion dorsal and plantar from a level of the central 3 mets
upon WB, where should the bisection of the posterior surface of the calcaneus lie
what should the relationship of the forefoot and rearfoot be to each other
paralell to each other
what if the ankle DF is less then 10 when the knee is flexed or extended
-there is an osseous or soleus equinus
ankle dorsiflexion is only less then 10 with extension
gastroc equinus
STJ neutral
-point that divides the medial 2/3 of motion from the lateral 1/3 of motion
-30 total (20 inversion, 10 eversion)
-minimum of 8-12 for normal ambulation
how much movt should the 1st ray have and how to you test that
-5 mm above and 5 mm below the lesser mets
-stabilize mets 2-5 and grasp the 1st met head and move it up and down
what is normal malleolar torsion
13-18 externally rotated
normal hip rotation
-45 internal and 45 external
-total ROM 90
what is angle of gait and what is its norm
-number of degrees that the foot is deviated from the line of progression of gait
-7-10 abducted from the line of progression
what is NCSP and what is RCSP
-NCSP is the angular relationship b/w the bisection of the calcaneus and the ground when STJ is in neutral
-RCSP is degrees the calcaneus bisector deviates from perpendcular with the groun when the STJ is in a relaxed state and the pt is standing in angle and base of gait
symptoms of RF varus (calc is inverted relative to the ground when STJ is in neutral)
-callus plantar 4th and 5th met heads
-tailors bunion
-haglunds deformity
-inversion ankle sprains
-adductovarus of 4th, 5th
-mild HAV
symptoms of RF valgus (calcaneus is everted relative to the ground when STJ is neutral)
-callus plantar 2nd met head (occasionally)
-fatigue muscles
-arch pain
-HAV deformity
symptoms of FF varus
-callus plantar 2,4, and/or 5th met head
-muscle fatigue
-tailors bunion
-adductovarus of 4th, 5th
-plantar fascitis/heel spur
adductovarus is common effect of what foot deformities
-RF and FF varus
symptoms of FF valgus (PF 1st ray)
-callus 1st and 5th met heads
-tibial sesamoiditis
-lateral knee strain
-flexion contracture of lesser digits
symptoms of met primus elevatus (1st ray has a resting position above the plane of the lesser mets)
-callus 2nd met and hallux IPJ
-dorsal bunion
-hallux limitus/rigidus
symptoms of equinus
-corn of 5th toe
-adductovarus of 4th and 5th
-HAV deformity
-plantar fascitis/heel spur
-neuroma symptoms
-contracture of all the digits (extensor substitution)
what is extensor substitution
-occurs when the anterior muscles are weak
-the EDL is then recruited to raise the foot in swing phase
-the EDL then overpowers the lumbricals that normally equalize the EDL pull and you get digital contractures
what is flexor substitution
-occurs when there is a weakness in the major calf muscles (Gastrocnemius and Soleus muscles), and other tendons, including those that flex the toes
-Flexor Digitorum Longus tendons) are recruited to help the foot in heel-off. Because of their overuse, the flexor tendons to the toes overpower the extensors, and hammertoes may develop.
what is the MC cause of hammertoes
-flexor stabilization
-This occurs in patients who excessively pronate
-the FDL is recruited to stabilize the foot. But because the muscle attaches to the toes by way of a tendon, it begins to overpower the small muscles (Interosseous muscles) that stabilize the toes, and the toes contract.
-Adductovarus rotation of the fourth and fifth toes, (where the toes rotate on their sides), is commonly seen with this condition.
what is the relationship b/w axis of motion and plane of motion
-axis of motion is always perpendicular to the plane in which the motion takes place
-the motion takes place in one plane and hte axis lies in the other two planes
the greater the amount of degrees b/w an axis of motion and a cardinal body plane, what will happen to the amount of motion that occurs in that body plane
-motion will increase
range of DF and PF of the ankle
20-30 DF
30-50 PF
-only 10 DF from neutral needed for walking
what joint has triplanar motion (pronation and supination)
STJ (its axis lies oblique to all three plane)
MTJ (bc it has two axes)
1st ray
5th ray
where is the axis of the STJ located and where does it run
-42 from transverse and frontal
-16 from sagittal
-enters the heel and exits out the dorsal talar neck
STJ has an axis that is oblique to all three planes giving it triplane motion, how does the MTJ have triplane motion
-the MTJ has two axes (oblique and longitudinal)
what plane of motion does the oblique axis of MTJ move in, the longitudinal axis?
-oblique axis permits motion in transverse and sagittal (ab/add and DF/PF)
-longitudinal axis permits motion in frontal plane (eversion/inversion)
what bones does the 1st ray consist of
-1st met and medial cuneiform
which joint has a 1:1 ratio of sagital and frontal plane motion
-eventhough the 1st ray is triplanar, most of its motion is in the sag and frontal
-when it DF 1 degree, it also inverts 1 degree
-when it PF 1 degree, it also everts 1 degree
the 2nd, 3rd and 4th rays, as well as digital IPJ allow motion in what plane
-they are all uniplanar and produce purely sagittal plane motion
how many axes do the MPJ have
-two (transverse and sagittal)
how is the first MPJ a hinge (ginglymus) and an arthrodial joint (sliding)
-it acts as a hinge joint for the first 25 of DF
-then acts as a sliding joint with the 1st met PF and MPJ dorsiflexing after the intial 25 degrees
what does degrees of freedom of a joint mean
-it refers to the numbers of axes of a joint
-the ankle and most foot joints have one DOF
-the MPJ and MTJ each have 2 axes and thus 2 DOF
what bones does the 5th ray consist of
-the 5th met
-unlike the 1st ray consisting of 1st met and medial cuneiform
what planes of motion does the 5th ray permit movt in
-mainly the sagital and frontal (very little transverse)
Antetorsion of the femur is about 35-40 degrees at birth and untwists to 12 by adulthood, what if the adult remains in antetorsion
what is normal tibial torsion in an adult and how is it measure
-18-23 external
-measured by malleolar torsion which is 5 degrees less
if a infant has abnormal tibial torsion due to osseous (not soft tissue) deformity, how can you treat it
-it is rigid osseous deformity so you can use serial above the knee casting followed by maintenance with a Ganley splint or D-B bar
what does a reverse tailors sitting postion manifest in a child
-medial femoral torsion (anteversion)
-can cause knock knee
stance phase is the largest part of the gait cycle, what happens here
-heel strike and foot hits supinated
-foot flat (pronation is shock absorber due to internal leg rotation)
-heel lift
-toe off (resupination as rigid lever due to ext leg rotation)
as the gait progresses from the heel to the ankle to the forefoot what happens to the hip and knee
-when the ankle PF when the foot moves from heel contact to midstance the knee and hiip are flexed
-as the ankle starts to PF to toe off, the hip and knee extend to accelerate the WB leg into swing phase
summarize the action of the anterior muscles during gait
-the TA, EDL and PT are active at toe off and DF the foot
-remain active during swing
-show peak activity at heel strike to deccelerate the foot as it strikes the ground
summarize the action of the posterior muscles during gait
-TP, soleus, gastroc, plantaris, FHL, FDL
-fire during contact and terminate during propulsion to acheive heel off
Formula for calculated neutral calc position
=eversion -TROM/3 ; a positive number is valgus or neutral, negative is varus or neutral. This is STJ neutral, add tibial component for NCSP
A a
Calculate neutral position if eve is 10 and inver is 20
Minimal STJ ROM needed for ambulation
Calculate neutral position of the hip if: IR = 55, ER = 35
=IR – TROM/2; 55-90/2 = 10 Internal
From neutral position how much does the hip rotate Int and ext if IR = 55, ER = 35
TROM/2 = 45 in this case, so from neutral position the hip rotates 45 degrees in each direction
From neutral position how much does the hip rotate Int and ext if IR = 10, ER = 40
TROM/2 = 25 in this case, so from neutral position the hip rotates 25 degrees in each direction
Calculate neutral position of the hip if: IR = 10, ER = 40
=IR – TROM/2; 10-50/2 = 15 External
How does FF supinatus differ from FF varus
FF supinatus is a fixed position of the FF, where the FF is max pronated and locked about both MTJ axes caused by ST adaptation
What is the relationship between an axis of motion and a cardinal body plane
the greater the distance (up to 90 degrees) between an axis of motion and a cardinal body plane, the greater the amount of motion that will occur in that body plane
If an axis is oblique to all THREE body planes, what type of motion does this allow for
triplanar (pronation and supination) P: ab/evr/DF. Sup: add/inv/PF
Calculate STJ neutral position if: Maximum calc inversion right (12) ,left (15); maximum calc eversion right (6), left (3), with tibial varum 1 degree bilaterally.
Formula: TROM/3 – evr (Right 0, Left 3 varus)
Calculate NCSP if: Maximum calc inversion right (12) ,left (15); maximum calc eversion right (6, left (3), with tibial varum 1 degree bilaterally
Formula: neutral position (from TROM/3 – evr) plus any tibial component. So Right has NCSP of 0 + 1 varus = 1 varus, left has NCSP of 3 RF varus + 1 varus = 4 RF varus
Calculate RCSP if: Maximum calc inversion right (12) ,left (15); maximum calc eversion right (6), left (3), with tibial varum 1 degree bilaterally
since this yields a RF varus (RSCP) of 3 degrees on the right and 4 degrees on the left, this individual will compensate at the STJ to bring the calc to perpendicular to the ground using all STJ pronatory ROM, since pronation is 1/3 of the TROM of 18 degrees, you have 6 degrees available which will bring the NCSP of both sides to ) degrees.
Calculate STJ neutral position, NCSP and RCSP if: Calc inv Right 16, Left (15), calc eversion right (2), left (3); tibial varum Right (3), left (2)
STJ neutral: Right 4 inv, Left 3 inv. NCSP: Right 7 varus, Left 5 varus. RCSP Right 1 varus, Left 0,with the STJ still having 1 more degree of compensation remaining on the left
How do you calculate STJ neutral position
with the formula TROM/3-eversion (positive is varus, negative is valgus)
How do you calculate NCSP
adjust your STJ neutral position with the amount of tibial varum that is present
How do you calculate RCSP
adjust your NCSP with the amount of compensation you have available with pronation, remembering that you have 1/3 of the TROM available for pronation compensation
What is the relationship of the oblique and longitudinal MTJ axis at maximum supination
the axes are divergent, they are parallel in pronation