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25 Cards in this Set
- Front
- Back
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What is ankle or talipes equinus?
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It is a sagittal plane deformity in which there is < than 10 degrees of DF
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Where does ankle or talipes equinus occur?
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At the AJ when the STJ is in neutral and the MTJ maximally pronated at both axis
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Is ankle or talipes equinus muscular or osseus deformity?
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It is both, if muscular it involves the gastrocnemius and/or soleus
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What is the prevelence of equinus?
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Estimated to be 96% present in 96% of females with biomechanically related foot pain
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What is the aetiology behind equinus and LLD?
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- Congenital muscle shortage (contracture) of part or all of the tricep surae
- Osseus bloackage of DF due to breaking of tibia or altered anatomy - Tight hamstrings or iliopsoas requiring compensatory DF at ankle |
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An aetiology of LLD and Equinus is posterior muscle contracture..waht is it?
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Results of..Spastic paralysis, UMNL (upper muscle neuron lesion) such as cerebal palsy and CVA
- Tonic muscle spasms (response to painful area - can be overcome by constant force) - Dynamic muscle imbalance due to LMNL sych as polio affecting anterior group, resulting in unopposed posterior contracture |
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How does Davis' law relate in regards to the aetiology of equinus and LLD?
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Prolonged bed rest or wearing high heeled shoes
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How does excessive pronation of STJ or MTJ lead to LLD and Equinus?
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Decreased tension in posterior leg muscles
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What are the signs and symptoms of compensated LLD and equinus?
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-Foot excessively pronated during gait
- Midfoot collapse/break - Pronation induced pathologies such as HAV, neuroma and postural fatigue -One of the most destructive pathologies |
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What are the signs and symptoms of an uncompensated LLD and equinus?
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- Bouncy type gait (early heel lift or toe walking (more servere))
- Inc wb in ffoot, lead to callus on ball of feet + clawing of lesser digits - secondary hamstring contractures - Proximal compensation. Recurvatum of knee, forward postural position, inc lordosis of lower back, abd/add gait |
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What are the treatments for euqinus and LLD?
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- Stretching of tight structures (stretches/casting)
- Orthoses to control pronation - Heel lifts if symptomatology in tricep surae - Surgical lengthening |
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What are the 3 categories of Limb length discrepencies?
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- Structural
- Functional - Environmental |
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Describe the structural category of LLD..
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difference in actual length of tibia and/or femur. May be congenital, traumatic eg post surgical, infection, burn or developemental
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Describe the functional category of LLD...
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Bony aspects equal in length but function assymetrically eg scoliosis, pelvic tilt, assymetrical pronation in feet
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Describe the environmental category of LLD...
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uneven surfaces, shoe wear
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What are factors relating to how often and when to treat LLD and equinus?
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- Treat when symptomatic as a small amount may not affect some but disrupt others, depending on ROM and activities, also if greater than 1-2cm
- Must assess if treatment will cause less than the presenting situation |
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Describe how compensation for LLD may occur?
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May occur at any level
- STJ will pronate more on longer side, supinate on shorter - AJ will PF on shorter side - knee may flex, recurvatum, varum/valgum of longer leg |
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Compensation for LLD may occur at spine level, describe.
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Spine may:
1. not compensate - pelvis and shoulder drop on shorter side 2. lumbar and cervical scoliosis with tilt of shoulder/head to long side 3. Lumbar scoliosis with slight or no shoulder tilt on long side - hence shoulder tilt not a good indicator of long/short side |
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What are the 3 parts where sequelae may occur for LLD?
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Back pain, Hip pain, Lower limb compensation sequelae
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Back pain is a sequelae, describe.
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Scoliotic compensation causes compression of intervertebral discs which may cause herniation or OA. Asymmetrical muscle activity may cause nerve compression
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Hip pain is a sequelae, describe.
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Elevation of pelvis may cause a decrease in contact area of the femur in the acetabulum resulting in OA
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What is involved in the diagnosis of LLD?
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- Look for assymetrical symptoms (shoe wear, gait patterns)
- Diffrentiation between structural and functional |
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How do we look for structural LLD?
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- Measure of ASIS/umbilicus to lat/med malleolus
- Telescoping of knee (supine) or indirectly with lifts until pelvis even - Plain Xrays, CT or MRI |
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How do we look for functional LLD?
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ASIS to floor in NCSP and RCSP
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What are treatments for LLD?
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- Heel lifts if less than 1cm
- Orthoses with/without heel rain incorporated - Physiotherapy/chiropractic consultation especially with scoliotic or pelvic involvement |
