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257 Cards in this Set
- Front
- Back
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Toe most commonly affected by osteoarthritis
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Great toe
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Nerve that gives special sensation between the 1st and 2nd toes
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Deep Peroneal n
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Antagonist of the Posterior Tibialis
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Peroneus Brevis
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Statistics associating foot problems and age
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99% normal at birth
8% trouble-1st year 40% trouble- 5yrs old 80% trouble by 20yo |
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What type of joint is the ankle?
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Hinge/Ginglymus Joint
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Foot absorbs ______ and balances the body.
Acts as a _______lever in supination Acts as a ______ _______ in pronation |
Shock
Rigid Mobile |
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Bones involved and Keystone of the Medial Longitudinal Arch
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Bones: calc, talus, navicular, cuneiforms 1/2, metatarsals 1/2
Keystone: head of the talus |
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Bones involved and Keystone of the Lateral Longitudinal Arch
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Bone: Calc, cuboid, 4/5th metatarsals
Keystone: Cuboid |
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Most important bone in the foot
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CUBOID
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Bones involved and Cornerstone of the Transverse Arch
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Bones: Cuneiforms 1/2/3, Cuboid
Cornerstone: Cuboid |
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Bones involved in the Anterior Transverse Arch
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Bones: Metatarsals 1-5 (proximal to metatarsal heads)
Shaded Golden Arch |
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How many bones in each foot
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26
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How many ligaments in the foot
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107
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how many muscles in the foot
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19
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Characteristics of the Talus
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*Part of talo-crural joint
*Seat of upright posture *NO MUSCULAR ATTACHMENT *Talar Dome: between the tibia/fibula |
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When bone of the foot has no muscular attachments?
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Talus
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Characteristics of the Cuboid
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*common subluxation/fixation area
*it is a Cornerstone AND a Keystone *ALWAYS involved with foot problems *related to fibular head subluxations *treatment with Cuboid Rock |
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What bone of the foot is always involved with foot problems?
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Cuboid
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What is the treatment of a displaced Cuboid?
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Cuboid rock
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Characteristics of the 4th Metatarsal
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*common site for Stress Fracture and Morton's Neuroma
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What are the characteristics of Morton's Neuroma?
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Fibrous adhesions between mets 3/4
Well localized pain Callous with random re-growth of nerve |
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Characteristics of the 5th Metatarsal
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*common Avulsion site (btw 5th and Styloid)---very painful to walk on forefoot
*Peroneus Brevis attachment |
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How many sesamoid bones are in the foot and where are they?
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2- under the great toe
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With a dislocation and _____ _____ often fracture the sesamoid bones
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Hallux Valgus
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Characteristics of the Lateral Malleolus
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*Avulsion site- with high ankle sprain (injury at syndesmosis)
*BOOT fracture will happen here |
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2 bones of the LE that are non-weight bearing
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Fibula and Patella
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Where does a Boot Fracture occur (bone landmark)
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Lateral Malleolus
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What soft tissue structure:
an avascular zone of 2-4cm above the calcaneus |
Achilles Tendon
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Loss of dorsiflexion of the Achilles Tendon with aging is associated with what (3) things?
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1. Pronation at Midstance "too long"
2. Spontaneous Rupture (>40yo) due to being sedentary too long and then trying to do something active 3. Loss of Stability |
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How we sleep can influence what soft tissue structure?
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Achilles Tendon
Plantar Fascia |
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Dorsiflexion of the GREAT toe leads to elevation of the talo-navicular cuneiform complex; problems arise due to the fact that Plantar Fascia is inelastic!
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Windlass Effect
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the Windlass Effect is when dorsiflexion of the great toe leads to what?
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Elevation of the talo-navicular cuneiform complex
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Treatment of problems associated with the Windlass Effect
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Fixation of the talo-navicular cuneiform complex
Wearing a 'night-splint/boot' |
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What are the soft tissue structures of the foot/ankle?
(6) |
Achilles Tendon
Plantar Fascia Spring Ligament Deltoid Ligament Talofibular Ligament Neuroma |
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What are the 3 Talo-Fibular Ligaments?
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Anterior (I)
Calcaneal (II) Posterior (III) (viewed on LATERAL ankle) |
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How are Ankle Sprains graded?
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I, II, III
I: if Anterior T-F lig hurts II: Calcaneal T-F lig hurts, ATF torn III: if all 3 hurt: PTF sore, ATF torn --significant disability |
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What is the most common type of ankle sprain?
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Plantar Flexion-Inversion Sprains
(80%) |
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What is the Spring Ligament?
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Plantar calcaneonavicular ligament
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What deformation can occur with the Spring Ligament?
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*Plastic deformation with Pronation
*Pes Planus= Flat Foot (may benefit from restoration of medial longitudinal arch height) |
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Which side of the ankle are the Deltoid Ligaments located?
List the Deltoid Ligaments (4) |
Medial side
1. Anterior Tibiotalar(ATT) 2. Posterior (PTT) 3. Tibiocalcaneal 4. Tibionavicular |
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What is Morton's Neuroma?
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*re-growth of nerve tissue usually from irritation or trauma
*MC between 3rd and 4th metatarsals *not actually a tumor! *feels like walking on a marble |
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Treatment of Morton's Neuroma
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Cortisone
to demineralize bone and shrink the size of the neuroma |
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ROMs of the Ankle
(AID PEAb) |
Adduction: 20*
Inversion: 30* Dorsiflexion 20* Plantarflex 40* Eversion 20* Abduction 10* |
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ROMs of the Great Toe
(Flex/Ext) |
Flex: 45* (plantarflex)
Extension: 70* (dorsiflex) |
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Mechanism of Injury
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How you get hurt:
Overuse/Overtraining Training Injury |
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What types of flooring are bad for training?
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Astroturf
Our Gym Floor |
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Symptoms of:
1. Over-reaching 2. Over-training |
1. sore 1-2 days
2. sore several days |
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Mechanical defects that may contribute to a Mechanism of Injury (4)
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Pes Planus
Tarsal Coalition Pathologic Pronation Toe Deformities (hammer/claw/mallet toe, hallux valgus) |
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Describe the Hard Level Floor Theory
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From industrialization of cement flooring in society shoes have become a necessity to protect our feet. (Good for everything except our feet)
Shoes have become a soft cast on the foot and prevent our muscles from developing properly or cause them to atrophy. Leads to problems in the mm of the foot -->posture -->poor body mechanics. Creates wear and tear injuries such as plantar fasciitis or Achilles tendon problems |
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What theory describes the following points:
1. Unrelenting Stress on the foot 2. Lack of Proprioception in the foot 3. Soft cast nature of shoes |
Hard Level Floor Theory
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Percentage of people who wear shoes too small
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60%
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Non-mechanical causes of "Mechanism of Injury"
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Hard Level Floor (theory)
Poor Quality Shoes Obesity |
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What is the % of obese Americans?
What is it predicted to be in 2050? |
60% current
100% by 2050 |
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Obesity is now considered a DISEASE in the US because... (3)
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1. places excessive stress on knees
2. Increased force of ground contact 3. Q Angle (Diseases can only be treated by drugs--controversial) |
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How do Shin Splints present?
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"garbage can" diagnosis
*Vague anterior shin pain *Pain on medial border of tibia with pressure |
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Shin splints always involve what muscle?
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Posterior Tibialis
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What are some causes of shin splints?
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Poorly conditioned athlete
"Training Error"- too much, too soon |
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Treatment for Shin Splints?
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Foot Drills
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Characteristics of Foot Drop
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(fairly rare)
*peroneal nerve damage *L4/L5 disc injury *weak Tib Ant (80% of Dorsiflexion is from Tib Ant-- therefore will have significant loss) *seen with peripheral neuropathy or diabetes |
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Signs of an Achilles Injury
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*Pain with Plantar Flexion
*Rubberband feel around tendon |
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Treatment of Achilles Injury
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Eccentric lifts (slow lowering)
- to strengthen gastroc/soleus |
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Common presentation of Myofascial Trigger Points (MFTP)
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"Constellation Pattern" in...
Soleus Posterior Tib Flexor Hallicus Longus Gastroc Peronei |
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Characteristics of Adhesions
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*Scar/Connective Tissue
*70% as strong as healthy tissue **Consistency of oak tag folder (cover on an old book) |
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Reiter's Syndrome includes...
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Polyarthritis
Conjunctivitis Urethreitis (Reitter's is an STD) |
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Reiter's Syndrome occurs more in which sex?
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Males
50:1 |
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"Cannot see, cannot pee, cannot dance with me"
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Reiter's Syndrome
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Black Toe define/characteristics
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repeated micro trauma ruptures of the capillaries of the toe
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What causes Black Toe
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"Pawing" action of toes
--basketball, court sports, marathon running, hikers |
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Treatment of Black Toe
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Cross file nail bed with Emory Board
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Postural Muscles
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maintain our posture
-slow-oxidative, glycolytic -red fibers SOLEUS is the most important because it is closest to the ground |
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Most important muscle in the lower extremity according to AK
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Soleus
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o As a result of many repetitions of a skill or technical element, the fundamental nervous processes of excitation and inhibition become properly coordinated
this results in.... |
Stable, well-coordinated, efficient and fine motor skills
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Main goals of ankle rehabilitation are (5)
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1. restore ROM
2. strengthen joint capsule 3. restore proprioception 4. regain ligament strength 5. restore function |
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_______ is more important than strength when it comes to reflex muscular stimulation of a joint
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Speed
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Direct measure of proprioception
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Postural Sway
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Proprioceptive training heightens ________ control and benefits human movement
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Postural
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Homunculus
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Hands/Face have the largest representation
Foot/Ankle much less |
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Neuroplasticity
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nerves can be trained
via footwork/plyometrics |
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The process of restoring someone to a useful life who has been ill, injured or otherwise handicapped
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Rehabilitation
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4 Goals of Rehabilitation
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1. Immediate: swelling, limiting de-conditioning
2. Restore ROM, strength, balance, endurance 3. Test to return to activity 4. Resume training for lifestyle, occupational or performance demands |
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-Physical work where performance based outcomes are the goal
-May not be a natural or healthy thing to do for your body |
Training
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Green Zone vs Red Zone
(Training) |
Green: can do w/o pain
Red: painful |
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Rhythmic vs Stabilization
(Training) |
Rhythmic: bike, swim, run
Stabilize: Bosu, Yoga, Core strengthening |
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Recommending sets, reps, frequency, intensity, density, etc.
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Exercise Prescription
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Activation of muscles important for
good posture, control of repeated movements, control of gain (less wear and tear on body) |
Balance
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Alexander Technique for actors, singers, etc. places emphasis on _______
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Body Posture
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Signs of instability of the pelvis
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-Constellation pattern of MFTPs
-Trendelenberg Sign -Poor Red Fiber muscle actions -Poor Core stability |
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Balance is important in sports for ________ and ________
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speed actions
accuracy (1/100th second clap demo) |
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ADLs
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Activities of Daily Living
-what is taken into account in lawsuits i.e. getting dressed, walking, etc |
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85% of foot injuries are....
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Sprained ankels
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Why do people sprain ankles? (2)
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1. poorly developed neural pathways
2. previous injury-->muscular atrophy-->loss of proprioception-->functional instability-->reinjury |
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What to do when someone sprains their ankle
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Leave shoe on (so can't swell)
Long-axis traction of the foot/toes |
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Cause of Chronic Ankle Sprains
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lack of adequate proprioceptive input and consequent dysregulartory mechanism of CNS… the brain is forced to program our movements without sufficient information (i.e. Proprioceptive input)
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How to improve proprioceptive input (2)
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1. challenge the system
--one leg drills, balance shoes, balance board work, plyometrics, classic balance techniques 2. clarify the pathways |
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Factors that negatively affect proprioception (4)
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1. Focus -- body can only focus on one thing
2. Fatigue -- muscular, CNS, nutritional, diet, disease, vaccination 3. Histological Factors -- genetic impediments of nerves/tissues 4. Inflammatory Responses --swelling gets in the way, macrophages proliferate, can lead to degeneration |
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Osteoarthritis = ____________
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DJD
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Avulsion Fracture
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bone pulled apart
-indicates tendon may be stronger than the bone (why sometimes a break is better than tearing a ligament) |
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Salter Harris Fractures
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Fracture at the growth plate
Types I-V Type II is MC Type V: Compression fracture |
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Sharpey's fibers attach to the
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Periosteum
--with poor proprioception; Sharpey's Fibers will be tugged and can created Tendonitis |
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Periosteum has an inner ______ layer which is more metabolically active
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Cambrium
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Cortex/Compact Bone
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Densest and Strongest of all bone
Haversian Canal Lamellar bone (thin plates) Strong indicator of bone tumors and cancers |
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Endosteum
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membrane lining the medullary cavity of bone
*web-like; covering trabeculae in medulla *also covers Inner Cortical Margins |
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Medulla
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Inner cavity of bone
*transverse by thin, inner connecting trabeculae |
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Apophysis
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site of muscular attachments
common avulsion area Most famous Apophysis= Tibial Tubercle (Osgood-Schlatters) |
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Site of Osgood-Schlatters
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Tibial Tubercle
(Most famous Apophysis) |
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Longest part of the bone
Thickened cortex |
Diaphysis
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End of growing bone
-composed of cartilage -fuses with shaft at skeletal maturity (16-25yo) |
Epiphysis
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Most metabolically active site of bone
-common site of tumors and infections (because metabolically active) |
Metaphysis
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Why is the Metaphysis a common site of tumors and infection
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it is metabolically active
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AKA epiphyseal growth plate, bone growth center, epiphyseal growth plate
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Physis
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-Cartilage growth plate btw Metaphysis and Epiphysis
-adjacent layers responsible for providing longitudinal growth of bone -radiolucent during skeletal development |
Physis
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Parents worry if child injures this part of the bone
--worried about stunted growth, shortened limb |
Physis (epiphyseal growth plate)
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#1 rule of radiology
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2+ images!
(usually A-P, and L-->M) **want the 2 views to be perpendicular |
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ABCDs
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Alignment
Bones Cartilage/Discs Destruction Soft Tissue |
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What are you inspecting in A of ABCDs
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Alignment
• Are the lines of the bones smooth with natural breaks (must know normal) • Use knowledge of posture; is there… (listhesis, rotation, malposition) |
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What are you inspecting in B of ABCDs
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Bones
• Count the # of bones (CV, TV, LV, bones in wrist, etc) • Note the cortex (abnormal/’pencil-thin’ densities; abnormal lucencies) • Note the medulla (trabeculae patterns) |
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What are you inspecting in C of ABCDs
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Cartilage/Discs
Well-maintained disc heights? Medial side knee bears 80% weight • Vacuum phenomena? (Accumulation of Gas) • Evidence of erosions? |
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What are you inspecting in D of ABCDs
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Destruction
*Evidence of… • Bony pathology (various forms of arthritis) • Systemic disease (cancers) • Metabolic disease (localized infection) |
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What are you inspecting in 's' of ABCDs
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Soft Tissue
Evidence of: *Edema *Foreign Body *Artifact |
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Fractures involving the Epiphyseal (Physeal) Plate
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Salter-Harris Fracture
(I-V) |
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MC Salter Harris Fracture
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Type II: Shear Stress Fracture
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Salter Harris- Compression Fracture = Type ____
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V: Compression Fracture
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What are you looking for on an xray of the HIP
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OA
DJD SCFE-slipped capital femoral epiphysis Acetabulum Protrusio Smith-Peterson Pins |
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What are you looking for on an xray of the KNEE
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OA
Fracture Osgood-Schlatter's |
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What injuries/anomalies are you looking for on an xray of the Foot
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Pott's Fracture
Gout DJD/OA Polydactyly |
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Hip OA vs Knee OA (on radiograph)
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Both: joint space narrowing, osteophytes, sclerosis (whitening)
Knee: intra-articular bodies, articular deformity, MEDIAL side prevalence (decreased joint space=pathogenic sign) |
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Pathogenic Sign of Knee OA on Radiograph
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Medial Side decreased joint space
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Hip DJD
Clinical Signs |
*Decreased ROM (flex/aBduction),
*External rotation of the thigh/foot *MAY have unrelenting pain (cannot bear weight/standing) |
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Hip DJD
Radiographic Signs |
Decreased Joint Space
Osteophytes Sclerosis (whitening) (all same as OA HIP) |
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Slipped Capital Femoral Epiphysis (SCFE)
(HIP) Clinical Signs |
Salter-Harris Type I (epiphysis has slipped off bone)
*adol males>females; blacks>whites *10-15yo *rapid growth period=increased shear stress *Avascular necrosis 1.5% **Heals with short limb** |
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Acetabulum Protrusio
(HIP) |
Medial migration of femoral head through pelvis
Obliterated Kohler's Tear Drop Causes: *RA/DJD *Female Triad *Neoplasm |
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Smith-Peterson Pins
(HIP) |
Hip Fracture from STRESS
*Callous formation (Xray) *Subsequent spontaneous hip fractures |
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Closed Femoral Fracture
(Knee) |
Fibula (osteoporosis) because fibula is a non-weight bearing bone
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Osgood-Schlatters
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MC: Adol. Males
Macro/micro trauma (jumping activities) Pain, swelling, tenderness at TIBIAL TUBERCLE Usual loss of flexion at knee |
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Pott's Fracture
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aka Boot Fracture
*6-7cm above the lateral malleolus *leaping or jumping *Less severe=high ankle sprain |
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Gout of Great Toe
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Cause: excessive human indulgence (wine, fatty foods, etc. without enough water)
*Increased serum uric acid *Precursor to heart disease **Greatest at big toe because farthest from heart |
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DJD of the Great Toe (1st MTP)
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MC area of DJD in the LE
*associated with Hallux Valgus= BUNION *joint is stressed in forward locomotion **can lead to DJD later on in life--altered gait--LBP |
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Polydactyly
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excess # of digits
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Injury to tendon that may arise from instability or loss of balance
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Tendonitis
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training component that trains speed qualities, "stretch-shortening" cycle
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Plyometrics
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Anisotrophic:
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quality of joint to be used in the plane that it was designed for
I.e. Elbow moves in sagittal plane, Knee flexes/extends |
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"Too much, Too soon"
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Overuse syndrome
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Repetitive Motion Injury
examples |
Assemby line
"I love Lucy" |
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Overtraining syndrome
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Fatigue-->Over Reaching -->Over Training -->Chronic Fatigue
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Why did Selye choose the word "stress?"
|
his English was not yet strong enough to distinguish between stress and strain (Stress for Life)
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_____________deficiencies can cause both tight muscles and defective connective tissue
|
Magnesium
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_____________may produce alteration of the patellar reflex. Reflex is not altered in Meralgia Parathetica
|
L3 Disc Prolapse
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Lateral Postural Analysis
|
Observe from the feet UP:
Lateral malleolus, Knee, Greater trochanter, AC joint, EAM, Coronal Suture |
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P-A Postural Assessment
|
Foot Posture
Knees: Varus/Valgus Hip height 12th rib Inferior angle of the scapula Shoulder height (hand dominant side will have lower shoulder b/c lat dorsi and levator scap) Ear lobe height Head tilt Chin visible? |
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A tight psoas will present how on the WEAK side
|
Toe-in
Pronation of foot |
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A tight psoas will present how on the TIGHT side
|
High pelvis/hip
Reactive scoliosis |
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A tight piriformis will present how
|
Left foot toes out
Sciatic problems Piriformis syndrome --if clear up piriformis problem the sciatic problems should regress |
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Anterior shear is a good way to stretch the _________
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Psoas
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A weak Glut Med will present how
|
Elevation of right hip/shoulder/ear
*Right PI listing usually indicates R Glut is stronger (Trendelenberg sign) |
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Glut Med is necessary for _______________ stability
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Medial and Lateral
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A weak glut medius, tight piriformis, +/- tight psoas that exists for a period of time can lead to...
|
excessive 'wear and tear'
ultimately will lead to injury |
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____% of all athletic injuries involve the foot and ankle
|
15
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_____%of running injuries are from the knee down
|
79
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a FOOSH injury generates how much force at the ground?
|
3-5x body weight
|
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Female basketball players are ___times more likely to have an ACL injury than males
|
8x
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Why do people get hurt?
|
Poor balance, Weak Feet
Poor practice design, Poor diet Poor condition/anatomical adaptations, Improper rest, Unstable core, Accumulation of Fibrous Material, Accidents** (only one out of our own control) |
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Age-related nature of Injuries
Girls (<15yo) |
Instability 78%
Stabilize with: balance boards, strength training, yoga |
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Age-related nature of Injuries
Women |
Overuse, Alignment 34%
causes increased Q angle, pathological pronation, genu valgus, female triad |
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Age-related nature of Injuries
Boys (<15yo) |
Growth Plates 29%
*knee, heel, elbow, Salter-Harris fractures, Osgood Schlatter's |
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Age-related nature of Injuries
Men |
Overuse 81%
|
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What area is most prone to injury (chronic overuse)?
|
Musculotendonous Junction
|
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Common Repetitive Motion injuries
|
Strains, Sprains, Tendonitis
|
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Psychological issues that may cause injuries
|
Compulsive behaviors
Anxiety or Depression (VERY important to understand secondary factors) |
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Exception to "train movements, not muscles"
|
SNATCH movements
--use every muscle in body in 1-2seconds |
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Dynamic stabilizers that need to be specifically trained anisotrophically
|
Glut Med
Tib Post Adductors |
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Must be able to do this if going to perform plyometrics
|
Squat 1.5x bodyweight
|
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"Negatives"
Downhill skiers use these types of exercises Strongest action of the body --requires longest recovery Must be used sparingly |
Eccentric Strength
|
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Core Stability does NOT = _______
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Core Strength
|
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Proprio responsiveness of intrinsic muscles
*Ability of trunk muscles to stabilize torso in order to accelerate limbs *Trained with balance activities and rotational movements **Red Fiber= Strength and Speed |
Core Stability
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Torque
|
Rotary "stretch" reflex
Allows for greater generation of power Extremes can cause injury **Elasticity and Anatomical Adaptation** (think of when you throw a ball far) |
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________ stabilizes shoulder girdle
|
Rotator Cuff
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________ stabilizes scapula
|
Serratus Anterior
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_______stabilizes wrist
|
Forearm
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Wrist and fingers are important for ______ strength
|
grip
|
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Heel cups can prevent ___________
|
bruising of the calcaneus by gathering the fat pad
(less is more, hard heel cups are much better than soft/gel ones) |
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Abductors and Adductors provide ________ and ________ stability
|
Medial
Lateral |
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_______ abductors and adductors will help eliminate medial-lateral sway
|
Strong
|
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When prevention is a planned priority the majority of illnesses and injuries will __________
|
decrease or disappear
|
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Varus Wedge
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in the heel of a shoe; tilts the heel into a supinated position
ie. Brooks shoes |
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Navicular drop test is for _____
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pathologic pronation
=1cm |
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Velocity of mid-foot pronation is created by ___________
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Tibialis Posterior
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Subtalar Neutral
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15* Dorsiflexed
Angle at which orthotics should be cast |
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High foot temperatures are useful in identifying patients with ________ or those at risk for _________
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Diabetes
Foot Ulceration/s |
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_____________ due to structural imbalance can expose the kinetic chain to harmful forces such as abnormal shearing, bending, or torque
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Poor biomechanics
|
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5% of all ________cases are from faulty foot posture
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sciatic
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Tight shoes inhibit ____________
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shock absorption
|
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Calliet's Triad says that...
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Foot and Ankle pain must always be caused by either:
*Abnormal stress on normal structure OR **Normal stress on abnormal structure OR ***Abnormal stress on Abnormal structure |
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Process of Foot Exam
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1. History/Mech of Injury
2. Inspection- DASED 3. Palpation- MALT 4. Can the patient bear weight? 5. Can the patient heel walk and toe walk? 6. Quick check of L5-S1 |
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Navicular Drop Test is done for __________
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Pathologic pronation
|
|
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How is the Navicular Drop Test Performed?
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Shoes off, seated. Place mark at navicular.
Measure height of navicular non-weight bearing followed by weight-bearing If drop is >1cm= + sign **obviously there is a degree of variability (if patient is very large/tall/etc.) |
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Insole
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where foot touches the sock liner
|
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Outer Sole
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where rubber meets the floor
|
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Midsole
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wears out FIRST
*will get lateral knee pain, patellar pain, and/or SI joint pain when this occurs |
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Heel Counter
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helps to hold the heel in position
|
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Rocker Bottom Shoe Design
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Activates Windlass Effect!
Supination at midstance-->Increased stress on plantar fascia-->foot problem of the 90s *can lead to plantar fasciitis |
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Foot/shoe problem of the 90s
|
Rocker Bottom Shoe Design
|
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Part of the shoe that wears out 1st
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Midsole
|
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Goals of Orthotics (lots)
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oDecrease shock
oDecrease ground reaction forces oRealign foot •Attain subtalar neutral oAbsorb shear stress oControl velocity of mid-foot pronation •Reduce: Lateral-medial “whip” of Bowstring Effect |
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Orthotics may help... (lots)
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oPes planus
oStress Fractures oPlantar Fasciitis oShin Splints oKnee Pain oAchilles Problems oForefoot Varus oFlexor Hallicus Rigidus •Sustained trauma, obesity, etc. oLow Back Pain |
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3 Types of Orthotics
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1. Semi-rigid (MC)
2. Rigid 3. Soft |
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Semi-Rigid Orthotic
|
MC orthotic
*Realign foot into neutral position *Absorb shear stress (all types do this) *Decrease shock |
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Rigid Orthotic
|
*Realign foot into neutral position
*Absorb shear stress (all types of orthotics do this) ****does not decrease shock like Semi-Rigid and Soft orthotics do |
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Soft Orthotic
|
*Absorb shear shock (all orthotics do this)
**Decrease shock ****does not realign foot into neutral like Rigid and Semi-rigid do |
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General casting of an Orthotic Cast
|
*foot in subtalar neutral (old way)-- Digital Force Plate (New and BEST way)
*weight bearing or semi weight bearing |
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Modifications of orthotics
|
Posting- heel
Rearfoot Varus Wedge (calcaneus in varus) Forefoot posting (for toe-in) Heel Cups (cushion 49%) Metatarsal pads (support Anterior Transverse Arch, lifts and separates MTs, good for Morton's Neuroma) |
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Which orthotic modification may be beneficial for those suffering from Morton's Neuroma?
|
Metatarsal pad
|
|
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HIPPRONEL
|
History
Inspection Palpation Percussion ROM Orthopedic Tests Neuro Testing Exams (xrays, etc) Labs |
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History (of HIPPRONEL)
|
Mechanism, and
Location: Point (to spot): torn muscle tissue Trace (area): nerve problem Circle: more vague muscular problem (i.e. trigger points) |
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Assessment/Diagnosis Tools
|
POMP
HIPPRONEL Radiology Gait Analysis Posture Analysis Listings Pronation/Supination |
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Great Toe most often affected in
|
OA
and Gout |
|
|
Landmark bone of the foot's largest arch
|
Head of the Talus
(Medial Longitudinal Arch) |
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|
5th metatarsals are susceptible to ___-
|
Avulsion
|
|
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Largest range of motion at the ankle
|
Plantar flexion
|
|
|
Common metatarsal stress fracture site
|
4th Metatarsal
|
|
|
Good exercise to prevent Achilles problems
|
Eccentric lifts
|
|
|
The 'seat' of upright posture
|
Talus
|
|
|
Foot injuries seen with recurrent ankle sprains are indicative of what?
|
Instability
|
|
|
Possible cause of Multiple Sclerosis
|
Climate
|
|
|
A grotesque representation of the body's motor/sensory
|
Homunculus
|
|
|
Muscle regeneration is ___x faster than nerves
|
7
|
|
|
A difficult clinical challenge
|
Repetition
|
|
|
Feldenkrais
|
a balance technique
|
|
|
Largest part of the Homunculus
|
Hands
|
|
|
Potential cause of CNS compromise
|
vaccination
|
|
|
A distraction maneuver
|
Jendrassik's maneuver
|
|
|
Healing bone shows a _______ on a radiograph
|
Callous
|
|
|
3 Components of Posture
|
Listhesis
Rotation Malposition |
|
|
Systemic precursor of heart disease
|
Gout
|
|
|
Lost with medial migration of the femoral head
|
Kohler's tear drop
--Acetabulum Protrusio |
|
|
Loss of joint space in OA of the knee will occur where
|
Medial side
|
|
|
MC type of Salter-Harris Fracture
|
II
|
|
|
Strongest portion of bone
|
Cortex
|
|
|
What causes an SCFE-slipped capital femoral epiphysis?
|
Shear force
|
|
|
Muscular attachment of growing bone
|
Apophysis
|
|
|
Acidic body pH is an example of a
|
physiological injury
|
|
|
L3 disc prolapse may alter this reflex
|
Patellar
|
|
|
Rotary Stretch Reflex
|
Torque
|
|
|
Protects the calcaneal fat pad
|
Heel Cup
|
|
|
Tight piriformis causes
|
Toe out
|
|
|
Process for diagnosing foot problems
|
Calliet's Triad
|
|
|
DASED is which part of HISTORY
|
Inspection
|
|
|
______ pronation causes calcaneus valgus
|
subtalar joint
|
|
|
MALT
|
Malpositions
Anomalies Landmarks Tenderness |
|
|
What supports the Anterior Transverse Arch (in an orthotic)
|
Metatarsal Pad
|
|
|
CKC: Head of the Talus goes "______"
|
DAM
Down Anterior Medial |
|
|
CKC: Muscle that controls velocity of mid-foot pronation. Poorly conditioned in almost everyone)
|
Posterior Tibialis
|
|
|
CKC: Tibia and Femur have ______ Rotation
|
Internal Rotation
--tibia leads action |
|
|
CKC: Piriformis and Psoas initiate ______
|
Eccentric Contraction (decelerating)
*usually poorly conditioned and coordinated |
|
|
CKC: Anterior and Inferior tilt of the _______
|
Sacral base (due to unlevening of pelvis)
Leads to rotation of L5 |
|
|
CKC: Facet imbrication occurs when
|
Rotation of L5
Facet imbrication (contralaterally) to prevent further rotation (painful to the touch) |
|
|
CKC: Lumbar Reactive Scoliosis happens on what side and in response to what?
|
Convexity on side of ground contact (leg in reverse C)
-reverses with the next step to produce sway (normal) |
|
|
CKC: Weak hips can cause:
|
knee problems
ITB syndrome tracking problems patellar tendonitis **weak muscles!! Obturator internus/externus, gemelli, etc |
