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66 Cards in this Set
- Front
- Back
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how many steps does a person take in a day?
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12,000
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how many lbs of pressure does a 150lb person transmit with a step.
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1,800,000lbs
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what part of the foot receives 60-75% of the pressure?
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the one square inch of the weight bearing heel
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how many miles are a pair of shoes good for for running?
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500-1000 miles
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what is the term for flat foot?
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pes planus; it can be congenital or acquired
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describe the differences in the acquired vs. congenital pes planus.
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CONGENITAL pes planus -the person has been flat footed since birth and the arch is usually rigid; you don't prescribe orthotics; ACQUIRED pes planus: the arch is normal when there is no weight and flat when weight was put on it (supple arch)
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in pes planus describe the talar bone and what happens to shoes.
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the talar head displaces medially and plantarward; the medial part of the shoe wears down
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name the symptoms of pes planus.
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pain over the spring ligament, pain or cramping in the tibialis anterior and tibialis posterior muscle
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what would cause a spring ligament sprain?
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running over uneven surfaces in soft shoes, everting the foot;
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where is the pain located in a spring ligament sprain?
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pain is over the calcaneonavicular potion of the spring ligament
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the gap between the ____ and the ____ bones is supported by the tibialis posterior tendon and the spring ligament.
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navicular and sustentaculum tali; as the talar head rotates it destroys the ligament
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name the etiologies for pes planus.
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genu varus; compensation for leg length inequality; external tibial torsion
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when measuring the tibial torsion you evaluate it by using the _____.
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thigh-foot axis
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what is the normal thigh-foot axis?
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0-30degrees
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external tibial torsion turns the foot _____. what degrees is the thigh-foot axis?
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lateralward; >30degrees
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how do you treat pes planus?
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can't treat congenital pes planus; if the arch is rigid, you must first make it soft in order to use an orthotic device; orthotics should be flexible
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the arch orthosis should ____ the foot when it is unloaded.
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touch
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This orthotic is a medial heel wedge that is used in pes planus, it supports the medial longitudinal arch.
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Thomas Heel
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Name the different arches and what they are for.
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Scaphoid Pad: insole support (weak muscles and plantar fascia); Thomas Heel (supports a valgus); medial Heel and sole wedges (for valgus)
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Name the complications of pes planus.
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tarsal tunnel syndrome; metatarsalgia, plantar fasciitis
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Tarsal Tunnel Syndrome is entrapment of ___ nerve beneath the _____ ligament.
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posterior tibial nerve beneath the Deltoid ligament
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What does TTS feel like?
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intense burning pain on the sole of the foot (causalgia)
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How do you treat Tarsal Tunnel Syndrome?
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correct the pes planus, arch orthotics, NSAIDs, local injection of corticosteriods, High dose Pyridoxine; lastly surgical decompression
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name the term for excessively plantar flexed arch that is more common in women and exacerbated by wearing high heels.
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pes cavus
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in pes cavus the symptoms of what other type of arch are present?
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pes planus
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what usually develops in pes cavus?
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hammer toes or claw toes; get splaying of the metatarsals and collapse of the transverse arch of the foot
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why do the hammer and claw toes present?
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the arch is congenitally high and its normal for the tendons; when the foot is unloaded and stretched, the tendons pull the toes back and create abnormalities
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in a pt with pes cavus their transverse arch is so high that only what metatarsals generally bear the weight of the body in gait?
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1st and 5th metatarsal
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where is the transverse arch located?
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directly behind the metatarsal heads
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a dropped 2nd metatarsal head is associated with ___.
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plantar callus
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what is metatarsalgia and name some things that are associated with it.
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pain that occurs in the metatarsal area; may be caused by splaying of the metatarsals, morton's neuroma, avascular necrosis, metatarsal stress fracture
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in general all forms of metatarsalgia may benefit from what?
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metatarsal bar - shifts some weight to the toes
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_____ is the most common occurence of wearing high heels.
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splaying of the metatarsals
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how do you treat the splaying the metatarsals brought on by too much high heel wearing?
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heel lift regression and using shoes with a narrower toe box
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what is and how do you get a Morton's Neuroma?
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it is a swelling of the digital branches of the plantar nerve with hypertrophy of the fibrous neural sheath; it occurs with repetitive microtrauma and compression from too narrow toe box (typically occurs b/w the 3 and 4th metatarsal
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how do you treat a morton's neuroma?
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you must correct the underlying problem and fix the abnormal foot mechanics and it will regress over time; may need special orthotics
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Avascular Necrosis of the metatarsal head is also called ____ and is esp. prevalent in what population?
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Freiberg Infarction; diabetics with impaired microcirculation
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X-ray reveals ___ initially and later ____ in avascular necrosis.
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osteosclerosis; followed by osteolysis
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Treatment for avascular necrosis is what?
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met. arch pad, bar, and no running or jumping for 6-12wks (don't know how this helps diabetics)
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This classification is used to measure the fracture of a 5th metatarsal.
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Jones Classification.
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Describe the type I Jones fractures.
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Type I: fracture line is well delineated; no sclerosis or periosteal rxn (tx: non-weight bearing cast or below knee boot for at least 6wks) healing may not be evident for at least 3 months
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Describe a type II jOnes fracture.
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Type II: fracture line is widened and sclerosis is evident; tx: non-surgical, takes longer to heal
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Describe type III JF.
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the widened fracture line is obliterated by sclerosis and/or periosteal rxn; there is presence of non-union; TX: surgical treatment is always required
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Describe the symptoms of plantar fasciitis.
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pain occurs on initial weight bearing upon arising from bed and goes away with use. it remains calm until increased activity like heavy walking, running, or fatigue.; very painful; exacerbated by hard surfaces
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Name the physical findings in plantar fasciitis.
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tenderness and swelling at the medial calcaneal tubercle; longitudinal arch collapse; Morton's Foot; May get a traction osteophyte - heel spur
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plantar fasciitis causes _____ hypertonicity.
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gastrocnemius hypertonicity
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PF may be associated with the onset of what GI problem?
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Crohn's Dz or Ulcerative Colitis
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Name some treatments for plantar fasciitis.
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correct the arch collapse, heel cushion, OMT (plantar fascia, arch springing); stretching, NSAIDs, corticosteriods, last resort: surgical excision of the heel spur
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where is the cuboid located?
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on the lateral side of the foot behind the styloid process of the 5th metatarsal.
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what tendon runs over the cuboid and goes under the foot and connects to the medial cuneiform bone all the way on the medial side of the foot?
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the fibularis longus tendon
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What tendon attaches to the styloid process of the 5th metatarsal?
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fibularis brevis tendon and is called the major everter of the foot
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what causes cuboid syndrome?
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inverted ankle sprain, stretches the fibularis longus and sends pain up the lateral leg
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what OMT tx can you use in cuboid syndrome?
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Cuboid Modification of the Hiss Whip Technique
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what is the term to describe osteoarthritis with bone spurring on the dorsal surface of the 1st metatarsal? what problems does it cause?
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hallux rigidus; prevents normal toe off in normal gait; causes pain when going uphill or on uneven ground
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person ends up not using his/her 1st toe while walking. what is the tx for hallux rigidus?
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Modify the shoe (Rocker Sole); OMT (toe technique); Surgery (Keller Procedure and Arthrodesis)
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what is a bunion?
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a hallus valgus where the 1st metatarsal sticks out; cause traumatic bursae to form and often see a pronated foot (everted); probably a congenital predisposition that is exacerbated by tight shoes
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where are the sesamoid bones located and what happens when they are inflamed?
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2 sesamoid bones are under the 1st metatarsal bones; if a pt has sesamoidiis the pt will avoid using the big toe when walking
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name a common joint that is subluxated in ballet dancers.
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subtalar joint aka talocalcaneal joint
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what happens if you don't tx a subtalar joint subluxation with DMR or a hiss whip technique?
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untx leads to achilles tendinitis
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describe the symptoms, physical findings, and diagnosis in a calcaneal stress fracture.
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symptoms: pain in the heel; PE: pain on lateral compression of the calcaneus; DX: MRI or Radionuclide Bone Scan
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what is bursitis and what is it caused by?
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it is a retrocalcaneal inflammed bursae caused by repetitive microtrauma usually caused by ill-fitting shoes; aka Haglund Deformity or Pump Bump
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name the term that describes a painful swollen achilles tendon esp. at its attachment to the calcaneous.
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achilles tendinitis (may be a side-effect of quinolone antibiotic tx)
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Name the symptoms, etiology and incidence of the achilles tendon rupture.
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symptoms: inability to plantar flex foot and can't stand on ball of foot; ETIOLOGY: sharp blow to taut tendon or landing hard on the ball of the foot; INCIDENCE: males age 30-55
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How do you dx a ruptured achilles tendon?
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The Thompson Test
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how do you check that the vasculature has not been compromised?
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check pulses of the Posterior tibial artery, Dorsal Pedal A, and blanch the nail beds
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what can you do for someone with arterial insufficiency?
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treat the sympathetics in the lower thoracic and lumbar levels (T10-L2)
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