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103 Cards in this Set
- Front
- Back
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cardinal planes of movement @ the ankle |
-DF/PF (sagittal)
-inversion/eversion (frontal) -abduction and adduction (transverse) |
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tri-planar motion @ the ankle
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-pronation/supination
-involves all 3 functional segments of F/A |
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closed chain pronation
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-calcaneus everts
-talus slides down toward calcaneous, forward and medially (adducts and plantar flexes) -tibia internally rotates |
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closed chain supination
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-calcaneus inverts
-talus slides up and backwards (abducts and dorsiflexes) -tibia externally rotates |
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clinical evaluation of foot types/tendencies
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-done in prone
-foot hanging off end -palpate/measure STJ neutral -observe rearfoot-on-leg relationship -observe forefoot-on-rearfoot relationship |
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problems associated w/ foot types/tendencies
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-over-pronators
-under-pronators/supinators |
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overpronation
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-usually flexible foot type (good accomodation to various surfaces)
-less rigid lever for push off |
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foot pathologies associated with overpronation
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-pes planus
-rearfoot varus -ankle joint equinus |
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pes planus
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-"flat feet"
-flattened longitudinal arches -plantar soft tissues are overstretched -can become fixed |
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causes of pes planus
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-trauma
-muscle weakness -ligamentous laxity -overpronated feet |
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rearfoot varus
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-aka calacaneal varus, subtalar varus, hindfoot varus
-excessive calcaneal inversion in STJ neutral -STJ needs to excessively pronate for the medial aspect of the calcaneus to reach the ground during mid-stance |
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forefoot varus
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-supination (inversion) of the forefoot on hindfoot in STJ neutral
-STJ may compensate by overpronating to bring medial aspect of forefoot to ground in midstance |
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ankle joint equinus
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-foot is in a PF position w/ ankle DF limited to <10 degrees
-may be bony block or gastroc/soleus shortening -can occur @ TMT or midtarsal joint -may compensate during gait w/ pronation of STJ and/or midtarsal joint |
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musculoskeletal conditions related to overpronation
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-plantar fasciitis
-metatarsalgia -morton's neuroma -metatarsal stress fractures -tibialis posterior tendinitis -fibularis longus tendinitis -pinch callus -tarsal tunnel syndrome -PFPS |
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PT management of overpronation
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-improve dynamic support AND/OR
-provide external support -for ankle equinus....stretch |
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outsole
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-rubber
-where tread is -contacts ground |
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upper
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-where laces are
-wraps around top |
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midsole
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-made of foams : EVA, PU
-provides cushioning or support -determines category of shoe -determines how much motion control the shoe has |
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heel counter
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-plastic
-rigid -helps provide motion control to rearfoot |
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last
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-not part of shoe
-form upon which shoe is built -3 types : straight, curve, semicurve (implications for how much motion is allowed) |
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shoe categories
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-cushioning
-stability -motion control |
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cushioning shoe
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-curved last
-less rigid heel counter -midsole is soft, provides cushion |
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stability shoe
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-straight last
-rigid heel counter -stiff midsole (arch built in, rigid enough that it will limit pronation) |
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underpronation
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-may be associated w/ pes cavus or forefoot valgus
-usually more rigid foot type (poor accomodation to various surfaces) -rigid lever for push off -higher forces transmitted up kinetic chain |
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pes cavus
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-high arched foot
-exaggerated longitudinal arches -shortened plantar soft tissues |
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forefoot valgus
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-pronation (eversion) of the forefoot on the hindfoot in STJ neutral
-medial forefoot loading occurs too early in stance -STJ remains relatively supinated throughout stance |
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musculoskeletal conditions related to underpronation
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-lateral ankle sprain and chronic instability
-tibial stress fractures/"shin splints" |
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PT management of underpronation
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-footwear (cushioning shoe)
-stretching/joint mobilization |
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ankle and foot joints
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• Tibiofibular
– Proximal – Distal • Talocrural • Subtalar • Transverse tarsal • Tarsometatarsal • Metatarsophalangeal • Interphalangeal |
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what type of joint is the Proximal tibiofibular joint
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plane synovial joint
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Proximal tibiofibular joint
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• Fibula
– Convex • Tibia – Concave • Ligaments – Anterior and posterior ligaments of the head of the fibula |
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Distal Tibiofibular joint
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• Fibrous (syndesmosis)
joint • Fibula – Convex • Tibia – Concave • Ligaments – Anterior and posterior tibiofibular ligaments – Inferior transverse ligament |
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Talocrural Joint
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• Hinge joint
– Plantar flexion/Dorsiflexion • Talus – Convex • Tibia and Fibula – Concave • Ligaments – Collateral ligaments |
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Lateral Ligaments
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• Anterior talofibular
• Calcaneofibular • Posterior talofibular |
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Medial Ligaments (Deltoid)
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• Anterior tibiotalar
• Tibionavicular • Tibiocalcaneal • Posterior tibiotalar |
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Subtalar Joint
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• Plane type synovial
joint – Inversion/Eversion • Talus – Concave • Calcaneus – Convex • Ligaments – Talocalcaneal |
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what are the foot joints?
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• Transverse tarsal
• Tarsometatarsal • Metatarsophalangeal • Interphalangeal |
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Transverse Tarsal Joint
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• Compound joint
– Talonavicular joint – Calcaneocuboid joint |
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Tarsometatarsal Joint
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• Plane type synovial joint
– Gliding/Sliding • Tarsal bones – Convex • Metatarsal base – Concave • Ligaments – Tarsometatarsal (dorsal, plantar, interosseous) |
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Metatarsophalangeal Joint
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• Condyloid type of
synovial joint – Flexion/Extension – Abduction/Adduction – Circumduction • Metatarsals – Convex • Phalanges – Concave • Ligaments – Collateral, plantar |
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Interphalangeal Joint
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• Hinge type synovial
joint – Flexion/Extension • Head – Convex • Base – Concave • Ligaments – Collateral, plantar |
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Movements Within the Ankle and
Foot |
• Dorsiflexion/Plantar
Flexion • Inversion/Eversion • Ab/Adduction |
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Plantar/Dorsiflexion
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• Plantarflexion 0–50°
• Dorsiflexion 0–20° |
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Weight Bearing Dorsiflexion
ROM |
• Inclinometer placed at
tibial tuberosity • Patient lunges forward – Heel remains in contact with the ground • Normal values 30–50° • Good reliability – ICC= .95–.99 |
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inversion/eversion
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• Inversion: 0–35°
• Eversion: 0–15° |
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is there more inversion or eversion in the ankle?
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more inversion (0–35)
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when you invert foot
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you are adducting foot
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when you evert foot
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you are abducting foot
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when you ab/adduct foot you
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are doing other movements as well. not just ab/adducting.
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Supination & Pronation
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• Supination
– Increasing longitudinal arch – Heel is inverted • Pronation – Flattening of the longitudinal arch – Heel is everted |
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Metatarsal Movements
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• MTP flexion
– Great toe (0 – 45°) – Digits 2 – 5 (0 – 40°) • MTP extension – Great toe (0 – 70°) – Digits 2 – 5 (0–40°) • IP flexion – Great toe (0 – 90°) – Digits 2 – 5 (0 – 35°) |
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what toe has greater movement?
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great toe!
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Arches of the Foot
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• Longitudinal Arches
– Medial – Maintained by the medial structures of the foot – Lateral – More stable (maintained by the lateral structures of the foot) • Transverse Arch – Maintained by the medial structures of the foot • Provide mobility and stability of the foot |
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what are the arches of the foot?
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1. longitudinal arches
2. transverse arch |
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Functions of the Arches
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• Mobility
– Dampen the impact of weight bearing forces – Dampen the superimposed rotational motions – Adapt to changes in the supporting surfaces • Stability – Distribution of weight through the foot – Conversion of the flexible foot to a rigid lever |
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Plantar Aponeurosis
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• Attaches to the
medial calcaneal tubercle and expands proximal phalanx of each toe • Increases in tension from the beginning to the end of stance phase • Example "truss and tie–rod" |
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plantar fashia: AKA
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aponeurosis
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what are the compartments of the muscles of the leg?
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• Anterior
– Tibialis anterior – Extensor hallucis longus – Extensor digitorum longus – Fibularis tertius • Lateral compartment – Fibularis longus – Fibularis brevis • Superficial Posterior – Gastrocnemius – Soleus – Plantaris • Deep posterior – Popliteus – Flexor hallucis longus – Flexor digitorum longus – Tibialis posterior |
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Muscles of the Foot
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• 20 individual muscles
– Plantar aspect (14) – Dorsal aspect (2) – Intermediate (4) • Plantar muscles function as a group – Stance phase to maintain arches – Become most active in last half of gait cycle |
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how many layers of the foot are there?
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4 layers
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what is the first layer of the foot?
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– Abductor hallucis
– Flexor digitorum brevis – Abductor digiti minimi |
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what is the second layer of the foot?
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– Quadratus plantae
– Lumbricals |
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what is the third layer of the foot?
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– Flexor hallucis brevis
– Adductor hallucis – Flexor digiti minimi brevis |
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what is the fourth layer of the foot?
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– Plantar interossei (3
muscles – Dorsal interossei (4 muscles) |
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what are the force distribution of the foot?
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• Talus 100%
• Calcaneus 50% • Talonavicular and calcaneocuboid joints 50% |
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what is the windlass mechanism?
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• Great toe extension OR foot supination can draw
hindfoot and forefoot together (raise longitudinal arch) • Foot pronation increases tension in plantar aponeurosis – Limits MTP extension |
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Lateral ancle sprain
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• Mechanism of injury
– Forced plantar flexion and inversion • Stepping in a hole • Landing on a foot • Just walking or running • Common lower extremity injury – Up to 30% of all injuries – About 1–2 million per year in the U.S. |
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Hallux Valgus
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• Degenerative joint
disease • Lateral deviation of great toe – May cause bunion • Treatment – Splinting – Exercise – Surgery? |
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Medial Tibial Stress Syndrome
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• Common overuse
injury • Periosteal irritation – Tibialis posterior origin • Stress fracture • Treatment – Relative rest – Orthotics – Ice – Exercise |
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Plantar Fasciitis |
• Multiple sources of pain |
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Spontaneous achilles tendon rupture is a potential adverse reaction to what antibiotics?
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quinolones
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What test can be done to check for achilles tendon rupture?
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thompson test
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What are some of the hallmarks of diabetic foot?
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callus, pressure point, adaptive footware
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What is the traumatic disruption of the second metatrsal joint?
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Lisfranc fracture
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What is the difference between bi vs tri malleolar fractures?
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trimalleolar involves the distal posterior aspect of the tibia as well as the medial and lateral malleolus
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What are the risk factors for stress fractures?
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young female athletes ,osteoporosis
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Forefoot problems are more prevalent in what gender?
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female (shoes)
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Sudden onset of severe calf pain like a gun shot or hit with a raquet may be an indication of what?
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achilles tendon rupture
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Where is an achilles tendon rupture most likely to be located?
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5–7 cm above calcaneus
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What is the treatment for achilles tendon rupture?
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RICE 5–6 days,Nonsurgical–graduated casting, heel cord stretching 7 days post injury,Surgical–casting 8–12 weeks, tapered heel lifts, physical therapy
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What ligaments are most commonly torn in ankle sprain?
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anterior talofibular and calcaneofibular ligaments
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What are some potential consequences of an untreated ankle sprain?
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chronic pain,instability,arthritis
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Casting a sprain for greater than 3 weeks has what potential consequence?
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stiffness,slower return to normal
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What are two other names for diabetic foot?
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Charcot arthropathy ,neuropathic foot
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What is a charcot joint?
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repetitive stress or trauma due to lack of proprioception resulting in deformity or subluxations
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What are some important principles of self care for diabetic foot?
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self inspection,no bare feet,no heating pads,no self excavation,proper shoes
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What kind of motion may lead to a trimalleolar fracture?
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rotation or twisting
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What is the most likely mechanism of calcaneal or talus fracture?
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high velocity (motor vehicle, falls)
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How are calcaneal/talus fractures treated?
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open reduction
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What other fractures should be checked for with calcaneal/talus fractures?
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lumbar fractures
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What is the treatment for a broken toe?
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buddy strap,closed reduction with local anesthesia
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What bone in the foot is most commonly associated with stress fractures?
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2nd metatarsal
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Morton's neuroma occurs most commonly between which toes?
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3rd and 4th
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Who is most likely to get a Morton's neuroma?
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women 5:1
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How is Morton's neuroma diagnosed?
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sqeezing metatarsals elicits pain and popping sound
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How is Morton's neuroma treated?
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wide, box toed shoes, cushioning, injection, surgery
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Pain directly over the calcaneal tuberosity which increases with standing or walking may be an indication of what condition?
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plantar fasciitis
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Who is most at risk for plantar fasciitis?
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overweight females
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What is the treatment for plantar fasciitis?
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heel pads,ice,NSAIDS,Injection
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Paresthesias and dysethesias from ankle to arch that increases with ambulation may be an indication of what condition?
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tarsal tunnel syndrome
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What is the treatment for tarsal tunnel syndrome?
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orthotics,surgery (generally poor outcome)
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Why are sprains to the 1st MTP x–rayed?
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to rule out avulsion fracture
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What is turf toe?
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sprain to the 1st MTP |
