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foot ankle biomechanics
foot ankle biomechanics
297
Anatomy
Graduate
09/30/2012

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Term
what are the triplanar motions of pronation?
Definition
dorsiflexion, eversion, abduction
Term
in what plane does dorsiflexion occur
Definition
sagittal
Term
in what plane does eversion occur
Definition
frontal
Term
in what plane does abduction occur
Definition
transverse/horizontal
Term
what will likely happen if a patient is hypomobile with a certain movement at a joint
Definition
the same movement will occur/become hypermobile at a different joint in the same plane
Term
which of the joints in the foot/ankle are oriented in a pure vertical direction
Definition
none
Term
which of the joints in the foot/ankle are oriented in a pure AP direction
Definition
none
Term
what does motion in each plane depend on
Definition
motion in each plane depends on the degree to which the triplanar joint axis is aligned perpendicular to the plane of interest
Term
what is the direction of the axis that gives motion in the sagittal plane
Definition
medial lateral
Term
what motion of the distal segment on the proximal segment occurs in the sagittal plane with pronation
Definition
dorsiflexion
Term
what motion of the distal segment on the proximal segment occurs in the sagittal plane with supination
Definition
plantarflexion
Term
what is the direction of the axis that gives motion in the frontal plane
Definition
anterior-posterior
Term
what motion of the distal segment on the proximal segment occurs in the frontal plane with pronation
Definition
eversion
Term
what motion of the distal segment on the proximal segment occurs in the frontal plane with supination
Definition
inversion
Term
what is the direction of the axis that gives movement in the horizontal plane
Definition
vertical/longitudinal
Term
what motion of the distal segment on the proximal segment occurs in the horizontal plane with pronation
Definition
abduction
Term
what motion of the distal segment on the proximal segment occurs in the horizontal plane with supination
Definition
adduction
Term
what 2 bones make up the subtalar joint
Definition
talus, calcaneus
Term
with your leg on the ground, describe the movement of the talus and calcaneus in ankle dorsiflexion
Definition
talus plantarflexes on stable calcaneus
Term
when your foot is not on the ground, what is the motion at the subtalar joint that gives ankle dorsiflexion
Definition
calcaneus dorsiflexes on stable talus
Term
what is the motion of the talus when it plantarflexes on the calcaneus in order to dorsiflex the ankle with the foot on the ground
Definition
talus moves inferiorly
Term
what must move inveriorly with the talus when it moves inferiorly
Definition
navicular
Term
what part of the body is the leg
Definition
knee joint center to ankle joint center
Term
what bone is the primary mover at the subtalar jointto have ankle abduction with the foot off the ground
Definition
calcaneus abducts, taking the rest of the foot with it
Term
what bone is the primary mover at the subtalar joint to have ankle abduction with the foot on the ground
Definition
talus adducts to give you relative abduction of the foot
Term
how can you tell when a person adducts at their subtalar joint to give relative foot abduction?
Definition
medial pooch of the shoe
Term
what to do if a person adducts their talus at the subtalar joint to give relative abduction of their foot?
Definition
give them a shoe with a firm heel counter that comes up high and far anteriorly/medially
Term
what is the main purpose of the subtalar joint
Definition
help with shock absorption and maintaining balance on uneven ground
Term
what is the problem with pushing joints to the end of their available motion?
Definition
reduces contact area, and increases contact force (from tightening ligaments) thereby increasing contact pressure, thereby destroying articular cartilage
Term
what are the components of contact pressure?
Definition
contact force/contact area
Term
does articular cartilage have a nerve supply
Definition
no
Term
how do people feel pain with increased pressure on their articular cartilage?
Definition
the pain comes from pressure on subchondral bone
Term
what do we call a foot that is always supinated
Definition
cavus
Term
will a straight lasted or curve lasted shoe be more comfortable for someone with cavus foot
Definition
curve lasted
Term
is a cavus foot hypermobile or hypomobile
Definition
hypomobile
Term
what kind of shoe is better for cavus foot: firm or flexible?
Definition
flexible
Term
why is a flexible foot better for cavus foot
Definition
a cushier, more flexible shoe helps make up for the hypomobile supinated/cavus foot
Term
is a pronated foot more hypomobile or hypermobile
Definition
hypermobile
Term
is the navicular medial or lateral
Definition
medial
Term
is the cuboid medial or lateral
Definition
lateral
Term
where are the 3 cuneiforms
Definition
distal to the navicular
Term
what 2 bones make up the hindfoot
Definition
talus, calcaneus
Term
what 5 bones make up the midfoot
Definition
navicular, cuboid, 3 cuneiforms
Term
why are high heels bad for ankle sprains
Definition
already risky in sagittal plane (already plantarflexing), also narrow base contributes to wobbling in frontal plane
Term
what are 3 issues that contribute to lateral ankle sprain injuries
Definition
1. medial malleolus doesn't extend as far distally as lateral malleolus; 2. lateral ligaments are weaker than medial ligaments; 3. plantarflexion is the open packed position and also the position in which the weakest ligament has the greatest stretch
Term
what is the most common type of ankle sprain
Definition
inversion ankle sprain/lateral ligaments
Term
what usually goes along with an eversion ankle sprain
Definition
fracture
Term
are the lateral or medial ligaments stronger?
Definition
medial ligaments are stronger
Term
why is the incidence of OA at the ankle less than for knee, hip
Definition
the ankle has a lot of contact area
Term
what is the ligament with the greatest stretch in plantarflexion
Definition
anterior talofibular ligament
Term
what is the ligament with the greatest stretch in neutral
Definition
calcaneofibular ligament
Term
what is the weakest of the 3 lateral ligaments
Definition
anterior talofibular ligament
Term
when is the anterior talofibular ligament under the greatest stretch
Definition
plantarflexion, inversion
Term
what are the names of the 3 lateral ligaments
Definition
anterior talofibular ligament, posterior talofibular ligament, calcaneofibular ligament
Term
is the talus wider anteriorly or posteriorly
Definition
anteriorly
Term
what is the closepacked position of the talocrural joint
Definition
dorsiflexion
Term
what 2 combined movements lead to lateral ankle sprain
Definition
plantarflexion, inversion
Term
how does inversion change with plantarflexion
Definition
hypermobile inversion in plantarflexion because it is loose packed position
Term
how does risk of future ankle sprain change after first ankle sprain
Definition
increase 5x
Term
how to prevent repeated ankle sprains
Definition
wear a brace
Term
which lateral ligament is elongated the most with inversion
Definition
calcaneofibular ligament
Term
what provides stability to a joint
Definition
bony congruencies, ligaments, muscles
Term
how to rehab a sprained ankle
Definition
practice balance on unstable surfaces. Wear a brace that restricts plantarflexion and inversion
Term
explain the quality of a brace that allows it to restrict plantarflexion
Definition
a brace that extends farther on the foot from the ankle joint will act on a longer moment arm and give a greater resisting dorsiflexion moment
Term
what is an example of an exercise tool that can be used in rehabilitation efforts for ankle sprains
Definition
wobble board, wobble disc, balance pad,exercise sandals
Term
what is the worst kind of ankle sprain
Definition
syndesmosis injury
Term
are syndesmosis injuries common
Definition
no
Term
why is it important to identify syndesmosis injuries early
Definition
if you don't it will be bad. You need to maintain the integrity of the ankle mortise so that you will have normal movement of the talocrural joint.
Term
If there is bad integrity of the ankle mortise, what will happen
Definition
hypermobility of the talus on the mortise, leading to OA
Term
should syndesmosis injuries be radiographed weightbearing or nonweightbearing and wh
Definition
weightbearing to se the talus push up into the mortise and separate the fibula and tibia
Term
what to do if a radiograph shows diastasis between tibia and fibula
Definition
brace the bones together, put patient on crutches NWB, send them to orthopedist
Term
MOI for syndesmosis injury
Definition
forced dorsiflexion and external rotation, such as jumping (achilles tendon pulls calcaneus, calcaneus pulls talus up into mortise)
Term
what is the squeeze test
Definition
test for syndesmosis injury: squeeze tibia and fibula together just proximal to ankle. Continue to squeeze more proximally. Positive = pain at distal tib fib joint with more proximal squeezing
Term
treatment for positive squeeze test
Definition
brace, NWB
Term
when you're ready for patient with syndesmosis injury to begin weight bearing, what must you do
Definition
give them a heel lift to prevent dorsiflexion
Term
how can a person with syndesmosis injury walk up a hill
Definition
backwards, on tiptoe, zig zag
Term
can the interosseous membrane heal?
Definition
yes. It is soft tissue with a good blood supply. Essential that the bones/interosseous membrane be in a good position during healing to prevent future arthrits
Term
what is the dorsiflexion test
Definition
test for syndesmosis injury: support lower leg with one hand, cup heel with other hand, lift up on foot with forearm to put it into dorsiflexion
Term
when should you not do dorsiflexion test
Definition
if you already know the patient has a syndesmosis injury
Term
what is the external rotation test
Definition
test for syndesmosis injury: stabilize lower leg with one hand, cup heel with other hand and externally rotate/abduct the foot poking for pain in syndesmosis
Term
what is the point test
Definition
test for syndesmosis injury: poke at interosseous membrane just medial to lateral malleolus looking for pain
Term
how to treat syndesmosis injury
Definition
treat early; protected weightbearing; restricted dorsiflexion and foot external rotation (control pronation); heel lift and distal circumferential support to maintain integrity of mortise; deltoid ligament integrity and use of syndesmotic screw if fibular fracture is more than 4.5cm proximal to tibiotalar joint line
Term
what to ask when a person has pain
Definition
Where does it hurt? It hurts when you do what? Show me. Tell me the exact point when you have the pain
Term
at what point in gait do we have maximal dorsiflexion
Definition
just before heel off when the other foot hits the ground
Term
if a person has a syndesmosis screw, when are they most likely to have pain
Definition
dorsiflexion: as widest part of the talus comes into the mortise with dorsiflexion
Term
what options to give for time in gait with pain?
Definition
Does it hurt when you land, when you're over it, when the other foot hits the ground, or when you push off?
Term
how to treat for pain with syndesmosis screw
Definition
heel lift, the screw should come out
Term
what will happen if syndesmosis screw is not removed and there is pain
Definition
you'll have hypomobility that leads to OA
Term
what is the orientation of the joint axis of the talocrural joint
Definition
between the 2 malleoli
Term
if someone's lateral malleolus is much longer than their medial malleolus, what is the effect on orientation of the axis of the talocrural joint
Definition
more vertical than normal
Term
if someone's leg segment is inclined away from vertical because of genu varus or tibial varum, what is the effect on the talocrural joint axis
Definition
more vertical than normal
Term
if someone's talocrural joint axis is more vertical than normal, how does the ground reaction force on the foot change
Definition
ground will push more on the lateral side of the foot
Term
when the ground pushes more on the lateral side of the foot, what moment is created on the foot?
Definition
eversion moment
Term
when the foot feels an eversion moment from the ground because of increased vertical orientation of the talocrural joint, how does the foot's position change (triplanarly)
Definition
increases pronation
Term
what is the primary plane of excessive motion when a more vertical talocrural joint axis line leads to excessive pronation
Definition
frontal: excessive eversion
Term
with excessive eversion, how does stress on the foot change
Definition
tensile stress on medial side, compressive stress on lateral side
Term
does the talus/mortise force change with excessive eversion
Definition
yes
Term
what tissues are tender upon palpation when someone has excessive eversion
Definition
tenderness to palpation of medial tissues: medial bands of plantar fascia, tibialis posterior where it wraps around medial malleolus or inserts onto navicular, great to flexor, deltoid ligament
Term
how to treat someone with excessive eversion because of more vertical joint axis of talocrural
Definition
arch support/medial stabilizer to bring ground reaction force a little more central
Term
what can happen to someone with the same vertical malalignment of the talocrural joint who has hypomobile joints
Definition
they end up walking on the lateral side of their foot rather than everting into pronation.
Term
what is the effect of walking on the lateral side of your foot
Definition
you have less contact area in push off, leading to greater contact pressure => metatarsalgia and metatarsal stress fractures
Term
what is metatarsalgia
Definition
painful metatarsal heads
Term
does pain from walking on lateral side of foot increase in push off or landing
Definition
push off
Term
how to treat someone who walks on the lateral side of their foot
Definition
wear orthotic to bring sole up to great toe and spread out the pressure.
Term
what is a medial forefoot post
Definition
orthotic that brings sole up to great toe and spreads out pressure
Term
if someone has the same vertical misalignment of their talocrural joint and has the motion to pronate but doesn't, what will happen
Definition
they will have pain on both the medial and lateral sides of the foot. They will be fidgety with standing. They are sometimes pronated and sometimes not. The pain on the medial side will come first, followed by pain on lateral side of foot.
Term
address medial or lateral pain first for this person?
Definition
medial
Term
what gives external rotation of the ankle joint
Definition
external torsion of the tibfib segment
Term
what is the foot placement angle
Definition
angle of your foot relative to the direction you're walking
Term
what is a normal foot placement angle
Definition
6-10 deg turned out
Term
what will happen if you have excessive tibfib external torsion or femoral retroversion?
Definition
you will have more external rotation. The ground will push on the lateral side of your foot. This will lead to pronation.
Term
how to fix excessive pronation
Definition
medial stability
Term
what are the movements of the talocrural joint
Definition
primarily DF/PF, some abd/add, some inv/ev
Term
what problems limit dorsiflexion
Definition
tight triceps surae, bony exostosis on distal tibia or talus
Term
what is bony exostosis
Definition
bony information that shouldn't be there
Term
how to determine whether dorsiflexion is limited by tight triceps surae or bony exostosis
Definition
end feel/passive motion. Test ankle motion with knee flexed and extended. If you flex knee and still get painful ankle dorsiflexion, indicates bony exostosis
Term
what happens to someone with limited dorsiflexion at talocrural joint
Definition
midfoot joints become hypermobile in dorsiflexion, and they don’t like it. Increases their contact pressure.
Term
where can limitd dorsiflexion at talocrural joint hurt
Definition
achilles tendon (soft tissue), anterior talus (bony exostosis), below navicular (soft tissue stretching)
Term
how to fix if gastroc is limiting ankle dorsiflexion
Definition
heat, stretch, heel lift
Term
how to fix if pain on anterio talus reduces dorsiflexion
Definition
heel lift, the screw should come out
Term
how to fix if pain is at navicular
Definition
heel lift and support arch
Term
what ligament does the talar tilt test?
Definition
calcaneofibular ligament
Term
approximately how much tibial torsion is normal between the knee jointcenter to the ankle jiont center?
Definition
20-30 deg external tibial torsion
Term
describe the axis of the subtalar joint?
Definition
tipped up from horizontal about 45 degrees; halfway between AP directed, halfway between longitudinaly directed
Term
describe the main movements that occur at the subtalar joint
Definition
equal amounts of ABD/ADD, equal amounts in inversion/eversion
Term
what is the orientation of the orientation of the subtalar joint from the sagittal plane (how close to being AP)
Definition
about 16-23 degrees from AP
Term
is the subtalar joint close to being oriented purely medial-laterally?
Definition
no
Term
how much sagittal plane (qualitatively) do you expect to get from subtalar joint?
Definition
very little
Term
what are 2 reasons why a patient might not get enough dorsiflexion at talocrural joint
Definition
bony exostosis or tight triceps surae
Term
what happens if the talocrural joint isn't able to dorsiflex as much as it needs to?
Definition
subtalar will try to give dorsiflexion but it can't; midtarsal joints will try to give dorsiflexion
Term
what is an example of an environmental challenge that requires dorsiflexion?
Definition
walking up a hill
Term
how to help someone who has limited dorsiflexion and has pain walking up a hill
Definition
heel lift
Term
how do the talocrural and subtalar joints complement each other?
Definition
talocrural gives mostly PF/DF and not as much ABD/ADD, INV/EV; subtalar gives limited PF/DF and more ABD/ADD, INV/EV
Term
how does subtalar joint pronation affect the femur
Definition
causes internal rotation
Term
when the forefoot is inverted/supinated, how is the leg affected
Definition
the leg is externally rotated
Term
if you had piriformis syndrome, what foot position is likely to irritate it further?
Definition
foot pronation; causes internal rotation of the femur, pulling on the already tight piriformis
Term
if you have tight internal rotators/adducts, what foot position are you likely to have?
Definition
foot pronation
Term
why is it that excessive foot pronation causes hip internal rotation rather than just knee internal rotation?
Definition
the posterior knee ligaments are tight in extension so that the movement drives up to the hip
Term
besides internal rotation, what other motion at the hip is caused by foot pronation?
Definition
adduction
Term
if you pronate leading to hip adduction, what is the risk?
Definition
hip OA
Term
what 3 things want to destroy hip articular cartilage
Definition
impact loading, frictional abrasion, high contact pressures.
Term
what do you need to have to get friction?
Definition
pressure/force and sliding
Term
what are the 2 locations where IT band trouble is felt
Definition
lateral femoral condyle, greater trochanter
Term
on which leg is a person with a leg length inequality more likely to have hip OA and why
Definition
longer leg: maybe because of pronating, the hip joint on the longer limb is more adducted; can cause frictional abrasion/removal of articular cartilage because of abnormal contact pressure
Term
when someone has trochanteric bursitis, what is the likely cause
Definition
tight IT band
Term
how is pronating the foot a problem for IT band problems
Definition
pronating the foot stretches the IT band by adducting the hip.
Term
how does pronating the foot affect the knee in the frontal plane
Definition
causes valgus/reduces varus
Term
do you want someone with excessive varus to pronate and why
Definition
yes, to reduce their varus
Term
when the calcaneus is fixed on the ground/foot is fixed on the ground, what bony segment must move to give pronation at the subtalar joint and how
Definition
the talus must move into inversion to give relative eversion at the jiont; the talus adducts so that the subtalar joint is relatively abducted; the talus moves into plantarflexion to give the joint relative dorsiflexion
Term
when the talus adducts, what happens to the leg
Definition
it internally rotates
Term
what are the primary motions at the subtalar joint
Definition
inversion/eversion, adduction/abduction
Term
how to check inversion/eversion
Definition
put person prone on the table, measure with a goniometer with 1 degree increments, make a line that bisects distal third of the leg and make another line that bisects the rearfoot
Term
do people usually have more inversion or eversion?
Definition
inversion
Term
what would place demands on someone for the eversion component of subtalar joint pronation?
Definition
frontal plane challenges: walking on the ground that is higher laterally.
Term
why does walking on ground that is higher laterally drive eversion?
Definition
ground will push more on the lateral side of the foot, pushing foot into eversion
Term
if rice farmers who walk in furrows with ground that his higher laterally also have tibial varum and genu varus, what does that mean for the ground force into the foot and the resultant foot movement?
Definition
foot pushes into the ground laterally driving eversion
Term
what type of pain is common in rice farmers who have tibial varum and genu varus
Definition
lateral ankle pain: talus tries to move into eversion in the mortise
Term
how to take away some of the eversion drive either from anatomy or environment?
Definition
medial wedge
Term
if someone has lateral ankle mortise pain, what should you do?
Definition
lok at their anatomy, ask when they have the pain, ask what the ground surface is like
Term
if someone's ankle hurts when they walk on the beach, what should you think?
Definition
ankle mortise pain from talus everting as they run on uneven beach
Term
if you want to look at a person for asymmetry, what should you do
Definition
have them bring their feet all the way together to see if there is asymmetry as the legs are approaching the ground. Have them bear weight mostly on one limb.
Term
how do you look at someone as though they are in mistance of walking
Definition
have them stand with one foot on ground and other foot toes only on ground
Term
do joints in the human body like to be pushed to the limits of their motion?
Definition
no: you stretch soft tissues, increasing contact pressure; you reduce contact area = subchondral bone will have increased pressure
Term
what are the 2 joint axes of the transverse tarsal joints
Definition
longitudinal midtarsal joint axis, oblique midtarsal joints
Term
what are the articulations that make up the transverse tarsal joints
Definition
joint between the talus and the navicular AND the joint between the calcaneus and the cuboid
Term
what is the shape of the transverse tarsal joints
Definition
S
Term
where is the convexity of the transverse tarsal joints
Definition
the talonavicular has a convexity facing distally
Term
where is the concavity of the midtarsal joints
Definition
the calcaneocuboid has a concavity facing distally
Term
what actions occur at the midtarsal joint
Definition
frontal plane inversion/eversion
Term
what are the 2 main joints of the foot that give frontal plane motion
Definition
subtalar, transverse tarsal joints
Term
where are the intertarsal joints
Definition
joints between the bases of the metatarsals, cuneiforms, cuboid, navicular
Term
are the tarsal bones wider dorsally or plantarly
Definition
dorsally
Term
what is the architecture of the tarsal bones
Definition
keystone
Term
are the tarsal bones stable?
Definition
yes
Term
is there motion in the intertarsal joints
Definition
no
Term
what is the midfoot designed to do
Definition
to be stable and not move and provide a stable longitudinal arch and transverse arch (in the frontal plane)
Term
if any of the midfoot joints collapse, what does that bring to mind
Definition
foot flattening
Term
when someone has a collapsed midfoot, where might they have pain
Definition
on plantar side from tensile stress or on dorsal side from high contact pressures
Term
if a patient comes and their midfoot collapses and they have pain, what do you want to determine?
Definition
what is driving the midfoot to collapse
Term
what are some things that could cause a midfoot to collapse
Definition
they're not getting enough dorsiflexion at the talocrural joint; excessive bodyweight that causes excessive 3 point bending
Term
if you have varus, what does the GRF do?
Definition
drives the knee joint into more varus
Term
when a person with genu varus stands on one foot, do they have a big or small varus force from the ground and why?
Definition
powerful moment of genu varus rotation up from ground because there is a long moment arm from the ground up straight and then over to the knee (these are not in the same line because of the genu varus that already exists)
Term
what opposes the GRF rotation into genu varus force caused when someone with genu varus stands on one leg?
Definition
soft tissue forces on opposite side of knee (lateral side of knee) oppose the rotational force into varus
Term
what is the total force crossing the knee joint when someone with genu varus stands on one leg?
Definition
GRF AND soft tissue force opposing GRF force
Term
what is the pressure like in a joint that has genu varus?
Definition
sky high because the forces are high
Term
is the GRF force or the soft tissue force greater and explain why
Definition
the two moments are equal. Moment = force x moment arm. The soft tissue force has a smaller moment arm and therefore a larger force
Term
what is one of the big destroyers of articular cartilage?
Definition
pressure
Term
what is the formula for pressur
Definition
force/area
Term
what is the contact area when you have a malalignment like genu varus
Definition
small
Term
why is someone with genu varus going to have OA
Definition
decreased contact area, increased force
Term
if you could have some pronation in someone with genu varus, what will happen to the GRF moment arm?
Definition
it will get shorter
Term
if the GRF moment arm gets shorter in someone with genu varus who pronates, what will happen to the soft tissue force
Definition
it would go down
Term
if someone with genu varus pronates a little, how does this change pressure?
Definition
decreases force, increases contact area = decreases contact pressure by a lot
Term
if medial compartment OA in someone with genu varus worsens, what should be done?
Definition
unloader brace to reduce genu varus, surgery to reduce varus (wedging osteotomy), TKA, assistive device, encourage them to PRONATE
Term
what can you do to make someone with genu varus pronate?
Definition
lateral wedge
Term
how will the knee joint center position change related to the foot when someone with genu varus gets a lateral wedge?
Definition
move from lateral to the foot to closer to on top of the foot
Term
why does a lateral wedge drive pronation?
Definition
GRF goes up into lateral side of foot and pushes the foot into pronation
Term
should someone wearing a lateral wedge to increase pronation to reduce genu varus wear a supportive shoe or a flexible shoe
Definition
flexible. Supportive shoe would combat the pronation
Term
do you want heel lift in the shoe of someone who is wearing a lateral wedge to encourage pronation in someone with genu varus?
Definition
no. plantarflexion is a component of supination. We want the person to pronate.
Term
what are concerns of adding the lateral wedge in someone with genu varus?
Definition
it will drive excessive motion. Tell patient that if they have pain at hip or shoe, they should back off immediately.
Term
what is the normal valgus at the knee (what amount)?
Definition
6 degrees
Term
if someone has excessive genu valgus, what happens when they pronate?
Definition
they go into even more valgus.
Term
what to do if someone with excessive genu valgus pronates
Definition
determine what causes it and how to fix it
Term
if someone has excessive genu valgus, what type of stress is present on the lateral side of their knee
Definition
compressive
Term
if someone has excessive genu valgus, what kind of stress is present on the medial side of their knee
Definition
tensile
Term
if someone has foot pronation and excessive valgus, what are the big time forces that will be imposed on the patella during functional movements?
Definition
quads tendon pulling up, pateller tendon pulling down. Because of valgus, the resultant force vector of the tendons will be laterally directed.
Term
describe medial columnar collapse
Definition
someone has foot pronation that drives excessive genu valgus will cause the force from the quadriceps and patellar tendons to pull laterally in the frontal plane instead of superiorly and inferiorly in the sagittal plane. There could be high contact forces laterally OR in medial columnar collapse, the patella tilts medially
Term
if you have weak hip abductors and IR and then strengthen them, how will that affect medial columnar collapse?
Definition
should help reduce medial columnar collapse if the person uses their abductors and Ers with every step to reduce valgus
Term
why does strengthening hip ER/abductors not necessarily fix pronation caused genu valgus medial column collapse?
Definition
better to focus on the pronation that is driving the genu valgus. Strengthen the hip only if the hip is the problem
Term
how to strengthen hip abductors and Ers functionally
Definition
tie theraband around their thighs so they have to work against the theraband using Ers and abductors. Train them to do the functional activity correctly.
Term
if a person has fallen into medial columnar collapse, what else could add to the lateral resultant force?
Definition
IT band because the ITB is attached to the patella.
Term
are midfoot joints designed to give motion?
Definition
no
Term
what kind of stress would be on the plantar side with midfoot collapse?
Definition
tensile
Term
what kind of stress would be on the dorsal side with midfoot collapse?
Definition
compressive
Term
why is force high in midfoot collapse?
Definition
tensile stress on soft tissues will drive bones together more vigorously, driving up contact force. Also, contact area is reduced
Term
what is the composite axis of rotation of the combine axes of rotations of the 5 metatarsals?
Definition
metatarsal break
Term
describe the crease in a shoe of someone who walks on the lateral side of their foot to avoid pronation
Definition
it will be angled less relative to long axis of the foot
Term
why might someone avoid pronation or try to walk on the lateral side of their foot?
Definition
hallux rigidis, plantar fasciitis
Term
describe the way the center of pressure on the foot should go during stance phase of walking
Definition
should start posterior-laterally on the heel, move over to 1st webspace between metarsal heads 1 and 2 at time of push-off
Term
why do we want to be between heads 1 and 2 for pushoff?
Definition
great toe has larger surface area as well as its own muscle: flexor hallucis longus: gives us powerful pushoff
Term
what to check if someone is walking on the lateral side of their foot
Definition
can they extend the great toe? Stabilize the 1st metatarsal vigorously and push up on the proximal phalanx
Term
define vagurs
Definition
distal element is oriented toward the midline
Term
define valgus
Definition
distal element is oriented away from the midline
Term
in what plane are varus/valgus
Definition
frontal
Term
in forefoot valgus, is the forefoot oriented toward or away from the mildline?
Definition
away
Term
what position should patient be in to look for forefoot to rearfoot alignment
Definition
prone
Term
in neutral alignment between forefoot and rearfoot, what is the position of the 5 metatarsal heads?
Definition
all parallel to the plantar surface of the heel
Term
if all 5 metatarsal heads are neutral, how does that affect gait
Definition
all 5 metatarsal heads hit the ground at the same time and there is no drive in the frontal plane to go into inversion/eversion
Term
if you have a forefoot varus, what will happen when the foot hits the ground?
Definition
the heel will come down, and then inintially with foot flat, the ground will push on the lateral side of the forefoot causing eversion
Term
what are the most likely joints to provide eversion?
Definition
subtalar joint and transverse tarsal joints
Term
if the subtalar joint and transverse tarsal joints can't give all the eversion that's needed because of forefoot varus, what else might givec the motion?
Definition
medial columnar collapse
Term
what to do if the person has no movement to evert and they have forefoot varus and they are walking on the lateral side of their foot and it hurts?
Definition
see if mobilizations are effective. If not, put a medial wedge in the forefoot to give the great toe some contact, and pain should improve immediately.
Term
is forefoot vaglus common?
Definition
no. it is very rare
Term
describe the motion of the foot in forefoot valgus when you land in walking
Definition
heel pushes down, medial side of foot pushes down, ground pushes foot into inversion.
Term
if a hypomobile foot is also valgus, where might the inversion motion come from and why is that concerning?
Definition
rear portion of the joint: look out for lateral ankle sprain
Term
is it a good idea to look for forefoot varus/valgus in dorsiflexion?
Definition
no. that's useless. Look for it in resting position
Term
if you think a person has forefoot valgus, what could the problem be and how do you check to be sure whether it's forefoot valgus or the other problem?
Definition
could be plantarflexed 1st ray. Palpate all 5 metatarsal heads
Term
what are the 2 kinds of plantarflexed 1st rays?
Definition
flexible, rigid
Term
if you can get the plantarflexed 1st ray dorsal to the 2nd ray, will it be a problem?
Definition
no. it will not drive inversion.
Term
if the plantarflexed 1st toe is rigid, what will happen
Definition
ground force will be initally on the 1st metatarsal head. It will want to drive inversion
Term
how to treat rigid plantarflexed 1st ray
Definition
put a rectangle underneath metatarsals 2-5 so that all 5 metatarsals hit the ground at the same time
Term
is the reliability for measuring forefoot varus with goniometer very good?
Definition
no. too far from landmarks.
Term
what is the forefoot alignment of newborns? Why does it change?
Definition
children are born with forefoot varus. When they begin to walk, the ground pushes laterally on their foot, causing the foot to mvoe into eversion, and then the talus twists around too.
Term
what are the biomechanical functions of the forefoot?
Definition
shock absorption, moble adapter to uneven support surfaces, arched base of suport and rigid level for propulsion
Term
what is loading rate
Definition
how fast the foreces of the ground on the foot increase
Term
if someone has fast impact loading, will they have high or low loading rates
Definition
high
Term
what are high loading rates associated with?
Definition
tibial stress fractures, plantar fasciitis, other LE pathologies
Term
if someone has high loading rates/makes a lot of noise with everyday walking, what will the shock absorption curve look like?
Definition
repetitive impact loaders: instead of regular curve with 2 peaks on the GRF, they will have a transient impact, an initial bam before the regular curve with 2 peaks
Term
what to do for a repetitive impact loader
Definition
put a lot of material underneath the heel
Term
what formula to use when determining need for shock absorption with running/walking
Definition
force = mass x velocity/time
Term
if someone is having pain and landing hard, what to look at?
Definition
their mass, their velocity at landing (are they running downhill too fast/need to bend knees to land slower), use thicker sole material to prolong time.
Term
what joint/segment motions and deformation of body tissues can be used to prolong GRF absorption/attenuation
Definition
knee flexion, ankle plantarflexion, subtalar joint pronation, deformation of calcaneal fat pad, deformation of others soft tissues
Term
if you always run on the same side of the road that is sloped, what will happen
Definition
your talus will bam into the mortise. It will cause tensile stress on one side, compressive stress on the other.
Term
what is subtalar joint coalition?
Definition
no eversion/inversion from subtalar joint
Term
why do we need the foot and ankle joints to funciotn properly?
Definition
functiona ass mobile adapter to uneven ground surfaces, accommodate to anatomic things that are asking for motoin and put entire plantar aspect of the foot on the ground
Term
why do we want the foot to initially act as a shock absorpber
Definition
so that loading rates are decreased
Term
at what point of stance is pronation desirable
Definition
first part of gait cycle to increase delta T and to attenuate the GRF/act as shock absorber; get increased surface area between foot and ground to increase balance and decreae pressure
Term
why is excessive pronation bad
Definition
can cause potentially injurious tissue stress: medial tensile stress and lateral compression stress. Trouble with talus in the mortise
Term
in getting a rigid foot for push-off, is the stress at the top of the foot compressive, tensile, or shear?
Definition
compressive
Term
in getting a rigid foot for push-off, is the stress at the medial longitudinal arch compressive, tensile, or shear?
Definition
shear
Term
in getting a rigid foot for push-off, is the stress at the bottom of the foot compressive, tensile, or shear?
Definition
tensile
Term
with what type of stress is bone strongest
Definition
compression
Term
with what type of stress is bone weakest
Definition
shear
Term
what can you do to reduce foot flattening/looseness in push-off
Definition
try taping, strengthen foot intrinsics and extrinsics
Term
what 3 things create rigid foot at pushoff
Definition
1. bones are stiff because of 3 point bending; 2. keystone wedging in midfoot; 3. plantar soft tissues hold the foot together with tensile stress on plantar surface
Term
what to look at in someone with plantar fasciitis
Definition
bodyweight; impact loading if they fall through space a large distance
Term
what provides the truss support to the foot?
Definition
plantar fascia and intrinsic and extrinsic plantar muscles
Term
what 2 things can limit dorsiflexion?
Definition
bony exostosis or tight triceps surae
Term
if you can't get dorsiflexion at the talocrural joint, how will the foot respond
Definition
arch will collapse, stretching out plantar fascia
Term
when would you see a medial talonavicular bulge?
Definition
when dorsiflexion is coming from the subtalar joint
Term
what to do if limited dorsiflexion comes form tight triceps surae
Definition
heat it first, then stretch it: have them stand with foot back, leaning forward. Precautions to take: shoe, brace, and support the longitudinal arch so that it does not collapse and tension is placed entirely in triceps surae
Term
what to do in the meantime for someone with tight triceps surae leading to arch collapse/dorsiflexion at other joints
Definition
heel lift. Tell them they still have to stretch several times a day.
Term
for what reason might plantar fascia pain be greatest at toe off
Definition
greatest at toe off because the plantar fascia crosses the MTP joints, and as they go into extension, the plantar fascia tension is greatest.
Term
what 4 choices do you give someone when asking when their foot pain is greatest?
Definition
heel contact, midstance, just prior to toe off, toe off
Term
if someone gets the most plantar fasciitis pain at midstance, what is the cause and how to fix
Definition
3 point bending. Longterm fix body weight. Short term support the arch to reduce tensile stress
Term
if it hurts at heel off/just before toe off, what is the cause and how to treat
Definition
dorsiflexion is limited at the talocrural joint. Give them a temporary heel lift and see if it helps. Do passive ROM to see if they're tight in dorsiflexion
Term
what are contributors to plantar fasciitis
Definition
3 point bending, windlass mechanism, limited dorsiflexion, tight plantar fascia, excessive foot pronation
Term
what are inexpensive ways to stiffen a shoe's toe break
Definition
white, cloth athletic tape. Tape the insert inside the shoe. Bend the shoe down so that it is preloaded in a plantarflexed position. If this helps, you know that the windlass mechanism was an issue
Term
what is turf toe
Definition
hyperextension injury of the great toe
Term
what is a turf toe plate
Definition
rigid plate that goes right inside the shoe. (another way to stiffen the shoe)
Term
in what part of the foot is plantar fascia pain often felt
Definition
near the proximal insertion of the medial calcaneal tubercle.
Term
how to stretch tight plantar fascia
Definition
heat and stretch. Stretch with their hand or wrap a belt around their toe and pull or do standing heel cord stretch with towel under the toes to extend toes (just the toes against the towel, metatarsal heads should be down on the floor)
Term
should someone wear shoes while stretching plantar fascia
Definition
no
Term
why is plantar fasciitis pain often worse in the morning
Definition
people sleep with knee flexed and ankle plantarflexed. First thing when you stand up you stretch both of those things
Term
what should someone with plantarfasci tswear in the morning
Definition
supportive shoes. They should really never go barefoot until this is resolved.
Term
what should someone with plantar fasciitis do everytime they wake up or get up after sitting for a long time
Definition
stretch dorsiflexors and toe extensors
Term
why does pronation of the foot cause plantar fasciitis
Definition
with pronation of the foot, the longitudinal arch collapses, imposing tensile stress on the bands of the plantar fascia.
Term
what are some things that drive pronation
Definition
genu varus, tibfib varum, forefoot varus, excessive body weight, limited dorsiflexion
Term
how to reduce pronation in someone with forefoot varus
Definition
medial forefoot post
Term
what is a stasburg sock
Definition
sock that is supposed to keep knee extended, ankle dorsiflexed in sleep but doesn't work that great
Term
what provides dynamic support for rigid foot
Definition
muscles that pull forefoot to rearfoot
Term
what are the mobilities of the rays on each other?
Definition
ray 1 moves a lot on ray 2. rays 2 and 3 are hypomobile on each other. Ray 4 moves on ray 3. ray 5 moves a lot on ray 4.
Term
is the interosseous ligament of the subtalar joint tight in inversion or eversion?
Definition
tight in inversion. Hypomobile
Term
do we push off in inversion or eversion of the subtalar joint and why
Definition
go into inversion at the subtalar joint to stretch the interosseous ligament tightly
Term
do we land in subtalar joint eversion or inversion and why
Definition
subtalr joint everted in prontation. Ligaments are lax and joint is hypermobile. This is the initial position for loading and shock absorption and to accommodate to uneven ground surface
Term
is the subtalar joint more mobile in pronation or supination
Definition
pronation
Term
are the 2 subtalar joint axes parallel to each other in pronation or supination
Definition
pronation
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