Term
| what screens can be done to assess subtalar joint pronation |
|
Definition
| navicular drop test, rearfoot to leg angle, medial talonavicular bulge, longitudinal arch angle |
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|
Term
| how to do the navicular drop test? |
|
Definition
| Find the navicular tubercle. Ask patient to bring their weight to the other foot. Track the navicular as she goes from nonweightbearing to fullweightbearing. Look at where it starts, how far it falls, and where it ended up. |
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|
Term
| what is the navicular drop test meant to indicate? |
|
Definition
|
|
Term
| is subtalar joint pronation the only reason why the navicular might drop in the navicular drop test? |
|
Definition
| no, it can fall just because of midfoot joint collapse. |
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|
Term
| is motion needed at the subtalar joint? Why/why not? |
|
Definition
| Yes. The subtalar joint should move for shock absorption and to accommodate to uneven ground surfaces. |
|
|
Term
| what does it mean if the navicular doesn't drop at all/enough in the navicular drop test |
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Definition
| if it doesn't fall, the foot could be supinated/rigid/hypomobile. |
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|
Term
| what does the rearfoot to leg angle test show? |
|
Definition
| indicator of subtalar joint pronation |
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Term
| what parts of the foot/leg are moving vs stationary in the rearfoot to leg angle test when subtalar joint pronation is found? |
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Definition
| the calcaneus is moving into relative eversion and the leg moves into inversion to gives us the eversion component at the joint |
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|
Term
| what is the patient's position when you look for medial talonavicular bulge? |
|
Definition
| look for medial talonavicular bulge whenthe patient stands statically and when she walks. |
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|
Term
| are you likely to see more medial talonavicular bulge in standing or walking |
|
Definition
|
|
Term
| when in gait are you likely to see the most medial talonavicular bulge and why? |
|
Definition
| right at heel off because of a lack of dorsiflexion in the talocrural joint that drives dorsiflexoin at the talonavicular joint. |
|
|
Term
| what is another name for medial talonavicular bulge? |
|
Definition
|
|
Term
| what is the relationship/movement of the talus on the calcaneus when medial talonavicular bulge is present? |
|
Definition
| talus adducts on the calcaneus with subtalar joint pronation |
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|
Term
| is the longitudinal arch angle good to measure in the clinic |
|
Definition
| no. more commonly measured in research studies than in the clinic |
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|
Term
| if someone pronates a lot, will their longitudinal arch angle be larger or smaller? |
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Definition
|
|
Term
| if someone has tibial varum, will they need more eversion or inversion? |
|
Definition
| need more eversion to bring the medial aspect of the foot to the ground |
|
|
Term
| why is a tight triceps surae a problem in an older adult and what should you do about it? |
|
Definition
| falls risk because it changes their COM. Stretch their triceps surae, give them a heel lift. Also work on their balance/challenge their balance. |
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|
Term
| does genu recurvatum place the ankle in a more plantarflexed or dorsiflexed position? |
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Definition
|
|
Term
| how does tight triceps surae change knee position and ankle position? |
|
Definition
| tight triceps surae may position knee in recurvatum and ankle in plantarflexion as well as demanding dorsiflexion from midfoot. |
|
|
Term
| how to measure leg length in supine? |
|
Definition
|
|
Term
| what are sources of error in measuring leg length in supine? |
|
Definition
| landmarks, measurement, soft tissue asymmetries |
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|
Term
| what is a better way to determine leg length inequalities? |
|
Definition
| put them in standing. This is more functional, you can see how muscles work, takes into effect multiple planes |
|
|
Term
| what landmarks to look at when comparing leg heights in standing |
|
Definition
| greater trochanter, ASIS, iliac crest (can be a problem in the case of SIJ malalignment) |
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|
Term
| In what position should a patient's feet be when measuring leg length in standing? |
|
Definition
| feet spread apart the widght of hip joint so that you are looking at a rectangle |
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|
Term
| are pelvic leveling devices more reliable than your hands? |
|
Definition
|
|
Term
|
Definition
| palpation meter for measuring pelvic crest height difference and leg length discrepancy |
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|
Term
| what to do if someone has functional scoliosis from leg legnth inequality |
|
Definition
| corrective lift to see if back straightens. |
|
|
Term
| what other problems might occur from leg length inequality causing functional scoliosis |
|
Definition
| predispose someone to IT band trouble, hip OA |
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|
Term
| if someone is not having problems from LLI and the inequality is small, what should you do? |
|
Definition
| start with small lift and come up gradually |
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|
Term
| what is the average amount that someone must be corrected before their pain is reduced? |
|
Definition
|
|
Term
| in looking at the horizontal plane orientation of the patellae/q-angle, what are some things that might cause the patella to face medially? |
|
Definition
| hip IR, foot pronation, femoral antetorsion, forefoot varus leading to foot pronation |
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|
Term
| what are some issues/pains that might develop with genu valgus? |
|
Definition
| MTP joint pain from foot pronation, IT band tightness from excessive hip adduction, medial tensile stress at the knee, lateral compartment OA at the knee |
|
|
Term
| what to do if someone has genu valgus because of foot pronation |
|
Definition
|
|
Term
| what to observe in patella in supine exam? |
|
Definition
| medial/lateral glide, medial/lateral tilt, external/internal rotation |
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|
Term
| what to look at besides patella in supine exam |
|
Definition
| , hamstring extensibility, rectus femoris extensibility, extension of MTP joints |
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|
Term
| what are reasons why a patella might be laterally displaced outside the groove? How do you test this? |
|
Definition
| lateral retinaculum could be tight. Try pusing the patella medially with vigor. While it's over there, palpate medial facet to see if it's tender |
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|
Term
| how far should you be able to move the patella medially/laterallY |
|
Definition
| you sould be able to move it medially and laterally about half its distance |
|
|
Term
| if the medial or lateral tissues of the patella are tight, in what direction will the patella be pulled in addition to medial or lateral? |
|
Definition
|
|
Term
| what to do if someone's patella is tight medially and/or laterally? |
|
Definition
|
|
Term
| in what position do you assess medial/lateral tilt of the patella |
|
Definition
|
|
Term
| how to test hamstring muscle extensibility |
|
Definition
| patient supine. Raise the test leg to 90-90. ask patient to straighten their leg. Measure knee extension as indicator of hamstring extensibility. |
|
|
Term
| what to do if someones hamstrings are tight |
|
Definition
| have them do supine hamstring stretch 30s/day |
|
|
Term
| how do tight hamstrings affect the patella |
|
Definition
| increase in passive hamstring tension may increase quads/patellar tendon forces to meet net knee extension moment demands, increasing patellofemoral contact force |
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|
Term
| what kind of internal moment is needed from the knee to remain in a squatting position? |
|
Definition
|
|
Term
| what gives an internal extension moment at the knee in squatting |
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Definition
|
|
Term
| if hamstrings are tight and are trying to pull knee into flexion, what has to work against the hams |
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Definition
|
|
Term
| what does Thomas Test assess |
|
Definition
| iliopsoas and rectus femoris extensibility |
|
|
Term
| how to make the thomas test better? |
|
Definition
| lift thigh of test leg and gradually lower it down as you palpate the ASIS. Stop lowering when you feel the ASIS start to move. |
|
|
Term
| why do you stop lowering the leg in Mike Gross's version of the Thomas test when the ASIS starts moving? |
|
Definition
| the iliopsoas are pulling the ASIS forward at this point |
|
|
Term
| if someone has limited MTP extension, what compensations will you see? |
|
Definition
| increased toe out, increased pronation |
|
|
Term
| what might limit extension of the MTP joints? |
|
Definition
| exostoses on the dorsal aspect of the joint |
|
|
Term
| if you have exostoses on the dorsal aspect of the MTP joint, when will this hurt |
|
Definition
|
|
Term
| how will the bone respond to the increased pressure of the exostoses on the MTP joint |
|
Definition
| make new bone, worsening the situation |
|
|
Term
| how to treat limited MTP extension because of bony exostosis |
|
Definition
| See if you can give pain free motion by stretching soft tissues. Move concave phalange on stabilized convex metatarsal. Need dorsal roll and dorsal glide for this. Do not push on the distal phalanx because you don't want to get DPJ extension. Protect them |
|
|
Term
|
Definition
| pain at MTP joint, exostosis on dorsal aspect of joint. |
|
|
Term
| how to protect someone with hallux rigidus |
|
Definition
| rocker bottom shoe, grind out portion under phalanges of the great toe so that they will have a delayed and reduced push on the 1st MTP joint into extension |
|
|
Term
| what things are looked at in sidelying? |
|
Definition
|
|
Term
| what is the name of the test used to assess IT band extensibility |
|
Definition
|
|
Term
| where does the IT band cause pain |
|
Definition
| at greater trochanter or over lateral femoral condyle |
|
|
Term
| what is created to cause pain with greater trochanter at either location |
|
Definition
|
|
Term
| in what part of the gait cycle do people get IT band trouble |
|
Definition
|
|
Term
| what does IT band at the lateral femoral condyle feel like |
|
Definition
|
|
Term
| what does pain of IT band at greater trochanter feel like |
|
Definition
|
|
Term
| why do IT band trouble occur in midstance? |
|
Definition
| at midstance, the hip joint is extended, the knee is slightly flexed so that IT band is right over lateral femoral condyle and right over the greater trochanter |
|
|
Term
| what should the position of the leg be in Obers test and why |
|
Definition
| we want to test the IT band as it is in midstance because that is where it is at greatest length and also where it is most likely to cause trouble. Hip should be extended, knee slightly flexed |
|
|
Term
| how to do obers test (where to hold) |
|
Definition
| push vigorously on iliac crest to stabilize. Hold leg at knee. Bottom leg in hip and knee flexion for stability. |
|
|
Term
|
Definition
| squeeze IT band and see if patella moves laterally |
|
|
Term
| is greater IT band length needed for someone who walks with a narrow or wide base of support |
|
Definition
|
|
Term
| how much knee flexion to use for ober test |
|
Definition
|
|
Term
| why test quads extensibility with hip extended and with hip slightly flexed? |
|
Definition
| hip flexed takes out rectus femoris |
|
|
Term
| what is examined in prone |
|
Definition
| forefoot to rearfoot alignment, rearfoot motion and "neutral position", triceps surae extensibility, tibial torsion, femoral antetorsion/retrotorsion |
|
|
Term
| does forefoot varus beg pronation or supination? |
|
Definition
| pronation. Ground pushes up laterally first, pushing into pronation so that medial aspect will be brought to ground |
|
|
Term
| if someone needs pronation/eversion because of forefoot varus, where will the eversion come from? |
|
Definition
| subtalar and transverse tarsal joints |
|
|
Term
| what does someone with forefoot varus need in their shoe? |
|
Definition
| medial wedge in the front |
|
|
Term
| in subtalar joint pronation, is the forefoot abducted or adducted on the rearfoot? |
|
Definition
|
|
Term
| what to do for someone with tibial torsion? |
|
Definition
| medial wedge back of shoe |
|
|
Term
| why put a medial wedge in the back of the shoe of someone who has tibial torsion |
|
Definition
| the foot is being pushed into eversion. Medial wedge helps prevent too much eversion from happening |
|
|
Term
| if someone has a plantarflexed 1st ray, will their forefoot be driven into eversion or inversion |
|
Definition
|
|
Term
| what orthotics are needed for someone with plantarflexed 1st ray |
|
Definition
| rectangular cut out underneath 1st ray and its phalanges |
|
|
Term
| when looking at rearfoot motion in prone, what should you compare it to |
|
Definition
| motion used in standing and gait |
|
|
Term
| what to do to fix tib fib varum |
|
Definition
|
|
Term
| how much tibial torsion is normal? |
|
Definition
|
|
Term
| what is femoral antetorsion |
|
Definition
| twisted from proximal to distal end of femor anteriorly |
|
|
Term
| when people's legs kick out to the side when they run, what is the reason |
|
Definition
|
|
Term
| what is the test for femoral antetorsion/retrotorsion |
|
Definition
|
|
Term
| what is the normal amount of antetorsion? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| if someone W sits, what will that cause |
|
Definition
| femoral antetorsion. The support surface pushes up lateral to the femur. Imposes internal rotation force at distal end of femur.soft tissues at the proximal endof the femur create external rotation moment. |
|
|
Term
| what can happen to kids who sit criss cross applesauce too much |
|
Definition
| they get an external rotation moment on the distal end of the femur. They have a resisting internal rotation moment at the proximal end of their femur from soft tissues. Result is excessive retrotorsion of the femur, leading to toe out, leading to pronation |
|
|
Term
| should there be more movement of the midfoot in eversion or inversion and why |
|
Definition
| eversion: pronated foot, loose packed |
|
|
Term
|
Definition
| patella is higher. Patella tendon is too long. Patella sits above the trochlear groove. Not enough stability for the patella; patella will be influenced by soft tissues |
|
|
Term
|
Definition
| patellar tendon is too short. |
|
|
Term
| is it worse to have patella alta or baja |
|
Definition
|
|
Term
| what to do if someone has patella alta and patellofemoral pain |
|
Definition
| fix anything else you can. Can't fix patella alta. Loook for varus/valgus. |
|
|
Term
| what is equinas deformity |
|
Definition
| when the talocrural joint is in neutral and the plantar surface of the metatarsal heads are much lower |
|
|
Term
| does equinas deformity drive dorsiflexion or plantarflexion? |
|
Definition
|
|
Term
| if the talocrural joint can't give enough dorsiflexion needed for equinas, what will result |
|
Definition
|
|
Term
| what to do to compensate for equinas |
|
Definition
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