Term
| what are the triplanar motions of pronation? |
|
Definition
| dorsiflexion, eversion, abduction |
|
|
Term
| in what plane does dorsiflexion occur |
|
Definition
|
|
Term
| in what plane does eversion occur |
|
Definition
|
|
Term
| in what plane does abduction occur |
|
Definition
|
|
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
|
|
Term
| which of the joints in the foot/ankle are oriented in a pure AP direction |
|
Definition
|
|
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
|
|
Term
| what motion of the distal segment on the proximal segment occurs in the sagittal plane with pronation |
|
Definition
|
|
Term
| what motion of the distal segment on the proximal segment occurs in the sagittal plane with supination |
|
Definition
|
|
Term
| what is the direction of the axis that gives motion in the frontal plane |
|
Definition
|
|
Term
| what motion of the distal segment on the proximal segment occurs in the frontal plane with pronation |
|
Definition
|
|
Term
| what motion of the distal segment on the proximal segment occurs in the frontal plane with supination |
|
Definition
|
|
Term
| what is the direction of the axis that gives movement in the horizontal plane |
|
Definition
|
|
Term
| what motion of the distal segment on the proximal segment occurs in the horizontal plane with pronation |
|
Definition
|
|
Term
| what motion of the distal segment on the proximal segment occurs in the horizontal plane with supination |
|
Definition
|
|
Term
| what 2 bones make up the subtalar joint |
|
Definition
|
|
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
|
|
Term
| what must move inveriorly with the talus when it moves inferiorly |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| will a straight lasted or curve lasted shoe be more comfortable for someone with cavus foot |
|
Definition
|
|
Term
| is a cavus foot hypermobile or hypomobile |
|
Definition
|
|
Term
| what kind of shoe is better for cavus foot: firm or flexible? |
|
Definition
|
|
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
|
|
Term
| is the navicular medial or lateral |
|
Definition
|
|
Term
| is the cuboid medial or lateral |
|
Definition
|
|
Term
| where are the 3 cuneiforms |
|
Definition
|
|
Term
| what 2 bones make up the hindfoot |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| what is the closepacked position of the talocrural joint |
|
Definition
|
|
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
|
|
Term
| how to prevent repeated ankle sprains |
|
Definition
|
|
Term
| which lateral ligament is elongated the most with inversion |
|
Definition
|
|
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
|
|
Term
| are syndesmosis injuries common |
|
Definition
|
|
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
|
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
|
|
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
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
Definition
|
|
Term
| does pain from walking on lateral side of foot increase in push off or landing |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
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
|
|
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
|
|
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
|
|
Term
| how much sagittal plane (qualitatively) do you expect to get from subtalar joint? |
|
Definition
|
|
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
|
|
Term
| how to help someone who has limited dorsiflexion and has pain walking up a hill |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| if you pronate leading to hip adduction, what is the risk? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| what is the architecture of the tarsal bones |
|
Definition
|
|
Term
| are the tarsal bones stable? |
|
Definition
|
|
Term
| is there motion in the intertarsal joints |
|
Definition
|
|
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
|
|
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
|
|
Term
| what is the formula for pressur |
|
Definition
|
|
Term
| what is the contact area when you have a malalignment like genu varus |
|
Definition
|
|
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
|
|
Term
| if the GRF moment arm gets shorter in someone with genu varus who pronates, what will happen to the soft tissue force |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| if someone has excessive genu valgus, what kind of stress is present on the medial side of their knee |
|
Definition
|
|
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
|
|
Term
| what kind of stress would be on the plantar side with midfoot collapse? |
|
Definition
|
|
Term
| what kind of stress would be on the dorsal side with midfoot collapse? |
|
Definition
|
|
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
|
|
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
|
Definition
| distal element is oriented toward the midline |
|
|
Term
|
Definition
| distal element is oriented away from the midline |
|
|
Term
| in what plane are varus/valgus |
|
Definition
|
|
Term
| in forefoot valgus, is the forefoot oriented toward or away from the mildline? |
|
Definition
|
|
Term
| what position should patient be in to look for forefoot to rearfoot alignment |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
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
|
|
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
|
|
Term
| in getting a rigid foot for push-off, is the stress at the medial longitudinal arch compressive, tensile, or shear? |
|
Definition
|
|
Term
| in getting a rigid foot for push-off, is the stress at the bottom of the foot compressive, tensile, or shear? |
|
Definition
|
|
Term
| with what type of stress is bone strongest |
|
Definition
|
|
Term
| with what type of stress is bone weakest |
|
Definition
|
|
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
|
Definition
| hyperextension injury of the great toe |
|
|
Term
|
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
|
|
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
|
|
Term
|
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
|
|
Term
| are the 2 subtalar joint axes parallel to each other in pronation or supination |
|
Definition
|
|
