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OPP exam 3 > Mechanics of the foot > Flashcards

Mechanics of the foot Flashcards

1
Q

what is the shape of the ankle

A

Tibia forms a concave surface and fits into the body of the talus

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2
Q

what stabilizes the joint of the ankle

A 
capsule
deltoid ligament (medial)
anterior talofibular (ATF-always tear first!), 
posterior talofibular (PTF) & 
calcaneofibular ligaments
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3
Q

what is the deltoid ligament and what does it attach to

A

medial ligament

very very strong

attaches to the medial malleolus, tuberosity of navicular, the sustentaculum tali of the calcaneus and the medial tubercle of the talus

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4
Q

what is the first ligament to tear in an inversion ankle sprain and what does this ligament attach to

A

anterior talofibular

this attaches to the lateral malleolus and to the neck and lateral articular facet of the talus

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5
Q

where does the PTF attach

A

Attaches to the lateral malleolus & to the lateral tubercle of the post process of the talus

LATERAL ligament. can be hurt in inversion sprain

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6
Q

where does the calcaneofibular ligament attach

A

attaches to the lateral malleolus and the tubercle of the lateral surface of the calcaneus

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7
Q

what are the major motions of the tibiotalar joint many degrees is normal in each

A

plantar flexion (50)

dorsiflexion (20)

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8
Q

what are the major players in plantar flexion

A

gastrocnemius and soleus

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9
Q

what are the minor players in plantar flexion

A

plantaris
tibialis posterior
flexor hallucis longus
flexor digitorum longus

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10
Q

what are the major players in dorsiflexion

A

tibialis anterior

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11
Q

what are the minor players in dorsiflexion

A

extensor digitorum longus

extensor hallucis longus

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12
Q

in which position is the ankle most stable ?

A

dorsiflexion (with posterior glide of the talus)

when you sprain your ankle toes are usually down

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13
Q

what are the accessory motions of the ankle

A

Side-to-side glide,
rotation,
abduction and adduction only if the joint is plantar flexed.

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14
Q

what is the subtalar joint

A

talus on the calcaneus

two separate concave-convex articulations

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15
Q

what are the major motions of the subtalar joint

A

abduction (valgus)
adduction (varus)
this is in relationship to a fixed talus (so the heel deviates in and out)

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16
Q

what other foot bone does the talus articulate with

A

navicular

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17
Q

what other foot bone does the calcaneus articulate with

A

cuboid

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18
Q

motion of the hind foot is the combined motion of what two joints

A

subtalar

navicularcuoid

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19
Q

what occurs in inversion of the foot

A

medial rotation of the calcaneus and navicular
increases height of the medial arch
cuboid rotates down on calcaneus
plantar flexion of the ankle

So inversion is calc adduction + navicular rotation + glide on talus
These raise the medial portion of the foot and depress the lateral portions

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20
Q

what muscles are used in inversion of the foot

A

tibialis anterior and posterior

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21
Q

what occurs during eversion of the foot

A

lateral rotation of the calcaneous and navicular

Lateral rot of calc & nav
Decreases the height of the medial arch
Cuboid rotates up on calcareous
Dorsiflexion of ankle

So eversion is calc abduction + navicular rotation + glide on talus
These raise the lateral portion of the foot and depress the medial portions

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22
Q

what are the muscles used in eversion of the foot

A

fibularis longus and brevis

exterior muscles

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23
Q

what is pronation of the foot

A

eversion, dorsiflexion, abduction

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24
Q

what is supination of the foot

A

inversion, plantar flexion, adduction

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25
Q

what is the primary motion of the tarsometatarsal jts

A

flexion and extension

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26
Q

what is the primary motion of the intermetatarsal jts

A

sliding

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27
Q

what are the motions of the MTP’s

A

flexion
extension
abduction
adduction

they also slide, rotate and provide long axis traction

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28
Q

what is the motion of the interphalange jts

A

flexion and extension

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29
Q

what is the lateral arch for mostly

A

weight bearing and elasticity
built to transmit weight and thrust to the ground
limited mobility

type of LONGITUDINAL arch
has osseous support

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30
Q

what makes up the lateral arch

A

calcaneus, cuboid, 4th and 5th metarsals

31
Q

what is the medial arch for

A

for mobility
changes to adapt to terrain
does NOT have firm osseous support
helps control gait

32
Q

what makes up the medial arch

A 
calcaneus 
talus
navicular 
the cuneiforms 
1-3 Metatarsals
33
Q

what controls the medial arch

A 
plantar ligament 
plantar fascia
tibialis posterior
flexor digitalis longus
flexor hallucis longus
intrinsic muscles of the foot
34
Q

what causes high medial arch

A

adduction of foot and VARUS calcaneus

35
Q

what causes dropped medial arch

A

caused by abduction of foot and valgus calcaneus
and dorsiflexion of the ankle
(basically extreme pronation)

36
Q

do muscles support the medial arch of the foot?

A

NO

they help control it for balance and gait

37
Q

what are the 3 transverse arches

A

anterior
posterior
tarsal arch

38
Q

what makes up the anterior transverse arch

what is its function

A

made up of the MT heads

transmits weight to the ground

flattens with weight bearing

39
Q

what makes up the posterior transverse arch

A

MT bases

40
Q

what makes up the tarsal arch

what is its function

A

made up of navicular, cuboid, cuneiforms

assists is flexibility of foot as well as rotation

41
Q

what happens with loss of the transverse tarsal arch

A

pes planus (flat feet)

42
Q

what is the difference between functional flat feet and structural flat feet

A

Functional flat feet- when standing and walking and foot becomes flat, can treat with an orthotic

Structural flat feet- when patient is sitting and their feet are rigid and flat and they are stuck, these people usually have lots of other pain

43
Q

what are high arches called

what happens with high arches

A

pes cavus

there can be gait problems

44
Q

if the feet are pronated what else will be observed

A

the achilles on the pronated side will bow

45
Q

what happens with hammer toes

A

DIP is extended

PIP is flexed

46
Q

what happens with claw toes

A

flexion of both DIP and PIP

47
Q

what are bunions

what else can this be caused by

A

A bunion is the medial deviation of the 1st MTP with lateral deviation of the proximal phalanx of the hallux (great toe)

The MTP can be very tender, erythematous and swollen

Gout can also do this

This is actually a problem usually with the 2nd MTP pushing on the 1st MTP

48
Q

how far can you adduct the subtalar joint

A

20 degrees

49
Q

how far can you abduct the subtalar joint

A

10 degrees

50
Q

how do you motion test the subtalar (calcaneal) joint

how many degrees of motion are expected

A

The patient actively moves the foot first

Then the doctor passively moves the foot by gripping the calcneus in one hand and locking the talus by gripping the forefoot with the other. Then invert and evert the foot

Inversion/eversion 5 degrees of motion

51
Q

how do you motion test the MT’s

A

grasp the MT next to it and lock it out

52
Q

what are the motions of the hallux and how many degrees in each is expected

A

flexion 45 degrees

extension 70-90 degrees

53
Q

what happens in the stance phase of gait

A

heel strike
Foot rolls to lateral edge
Weight should roll back to ant transverse arch
The great toe should push (toe) off

54
Q

what is a common ankle injury and what are the ligaments involved

A

acute inversion ankle sprain

anterior talofibular (always tears first)

calcaneofibular

posterior talofibular (rare to see this except with fracture/dislocation)

55
Q

what is a grade 1 ankle inversion sprain

A

microtears with the ligament

Swelling and disability but no instability (no laxity)

56
Q

what is a grade 2 ankle inversion sprain

A

partial tear of the ligament

Severe swelling over the ankle, mild instability, antalgic(limp) gait, mild ligamentous laxity, laxity is noted with a good end point, decreased ROM (swelling, pain)

57
Q

what is a grade 3 ankle inversion sprain

A

complete tear

marked loss of function and complete instability, no endpoint noted on provocative testing

58
Q

what is the mechanism of injury of an acute inversion sprain

A

inversion and plantar flexion

generally from stepping on an uneven surface

59
Q

what are the symptoms of acute inversion ankle sprain

A 
Sx
Swelling
Eccymosis
TTP (tenderness to palpation) depending on degree of injury
Decreased ROM
Antalgic  gait
Poor lower extremity propreoception
Assessed with one leg standing test
60
Q

what do you do in diagnosis of acute inversion sprain

A

x-ray
anterior drawer test
talar tilt test
arches of the foot

61
Q

what will an X-ray reveal in anterior inversion sprain?
anterior drawer?
talar tilt?

A

negative x-ray

anterior drawer –> positive in 2nd and 3rd degree tears only

talar tilt test is positive
assesses the ATF ligament and calcaneofibular

62
Q

what does it mean if the arch of the foot is flat after a sprain? what is the next step

A

IF the arch is acutely flat; this may indicate tear of tibialis posterior tendon (a stabilizer of the foot)

If Tib Post tendon is torn—it must be surgically corrected within 14 days for optimal outcome to prevent degeneration of the foot

ORDER MRI

63
Q

who can the ottawa rules be used on?

A

patients over the age of 18

64
Q

what are the ottawa rules

A

ankle x-ray is required if bony tenderness at posterior edge of medial or lateral malleolus
or if inability to bear weight both immediately and in ED

foot x-ray required if bony tenderness at the base of the 5th metatarsal or the navicular
or if inability to bear weight immediatley or in the ed

65
Q

how do you do the anterior drawer test and what does a positive test tell you

A

Pt is sitting with legs dangling off table
Foot is in a few degrees of plantar flexion
Doc grabs front of tibia with the other hand cupping the calcaneus
Gently pull the calcaneus anterior as you push the tibia posterior
If normal the talus will not move on the tibia
If abnormal the talus slides anteriorly—this is a positive test

tells the status of the anterior talofibular ligament

66
Q

how do you do the talar tilt test

what is a positive test

A

Pt is sitting with legs dangling off table
Doc inverts the calcaneus
If the talus gaps or rocks in the ankle mortise, the ATF & calcaneofibular ligs are torn and the test is positive

67
Q

effects of a sprain on the body

A

The ankle inverts
The fibular head moves posterior, the lateral malleolus moves anterior
This could impinge the common fibular (peroneal) nerve and cause a foot drop
The tibia externally rotates
The femur internally rotates
Ipsilateral anterior innominate
Anterior torsion of the sacrum facing the side of the ankle sprain
So for a right ankle sprain, a Right on Right sacral torsion
L5 will rotate opposite of the sacrum

68
Q

treatment of acute ankle sprain grade 1 and 2 tears

A

Conservative treatment
PRICE (protection, rest ice, compression, elevation)
NSAIDs once Fx has been ruled out (anti-inlammatory)
Other pain medication
Crutches if needed
OMT

69
Q

what do you treat grade 3 tears with

A

PRICES
(protection, rest, ice, compression and elevation)
and SURGERY

70
Q

when can you start physical therapy for acute ankle sprain

A

once acute inflammation is over 48-72 hours

71
Q

how long do you continue ankle proprioception exercises (one leg standing or wobble board) for?

A

full 10 weeks to prevent recurrent sprains

72
Q

pectus excavatum

A

sunken chest

73
Q

pectus carnii

A

pigeon breast

74
Q

pseudoarthorsis

A

multiple joints

OPP exam 3 (11 decks)

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