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1

what is kinetics

the study of forces that cause motion

(forces, torques)

"the study of forces associated with motion using force plates, pressure platforms and/or inshoe sensors providing a direct description/orientation of foot posture"

2

what is kinematics

the study of describing movements

(velocity, acceleration)

"related to the measurement of motion irrespective of the forces involved using cameras to observe the intersegmental relationship of the trunk and limbs"

3

what is the role of the human foot

provides support and balance during standing

stabilises the body during gait

4

what does the foot have to do during stance phase (between heel strike and toe off)

to adapt to a changing patter of loading as the centre of mass of the body moves

5

what is the GRF

ground reaction force

equal and opposite reaction when the foot comes into contact with the ground

changes in direction and magnitude as the body propels itself forwards

6

what are the important mechanical structures of the foot

(3 things)

1 - the bony skeleton, which together with the ligaments and arches, provides relative rigidity and lever arm mechanism required to maintain balance

2 - joints which allow felxibility

3 - muscle and tendons which control foot movement

7

what does the foot need to do during the stance phase and what does failure to do so lead to

distribute and dissipate compressive, tensile, shearing, and rotatory forces

failure can lead to abnormal movements which produces excessive stress which can result in the breakdown of soft tissue and muscle

8

how many bones are in the foot

26

- 7 tarsals
- 5 metatarsals
- 14 phalanges

9

how many joints are in the foot

6

- ankle
- subtalar
- midtarsal
- tarsometatarsal
- MTP
- IP

10

what are the 4 segments of the foot

hindfoot
midfoot
forefoot
phalanges

11

what does the hindfoot consist of

talus
calcaneus

12

what is the function of the talus bone

orientated to transmit reactive forces from the foot through the ankle joint to the leg

lies between the calcaneus and tibia

13

what is the function of the calcaneus

largest and most posterior bone in the foot and provides a lever arm for the insertion of the Achilles tendon

14

what muscles acts through the achilles tendon and what do they do

gastrocnemius and soleus

impart powerful plantarfexion forces to the foot

15

what does the height, width and structure of the calcaneus allow it to do

withstand high tensile, bending and compressive forces on a regular basis w/out damage

16

what makes up the midfoot

navicular, the cuboid and three cuneiforms

17

what is the main role of the navicular bone

is the keystone for the medial longitudinal arch

18

what is the function of the cuneiforms

articulate with the first, second and third metatarsals distally

contribute to stability of midfoot

19

what makes up the forefoot

5 metatarsals

20

how is the first metatarsal different from the others

is the shortest and widest

21

how does the second metatarsal compare to the first

extends beyond the first

22

what is the second metatarsal so important

articulates with the intermediate,medial and lateral cuneiforms in a ‘key-like’ configuration which promotes stability

makes it the stiffest and most stable portion of the foot playing a key role in stabilizing foot posture after hallux surgery.

23

why attaches to the styloid, laterally and proximally on the fifth metatarsal and what injury can happen here as a result

the peroneus brevis tendon inserts

Avulsion # of the styloid commonly occurs when the foot is inverted against the contracting peroneus brevis muscle

24

what do the toes (phalanges) contribute to

weight bearing and load distribution

propulsion during the push-of phase of gait.

25

what are the 3 planes of motion in joints

sagittal plane
frontal (coronal) plane
transverse

26

what joints of the foot have one degree of freedom (i.e. only move in one plane)

subtalar
ankle
tarsometatarsal

27

what joints of the foot have two degree of freedom (i.e. move in two plane) and what are the 2 planes

midtarsal
MTP
IP joints

adduction-abduction
dorsiflexion-plantarflexion

28

what does the ankle joint consist of and what motion does it allow

articulation between distal part of the tibia and the body of the talus

dorsiflexion and plantarflexion

29

what is the ROM need at the ankle joint for normal locomotion

10 degrees of dorsiflexion
20 degrees of plantarflexion

30

why is there instability in the ankle joint during plantarflexion

has slight movement in transverse plane during plantarflexion

causing instability of the joint in this position

31

what is included in the subtalar joint

the talocalcaneal joint and the talocalcaneal part of the talocalcaneonavicular joint

32

at what degree does the axis of motion pass through the subtalar joint

42 degrees from the Transverse plane and 16 degree from the sagittal plane

33

what are the motions permitted at the subtalar joint

supination
pronation

34

what together forms the midtarsal joint

The talonavicular and the calcaneocuboid joints

35

what are the two axis of motion of the midtarsal joint and what motion does it contribute to

oblique axis
longitudinal axis

pronation/supination

36

what is the ROM at the MTP joint

up to 90 degrees extension
only few degrees flexion

37

what is ROM for IP joints

allow extension (related to abduction)

allow flexion (related to adduction)

38

what is the medial arch comprised of

the calcaneus, talus, navicular, the three cuneiforms and their three metatarsals

39

what are the pillars of the medial arch

tuberosity of the calcaneus posteriorly

heads of the medial three metatarsal bones anteriorly

40

what is the lateral arch comprised of

calcaneus, the cuboid and the lateral two metatarsals

41

how does the tension in the MA and LA change during walking

relatively rigid in standing but become more compliant during walking; the MA being the more flexible of the two

42

there is also a series of transverse arches - where are they centered round

the MTP joints
- form a convex curve in the direction of the dorsum

43

what happens to the TA's during walking

disappear and flatten to varying degrees during weight bearing

44

what supports the integrity of the arches

ligaments (particularly in LA)
muscles (particularly in MA)
tendons

provide strength, flexibility and movement.

45

what are the two groups of muscles operating on the foot

extrinsic muscles - from lower leg

intrinsic muscles - within foot itself

46

what is the function of the muscles during locomotion

provide stability and balance during standing

and a strong lever arm effect during propulsion

47

what are most of the problems associated with foot disorders related to

the weight bearing process at the foot-ground or foot/shoe-ground interface

48

what is the reference for one full gait cycle (GC) and what is the time interval known as

time interval between two consecutive heel strikes of the same foot on the ground

time interval known as stride time

49

stages of GC

heel strike
forefoot loading
midstance
heel off
toe off

50

what are the 2 phases of GC

stance phase (60%)
swing phase (40%)

51

what is double support in GC

when both feet are in touch with the ground

lasts 10% of GC and occurs twice in any GC

52

what counteracts the GRF

function of the lower limb muscles in conjunction with bones, joints and tendons of the foot

53

what is the function of lower limb muscles during gait

to stabilise and accelerate/decelerate the foot during both wt bearing and propulsion

54

some muscles in lower limb have more than one function - what roles does the long extensors have

- stabilise the joints of the toes during propulsion

- serve as accelerators in ankle joint dorsiflexion following toe off

- assist as decelerators of the foot at HS

55

some muscles in lower limb have more than one function - what roles does the tibialis anterior have

- decelerates the foot following HS

- accelerates to assist in ankle joint dorsiflexion following TO.

56

what occurs very shortly after HS

transient period
- GRF is anterior to both ankle and knee joint
- lasts between 10 and 20ms

57

how does the location of the GRF change after HS and what does this create

changes to a location posterior to both joints (ankle and knee)

creates an external plantarflexion moment around the ankle joint

58

what happens instantaneously when this external plantarflexion moment occurs

the tibialis anterior and the extensor hallucis longus muscle contract eccentrically

producing an internal dorsiflexion moment which decelerates the rate of ankle joint plantarflexion

59

what does the combo of the external plantarflexion moment and the internal dorsiflexion moment allow

synergistic action of these two muscle groups allows the foot to passively plantarflex in a smooth, regulated manner

ankle joint plantarflexion is virtually stopped synchronously with the forefoot making contact with the ground.

60

how is the subtalar joint, ankle and leg positioned during HS

subtalar - inverted
ankle - dorsiflexed
leg - internally rotated

61

what time delay was observed in the tibialis anterior in diabetic patients and what does this mean

180ms

late firing means normal modulating role of the muscle in lowering foot to the ground after HS is disturbed

leads to forefoot slap and high plantar pressure

62

during initial movement, what is the only part of the forefoot that makes contact with the ground and what happens as weight is transferred

the lateral side of the forefoot

as wt transferred to the forefoot, the effect of the GRF on the lateral side tends to evert the forefoot against resistance caused by contraction of TA

63

what does controlled relaxation of TA facilitate

smooth progressive loading of the forefoot from lateral to medial locations

GRF can evert the forefoot until full foot contact is achieved and loading is then transferred from lateral to medial side

64

what happens after HS but before forefoot contact

the calf muscles, i.e. the tibialis posterior, soleus and gastrocnemius, begin to contract

65

what do the calf muscles work to do

function to collectively decelerate subtalar joint pronation and internal leg rotation

continue to contract throughout MS phase

relax at HO

66

what happens to GRF during forefoot loading

GRF maintains its posterior direction but w/ increasing magnitude until MS

it then moves anteriorly along the foot - causes GRF to become smaller and ultimately reverse in direction [i.e. still posterior to the knee joint but now anterior to ankle joint]m

67

what happens at the beginning of the MS period

the posterior calf muscles become prime movers which initiate subtalar joint supination and external leg rotation.

Both the TP and soleus have attachments which create significant lever arms relative to the axis of motion of the subtalar joint.

68

what happens in relation to ankle after forefoot contact

the ankle is plantarflexed, and following this, the ankle joint begins to dorsiflex as the tibia moves forwards, over the foot.

tibia continues to move forward causing ankle joint dorsiflexion throughout MS period until point of HO

69

what does deceleration of forward tibial momentum also do

extend the knee in preparation for HO

[muscles which decelerate the forward momentum of the tibia to assist in knee extension are those which have significant lever arms for ankle joint plantarflexion]

70

what are the muscles that decelerate the forward momentum of the tibia/ have significant lever arms for ankle joint plantarflexion

[muscle that is also ankle joint plantarflexor]

tibialis posterior, soleus, and flexor digitorum longus

[gastrocnemius]

71

what stabilises the lesser tarus during the MS period and how do they do this

in early MS
- soleus, tibialis posterior, peroneus longus, and peroneus brevis muscles

soleus
- maintains the Sp stability of the cuboid in order to serve as an effective pulley for the function of peroneus longus

peroneus longus
- pulls the first ray laterally against the lesser tarsus

TP
- pulls the lesser tarsal bones medially.

overall effect
- compresses the lesser tarsus in the Tp, thus producing medio-lateral stability

72

how does the peroneus brevis complement the function of peroneus longus to help in maintaining transverse stability of the lesser tarsus during stance phase

the magnitude of the adduction force generated by TP exceeds that of the abduction force exerted by the peroneus longus.

peroneus brevis exerts an additional abduction force upon the lesser tarsus to thereby neutralize the otherwise existing imbalance.

73

when the foot is fully pronated what facilitates further abduction

pronation of the subtalar joint

[in CP, entire foot may be pronated into a flat foot position, called peroneal spastic flatfoot]

74

at HO, where is the GRF and what does it cause

anterior in relation to both ankle and knee joints creating an external dorsiflexor moment which is opposed by both the soleus and gastrocnemius muscles

75

what happens following HO in regards in terms of wt bearing and what happens simultaneously

foot momentarily bears full body weight alone

the vertical GRF generated exceeds that of bodyweight and the ball of the foot is also subjected to torque and high shear forces.

76

what is the major function of the intrinsic muscles during second half of MS phase

provide the tensile forces necessary to stabilise the bones of the metatarus and lesser tarus transversely and posteriorly against one another.

[when foot is abnormally pronated the IM muscles must function longer and stronger]

77

what interaction allows for the action of heel rise

interaction between forward momentum of the body, deceleration of the tibia, and passive knee flexion

78

what happens at the end of MS

the trunk is directed forwards relative to the foot, and the body is falling forwards over the weight-bearing foot.

Forward trunk momentum carries the thigh and leg with it

79

what does the knee do immediately prior to heel rise and what does the tibia do thereafter

begin to flex

tibia continues to move forward while the heel rises, maintaining ankle dorsiflexion into the early propulsion period

80

what muscles are responsible for tibia deceleration

TP, gastrocnemius and soleus with later assistance from the FDL and peroneus longus

81

what halts knee extension just before heel rise

contraction of the gastrocnemius muscle

82

what does the ankle do during propulsion phase

initially dorsiflexes slightly and then plantarflexes until TO

Shortly after heel rise, ankle dorsiflexion is stopped consequent to the weight no longer passing through the heel

calf muscles then plantarflex ankle

83

during the early stage of propulsion, what muscles are contributing to ankle joint plantarflexion

gastrocnemius, soleus, peroneus longus

transverse pedis - transverse stabiliser of the forefoot.

84

what happens shortly after heel rise and what muscles are involved

the lateral side of the foot lifts from the ground

weight is transferred to the medial side of forefoot where it concentrates on the great toe

peroneus longus and brevis

85

The long and short plantarflexors of the lesser digits stabilise the toes against the ground - but they cannot do so unless what

toes are converted into rigid beams by extensor mechanism.

86

what factors influence propulsion phase stability of the great toe

stability and plantarflexion of the first ray

normal sesamoid function

normal strength and function of the muscles responsible for hallux, and first MTP joint stability.

87

what movement must the hallux be able to do during final propulsion

65-70 degrees of dorsiflexion on the first metatarsal

(or it will sublux at the first MTP joint and become unstable)

88

where is GRF just prior to toe off

anterior to the ankle and posterior to the knee

89

what happens immediately before TO and what does this create

tibialis anterior begins to contract (until mid swing)

creates a smaller dorsiflexor moment around the ankle joint which helps in clearing the foot off the ground

90

what is an issue with gait analysis labs

have not proven to be cost effective

91

what is problems facing analysis in gait labs

type of analysis dependant on type of equipment and expertise of used

up to 1 and a half hour needed per subject to record gait data

92

what is GaitRite

portable gait analysis system,

relatively cheap, easy to use and provide an almost complete analysis instantaneously

93

what conditions is GaitRite useful for

"shuffling gait" and those with low assessment tolerance
e.g. Parkinson's disease

94

disadvantage of GaitRite

incompetent in providing inter-segmental relationship

(crucial in patients with CP)

95

devices that are add-ons to measuring gait and pressure

portable electromyography

goniometry

energy expenditure.

96

what does measuring pressure tell you

gait cycle
pressure points
gait pattern
foot print and posture
centre of pressure

97

what is foot/ankle proprioception

awareness of the position and motion of the foot joints in space with the ability to accurately match reference joint angles without visual feedback

98

how many injuries resulting in time lost through injury in running and jumping sports involve the ankle

20-25%

99

in ruptures of the fibular collateral ligament, what was functional instability suggested to be

mechanical instability

peroneal weakness

tibio-fibular strain and proprioceptive deficit

100

what are pilon fractures and how does it occur

fracture of distal part of the tibia involving the articular surface of the ankle

result of an axial loading injury which drives the talus into the tibia

101

what foot movements lead to injury

internal rotation
external rotation
abduction
adduction

102

extrinsic risk factors for the ankle

training errors, type of activity (e.g. sport), exercise time, equipment and environmental conditions

103

intrinsic risk factors for the ankle

height, weight and previous Hx of ankle sprain = lateral ankle sprain

muscle strength imbalance = eversion-to-inversion strength ratio and greater plantarflexion strength = higher incidence of inversion ankle sprain

104

Ankle injuries are fewer in unshod populations - what does this suggest

shoes may alter the ability of the protective mechanisms around the ankle in preventing damage

may be due to increased leverage at the ankle confirmed by the unnatural high heel and reduction of foot/ground sensation

105

what shoes had a 123% greater injury frequency of the lower limb compared to cheap shoes

expensive athletic shoes to that advertised safeguard feet through ‘cushioning impact’

106

what is general rules for treating a patient

Avoid Trial and Error Management

Always try to find the primary cause of the problem

Never treat the secondary symptoms without
knowing the primary cause

107

what can form as the results of friction with the inner shoe

dorsal callus formation

108

what causes damage in high heel shoes

forward shift of the centre of mass

- results in increased pressure under the metatarsal heads and toes
- results in abnormal joint and muscles function within the foot and lower leg
- results in ultimately abnormal balance, proprioception and body posture

109

what are the Sx that high heels cause

damage to calf muscles

painful knees and strained back muscles

enlarged joints

damage to soles and arches

hard skin/corns/bunions

deformed toes

110

what question can you ask the patient to find out if the shoes are causing the pain

do you get the same pains when you walk barefooted?

111

what is a compensatory measure for push off from the forefoot seen after shortening of the first rays (case B)

higher pressure values under the lesser toes

112

why did a dome/button insole not work with the women with shortening of the first rays (case B)

elevated the 2nd, 3rd and 4th metatarsal shafts which further extended the lesser toes and in turn increased the pressure under them

113

what was done for the women w/ increased pressure under her lesser toes (case B)

1 - transverse rocker that facilitates the transfer of load from the lateral to medial aspects of the foot

2- longitudinal rocker compensates for the first ray shortening and assists at the push off stage

114

what did wearing shoes smaller than the patients right foot cause (case C)

caused abnormal longitudinal forces along the first ray in addition to the irritation caused by the built-in arch

problem was localised around the mid-pt of the flexor hallucis longus (FHL)