Chapter 18 - The Foot Flashcards Preview

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Flashcards in Chapter 18 - The Foot Deck (120):
1

function of foot sesamoid bones

reduce pressure in weight bearing

increase mechanical advantage of flexor tendon

act as sliding pulleys for tendon

2

plantar fascia attaches where posteriorly?

calcanea tuberosity

3

sustenaculum tali located on the...

calcaneus

4

shape of the talus

broader anteriorly than posteriorly

bony alignment limits dorsiflexion

5

cuboid is on which side of the foot

lateral aspect of the foot

6

cuboid articulates with which metatarsals?

4th and 5th

7

cuneiforms sit between

the navicular and bases of metatarsals 1-3

8

medial longitudinal arch formed by

calcaneus, navicular, talus, 1st cuneiform, 1st metatarsal

9

spring ligament

attaches from calcaneus to navicular

10

navicular is on the

medial side of the foot

11

what tendons run along the medial longitudinal arch

posterior and anterior tibialis

12

lateral longitudinal arch

calcaneus, cuboid, 5th metatarsal

13

what tendons run along the lateral longitudinal arch

peroneus longus

14

anterior metatarsal arch

metatarsal heads

15

transverse arch

across transverse tarsal bones

16

what tendons run across the transverse arch

peroneal longus, tibialis posterior

17

plantar fascia supports the foot...

against downward forces

18

sub-talar joint

talus and calcaneus

19

sub-talar movements

inver/ever pron/sup

20

mechanics of pronation

calcaneus everts, talus PF and ADD, flattens medial longitudinal arch

21

mechanics of supination

calcaneus inverts, talus DF and ABD, increases medial longitudinal arch

22

pronation

eversion +abduction of forefoot

23

supination

inversion + adduction of the forefoot

24

muscles that pronate

peroneus longus/brevis/tertius

extensor digitorum longus

25

muscles that supinate

tibialis posterior,

flexor digitorum longus,

flexor hallucis longus,

tibialis anterior,

extensor hallucis longus

26

tibial nerve

posterior leg, plantar foot

27

common perineal nerve

front of leg, foot

28

arteries of foot

A/P tibial arteries

29

forefoot consists of

metatarsals and phlanges

30

mid foot consists of

navicular, cuboid, cuneiforms

31

rear foot consists of

calcaneus, talus

32

stance phase

initial contact of heel to toe off (60% of total gait)

heel strike, mid stance, push-off

33

heel strike

contact on lateral calcaneus with subtler supination and tibial ER

34

midstance

subtler joint pronates, and tribal IR (20%)

pronation maintained to provide shock absorption by unlocking the midfoot

35

push off

foot begins to supinate and will approach neutral subtler position at 70-90% of stance phase

supination locks the mid foot back up to form a rigid lever

36

swing phase

time between toe off and initial contact (NWB)

initial swing, mid swing, terminal swing

37

pronation involves what structural deformities

pes planes, forefoot varus, forefoot valgus, rear foot vars (in NWB)

38

pronation causes increased medial tension of..

post tib. and gastroc/soleus

39

pronation causes increased lateral compression of what joints

subtler and talocrural

40

pronation cause what at the knee

valgus force at the knee

41

excessive pronation

loose foot ->increased forefoot motion

compromises 1st met and attachment of peroneus longus

42

supination involves what structural deformities

forefoot valgus, pes Cavus

tibial ER compensation

43

Excessive supination causes

insufficient GRF absorption

puts weight on 1st and 5th mets

limits IR: inversion sprains, MTSS, peroneal tendinitis, IT band friction syndrome, trochanteric bursitis

44

pump bump aka

Haglaund's deformity

45

hallux valgus aka

bunion

46

sustenaculum tali located

medially

47

sinus tarsi located

laterally

48

pulses

posterior tibial (behind medial malleolus)

dorsal pedal

49

Longitudinal arch angle also known as

feiss line

50

feiss line test

draw line from medial malleolus, to 1st MTP joint (plantar). mark navicular tubercle (NWB)

they stand WB, ft 12 in apart, note position of navicular tubercle from ground

(+) navicular drops >2/3 to floor

51

NAvicualr drop test

sitting: mark navicular tuberosity, measure distance to ground

standing measure, looks or greater than 10 mm = (+) test

52

Morton's test

food in natural. apply transverse pressure to heads of metatarsals

(+) - sharp pain in forefoot

indicates: metarsalgia or neuroma

53

achilles tendon reflex

S1

54

talus fractures (etiology)

occurs in the dome

usually from severe INV/DF (medially) or INV/PF (laterally) with ER of tibia

55

talus fx s/sx

hx of ankle trauma, pain, catching, snapping, swelling, talar dome is tender over anterior joint line

56

talus fx management

x-ray, immobilize, protect, NWB progression

57

calcaneus fx etiology

landing after a jump

58

s/sx calcanea fx

swelling, pain, cannot WB, deformity

59

calcanea stress fx etiology

receptive heel strike, see in runners

60

management of calcanea stress fx

x-ray, bone scan, NWB

61

apophysitis of calcaneus aka

sever's disease

62

apophysitis of calcaneus etiology

occurs in young, physical active athletes - traction injury at apophysis of calcaneus where achilles tendon attaches

63

apophysitis of calcaneus s/sx

pain at posterior heel, pain during vigorous activity that is received with rest

64

apophysitis of calcaneus management

Rest, ice, stretching, NSAIDS

65

retrocalcaneal bursitis etiology

pressure from heel counter inflames bursa between achilles and calcaneus/

exostosis may develop

66

exostosis

bony outgrowth or callus

67

heel contusion etiology

sports demanding stop and go response or changes from horizontal to vertical movement.

68

heel contusion s/sx

pain in heal, cannot WB, warmth/redness

69

heel contusion management

RICE NSAIDS, heel cup, protective donut, wear shock absorbent footwear

70

tarsal tunnel formed by

osseous floor and flexor retinaculum

71

inside the tarsal tunnel

tibialis posterior, flexor hallucis longus, flexor digitorum muscles, tibial artery, tibial vein

72

tarsal tunnel synodrome s/sx

pain, paresthesia (medial and plantar), (+) Tinel's,

73

tarsal tunnel management

surgery (if chronic), NSAIDS, orthotic

74

Lisfranc Injury

Tarsometatarsal fx/Dislocation

75

lisfranc etiology

ankle is PF with rear foot locked, sudden forceful hyper PF of forefoot results in dorsal displacement of proximal end of metatarsals

76

lisfranc s/sx

subtle symptoms:

pain, swelling, tenderness on dorsum of foot, possible fx of metatarsals; disruption of supporting ligaments

77

lisfranc management

restore alignment (ORIF);

78

pes planus foot

flat foot

79

pes planus etiology

fallen ML arch, excessive pronation,

caused by: tight shoes, forefoot varus, trauma, excessive exercise

80

pes planus s/sx

pain, weakness/fatigue in arch, calcanea eversion, bulging navicular, flattening of arch,

81

pes planus management

taping, orthotics (medial wedge)

82

pes cavus foot

high arch, claw foot, hollow foot

83

pes Cavus foot etiology

excessive supination, congenital or neuro disorder

84

pes cavus foot s/sx

poor shock absorption, pain, metarsalgia, clawed/hammer toes,

forefoot valgus, shortened achilles, odd calluses on ball and heel of foot

85

pes cavus management

orthotics with lateral wedges, stretching achilles tendon and plantar fascia

86

plantar fasciitis etilogy

repeated tensile stress, hyperpronation, leg length discrepancy, toe running, limited DF

87

plantar fasciitis s/sx

anteromedial heel pain, morning pain, decreased pain with movement, pain w/ toe walking and during DF

88

plantar fasciitis management

RICE, NSAIDS, correct cause, arch support, taping, orthotics, walking boot, night splint,

89

Jones Fx Etiology

most common acute fx is fx to the diaphysis at the base of the 5th met

90

Jones Fx S/sx

swelling and p!, healing is slow; high non-union rate and healing course is unpredictable

91

Jones Fx Management

crutches, no immobilization, progress to weight bearing; treat early with internal fixation

92

metatarsal stress fracture etiology

most common - 2nd MT (marcher's fx) - runner who changed training surfaces.

93

metatarsal stress fx management

gradual return to activity, rest, orthotic to correct pronation

94

Bunionettes aka

tailor's bunions

95

Bunions etiology

associated with structural forefoot varus

narrow shoes or short shoes also pointed shoes

bursa over 1st MTP joint becomes inflamed and thickens. Joint is enlarged and toe is malaligned

96

Bunion S/sx

pain, swelling, joint enlargement; poorly fitting shoes increase irritations and pain; angulation of toe progresses

97

bunion management

wear correctly fitting shoes, orthotics, tape splint along with wedge b/w great toe/ 2nd toe

98

sesamoiditis etiology

caused by receptive hyperextension of the great toe (dancing/basketball)

99

sesamoiditis s/sx

pain under great toe, esp during push-off. Palpable tenderness under 1st MT head

100

sesamoiditis management

orthotics, metatarsal pads, arch supports, metatarsal bar

101

metatarsalgia etiology

pain under 2-3rd metatarsal heads

heavy callus forms, causes inflexibility of gastroc/soleus

also could be caused by fallen metatarsal arch

102

metatarsalgia s/sx

p! under met bones 2-4; caves deformity may cause metatarsalgia

103

metatarsalgia management

pad to elevate depressed met heads; remove callus buildup; stretching of gastroc/soleus; strengthening of intrinsic foot musculature

104

Morton's neuroma etiology

neuroma is a mass in nerve sheath between 3 and 4 metatarsals;

predisposing factors: collapse of transverse arch, excessive pronation

105

morton's neuroma s/sx

burning paresthesia, severe p! that radiates to toes, hyperextension of toes increases sx

106

morton's neuroma management

bone scan to rule out stress fx; teardrop-shaped pad placed b/w 3rd and 4th MT heads; narrow shoes may exacerbate problems

107

Turf Toes etiology

hyperextension injury resulting from sprain of the MTP joint of great toe

108

Turf Toe s/sx

pain and swelling, p! increased in push-off during walking, running, jumping

109

management of turf toe

stiffer forefoot of turf shoes, orthoplast under foot, tapping to prevent dorsiflexion, and rest

110

Morton's toe

1st toe is abnormally short

111

management of morton's toe

if painful use orthotic with medial wedge

112

hallux rigidus etiology

bony spurs on dorsal aspect of 1st MTP joint that results in impingement and a loss of active and passive DF

degenerative arthritic process

113

hallux rigidus s/sx

great toe unable to DF; forced DF increases pain, weight bearing on lateral foot when walking

114

hallux rigidus management

stiffer she with larger toe box, NSAIDs,

115

Hammertoe

flexible deformity that can become fixed; flexion contracture at PIP joint

116

Mallet toe

flexion contracture at DIP joint (involving flexor digitorum longus tendon).

117

Claw toe

flexion contracture at DIP joint and hyperextension at the MCP joint; callus develops over PIP joint and under metarsal head

118

subungal hematoma etiology

large force applied to toe, kicking another object. receptive shearing

119

subungal hematoma s/sx

bleeding may be immediate or slow, producing p!, bluish-purple color

120

subungal hematoma management

ice, release pressure by drilling hole into nail bed