Chapter 18 - The Foot Flashcards
(120 cards)
1
Q
function of foot sesamoid bones
A
reduce pressure in weight bearing
increase mechanical advantage of flexor tendon
act as sliding pulleys for tendon
2
Q
plantar fascia attaches where posteriorly?
A
calcanea tuberosity
3
Q
sustenaculum tali located on the…
A
calcaneus
4
Q
shape of the talus
A
broader anteriorly than posteriorly
bony alignment limits dorsiflexion
5
Q
cuboid is on which side of the foot
A
lateral aspect of the foot
6
Q
cuboid articulates with which metatarsals?
A
4th and 5th
7
Q
cuneiforms sit between
A
the navicular and bases of metatarsals 1-3
8
Q
medial longitudinal arch formed by
A
calcaneus, navicular, talus, 1st cuneiform, 1st metatarsal
9
Q
spring ligament
A
attaches from calcaneus to navicular
10
Q
navicular is on the
A
medial side of the foot
11
Q
what tendons run along the medial longitudinal arch
A
posterior and anterior tibialis
12
Q
lateral longitudinal arch
A
calcaneus, cuboid, 5th metatarsal
13
Q
what tendons run along the lateral longitudinal arch
A
peroneus longus
14
Q
anterior metatarsal arch
A
metatarsal heads
15
Q
transverse arch
A
across transverse tarsal bones
16
Q
what tendons run across the transverse arch
A
peroneal longus, tibialis posterior
17
Q
plantar fascia supports the foot…
A
against downward forces
18
Q
sub-talar joint
A
talus and calcaneus
19
Q
sub-talar movements
A
inver/ever pron/sup
20
Q
mechanics of pronation
A
calcaneus everts, talus PF and ADD, flattens medial longitudinal arch
21
Q
mechanics of supination
A
calcaneus inverts, talus DF and ABD, increases medial longitudinal arch
22
Q
pronation
A
eversion +abduction of forefoot
23
Q
supination
A
inversion + adduction of the forefoot
24
Q
muscles that pronate
A
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
