E&I - Week 1

Question 1

What movements are paired with pronation of the foot?

Answer 1

Eversion, Abduction, DF

Question 2

What movements are paired with supination of the foot?

Answer 2

Inversion, Adduction, PF

Question 3

Linkages of the PF and DF with other dimensions of the foot is due to what?

Answer 3

Oblique M/L axis of rotation of the foot which leads to associated motion at the talocrural joint

Question 4

What is one quick way you can find subtalar neutral?

Answer 4

Have the patient move in closed chain pronation and supination - this is reflective of the talus rolling on the calcaneus: since the calcaneus is fixed by gravity, it has to be the talus that is sliding

Question 5

Pronation and supination in WB occur as leg and talus _________ __________ over fixed calcaneus.

Answer 5

horizontally rotate

Question 6

What do you need to stabilize in order to assess transverse tarsal joint motion and how do you do this?

Answer 6

The subtalar joint Hold at the navicular and move distal

Question 7

What motions are available at the transverse tarsal joint?

Answer 7

Abduction/Adduction DF/PF

Question 8

Where do you grip to assess transverse tarsal DF/PF?

Answer 8

Sustenaculum tali (basically cup the heel of the foot in your hand with one hand and turn at the navicular with the other).

Question 9

Where will you find the most motion at the tarsometatarsal joint?

Answer 9

1st/4th/5th TMT joints

Question 10

Where will you find the least motion at the TMT joint?

Answer 10

2nd and 3rd TMT joints

Question 11

What upstream changes can occur in a foot that is pronated?

Answer 11

tibial IR (it follows the subtalar joint) valgus @ the knee hip IR and adduction contralateral pelvic hip drop

Question 12

What conditions can occur with pes planus?

Answer 12

plantar fasciitis posterior tibialis insufficiency anterior knee pain ACL injury

Question 13

What occurs to the talus in pes planus conditions?

Answer 13

displaced medially and plantarward from the navicular

Question 14

In what population is pes planus most common?

Answer 14

pediatric

Question 15

What is the difference between rigid pes planus and flexible pes planus and how can you test for this?

Answer 15

Rigid - arch dropped in WB and in NWB (in a heel raise the flat foot remains) Flexible - arch dropped only in WB (if you can dynamically create the arch then you’re good)

Question 16

What is tarsal coalition?

Answer 16

A bony structure abnormality associated with rigid pes planus where two of your tarsal bones are fused (usually malformation at the navicular).

Question 17

What kind of condition can a peroneal spasm create?

Answer 17

flexible type pes planus

Question 18

What kind of tendon dysfunction can create a flexible type pes planus dysfunction?

Answer 18

tibial

Question 19

Which type of pes planus is more likely to be seen in patients with Ehler’s, Down’s, Marfan’s?

Answer 19

flexible type

Question 20

What kind of symptoms might you expect to hear about from someone with flexible pes planus?

Answer 20

Usually painless in kids and will resolve by adolescence BUT can involve arch or foot pain with WB and will commonly have tenderness to head of the talus and posterior tibialis tendon.

Question 21

What are some clinical signs of posterior tibialis insufficiency?

Answer 21

swelling along tendon (basically right @ navicular), limited DF, pes planus but can’t rise or will rise only one side (make more difficult by having them invert), will see “too many toes” due to excessive pronation, will ultimately need MRI to confirm.

Question 22

What are some major signs of plantar fascia dysfunction?

Answer 22

1. Pain in the medial aspect of the inferior heel 2. Pain w/ first steps in the AM (you sleep in PF) 3. Pain increases after prolonged WB

Question 23

What can pes cavus be caused by?

Answer 23

Neuropathy/neuro disease, post trauma or fx, idiopathic

Question 24

What is Charcot-Marie Tooth and what condition is it associated with?

Answer 24

hereditary peripheral nerve damage (causes wasting of the intrinsic foot musculature which can cause pes cavus)

Question 25

What is the biggest difference between pes cavus and pes planus symptomatically?

Answer 25

pain is not at the arch in the case of pes cavus - it is often at the 1st met head and they will often have calluses on the met heads due to loading

Question 26

Other then the met heads, what other two foot structures are often compromised with pes cavus?

Answer 26

1. Plantar fascia 2. Achilles tendon

Question 27

What 3 structures will be notably painful in a lateral ankle sprain?

Answer 27

1. ATFL (lateral mall to lateral side of talus) 2. Calcaneofibular ligament (lateral mall to lateral calcaneus) 3. Sinus tarsi (tunnel bw calcaneus and talus)

Question 28

What clinical signs might be present upon seeing a lateral ankle sprain?

Answer 28

TTP forceful inversion MOI swelling / ecchymosis ROM / strength impairments positive talar tilt??? positive anterior drawer test limits in fx

Question 29

What two types of instability will someone with chronic ankle instability have?

Answer 29

mechanical and functional (perceived!) instability IN ADDITION TO recurrent sprains

Question 30

What is a syndesmotic ankle injury and how do you test for it?

Answer 30

a high ankle sprain posterior tib fib and anterior tib fib ligaments are torn along with interosseus membrane basically the bones of the lower leg separate which means the test for this is to squeeze these bones together

Question 31

What is this? What are some clinical symptoms associated with this?

Answer 31

The bulge is achilles tendinopathy and reflects long term changes to the tendon. 1. pain @ achilles tendon 2. pain during exercise 3. palpable crepitus or nodular swelling 4. limits in function

Question 32

How do you know the difference between paratenon and tendon involvement with reference to achilles tendinopathy?

Answer 32

Paratenon is the SHEATH that the tendon is in. If you hold the nodule and then actively and passively DF/PF, the nodule will remain under your fingers if this is a paratenon issue. If as you grip the point of maximal tenderness moves, it's the achilles tendon.

Question 33

What are some possible pathologies of the 1st metatarsal?

Answer 33

hallux limitis hallux rigidis turf toe hallux valgus

Question 34

What is hallux limitis? What is hallux rigidis?

Answer 34

Limitis: Limited extension of the first toe only when loaded - when unloaded, full ROM. Rigidis: you are limited in both loaded and unloaded. This is degeneration of the 1st MTP joint (and can happen due to long-term hallux rigidis).

Question 35

How much extension is needed at the first met?

Answer 35

50-60 deg

Question 36

What is turf toe and what is a possible MOI?

Answer 36

A forced hyperextension of the first met injury which could happen from someone with hallux limitis having something fall on the posterior end of the foot and push them into hyperex.

Question 37

What structures are often damaged in injury to plantar soft tissue structures?

Answer 37

plantar plate collateral ligaments sesamoid ligaments FHL and FHB tendons

Question 38

If someone has turf toe where will they be tender? What test will they be unable to pass?

Answer 38

1st MTP capsule, collateral ligaments, and sesamoid complex Dorsoplantar Drawer Test - they will have increased laxity OR pain

Question 39

What is hallux valgus? What kinds of things can cause it?

Answer 39

progressive lateral deviation of proximal 1st phalanx with respect to 1st met etiology: foot wear, excessive loading, genetics, laxity, age, pes planus, hallus limitis

Question 40

What are the patho-mechanics of hallux valgus?

Answer 40

Deformity will lead to lateral subluxation of phalanx/FHL which will cause the FHL to become an adductor, which pulls the PIP medially.

Question 41

What is an LAA? What is it useful for?

Answer 41

Medial Longitudinal Arch Angle: 1st Met to navic tub to medial malleolus - when measured the less obtuse the angle the more the arch is dropped OR the smaller the angle the worse the drop.

Question 42

How do you measure the rearfoot angle?

Answer 42

base of calcaneus to achilles tendon insertion to center of achilles at height of the medial malleolus to 15cm above mark #3 the actual angle is the lower calcaneus line to the line bisecting the lower leg

Question 43

How is the forefoot angle measured?

Answer 43

bisecting rearfoot and measuring angle to edge of table (this is an extrinsic measure)